Behavior change is a critical part of effective health care. The final decision to become healthier, however, is that of the patient and not the practitioner. Anyone who has treated patients knows that the adoption of a new healthy behavior, the cessation of an unhealthy behavior, or the commitment to adhere to medical advice is central to effective medical care and difficult to achieve. Rollnick, Miller, and Butler present this book as a means to aid practitioners in achieving behavior change in their patients. Although the goal may seem lofty, the work of these investigators has received much attention over the past decade. Motivational Interviewing (MI), a method of interacting with patients to enhance behavior change, is a well-tested and established method with over 160 randomized clinical trials demonstrating its efficacy across an array of medical conditions.
Motivational Interviewing runs on a sound understanding of behavior change principles. The authors have used their extensive knowledge of how patients respond when faced with the need to change their behavior to develop this method for enhancing change. Their methods have been presented in other texts, but this book is designed to present the essence of MI, rather than as formal training in the method, to allow practitioners to incorporate MI techniques into everyday practice.
The first section of the book briefly outlines behavior change principles and the spirit of MI. Examples are given in the context of everyday scenarios met by healthcare practitioners. The technique is simplified and highlights MI as a modification of techniques already used by most practitioners. The authors make the case that there are three ways one can interact with a patient: (1) following, (2) directing, and (3) guiding. It is the various combinations of these three methods that steer a practitioner toward the more motivational style of guiding. The premise is that following alone is inadequate and that directing often elicits defensiveness in patients who need to change their behavior. Guiding is the goal. Guidingyour patient does not mean that you have to abandon advice giving. In fact, advice giving is a large part of the guiding process. Advice, however, is given based upon what motivates the patient and not what necessarily motivates the treating practitioner. The overall goal is to guide the patient through the proper thought processes that will inevitably result in a salient reason, for that particular patient, to commit to changing his/her behavior.
The second section of the book focuses more on the core skills of MI. MI is placed on the backdrop of three simple things every practitioner does with a patient, asking, listening, and informing. Asking, listening, and informing are discussed in detail and in the context of traditional MI. Several examples are provided and the reader truly gains an understanding of the complexity of this style of interacting with patients. Specifically, the reader is walked through a better understanding of how to observe his/her own behavior, as well as that of the patient, so that s/he becomes a better user of these tools with the specific goal of enhancing behavior change.
In the final section of the book the authors focus on incorporating this technique into everyday clinical practice. This is where the book deviates most from previous texts by these authors. The authors make the case that these techniques can be incorporated easily into brief consultations to enhance behavior change. It remains true that extensive MI over successive sessions may be best for some patients, but that the approach can be highly effective for many if simply incorporated into brief clinical interactions. There is a chapter on consultation that describes methods of changing a consultation service to remove barriers to the motivational style of patient interaction. This is especially helpful when the practitioner has control over how the consultation service operates. Changing the system of your consultation service may require training your staff in some of these techniques, but the end result could be a much improved service with a focus on patient needs and the enhancement of behavior change.
In all, this book is a helpful tool for all practitioners seeking a better commitment to behavior change in their patients. The skill set needed to accomplish the goal of behavior change is already developed in most clinicians. This book guides the reader through the process of honing those skills and switching effortlessly through the various methods of patient interaction to best achieve change. As the authors claim, this may be a formal way of developing those skills long described as good bedside manner.