Clinicians can foster a working partnership with patients through the use of motivational interviewing.
For behavioral change to be successful, a collaborative relationship between clinician and patient is essential. Part 1 reviewed motivational interviewing for patients who are in the "No" precontemplation or "Maybe" contemplation stages of change. Here, part 2 examines how clinicians can help patients in the "Yes" preparation stage to develop a viable plan to progress toward taking action.
Preparation/Action stage: Ready for change
Preparing the plan
Helping the patient prepare a plan that is a comfortable fit is essential to being effective. For the patient who is overeating, an appropriate plan that looks at caloric reduction and increased activity may be in order. For the parent who is anxious about vaccines, a modified vaccine schedule may be an option. For the teenager who is smoking, a review of nicotine substitutes may be appropriate. This section looks at the many facets involved in helping patients successfully devise a plan that fits their individual needs for accomplishing behavioral change.
Let the patient create the plan
Allow the patient to brainstorm options and come up with strategies that he or she feels can be implemented. It is often reflexive for clinicians to jump in at this point and give advice. However, it is often more productive for the patient to come up with a plan that he or she owns. The clinician can ask the patient how he or she would like to proceed. An overweight teenager may then decide to reduce the amount of soda in the diet or cut back on visits to fast food restaurants for the next 2 weeks. A teenager who wants to quit smoking may choose to begin by reducing his or her cigarette use. The clinician should encourage these types of endeavors.
When dealing with patients who seem stuck, the clinician can stimulate brainstorming by asking questions such as, "What advice would you give to a friend who is trying to lose weight?" or "Have you done anything in the past to successfully lose weight?" or "What has someone you know done to lose weight?"
Keep it simple
Keep the plan simple, user friendly, and flexible. Economists have coined the term choice architecture to refer to effective models of change that are simple and comprehensible.2 Patients are more likely to implement a plan that is not overly taxing and complex. It is often better to implement a plan in small incremental steps and subsequently build on that foundation.