Motivating people to make changes (i)

The first of a series about using values and empathy to help people make choices

While I was completing my occupational therapy training, one of the lecturers said our roles was to be ‘professional motivators’. At the time I thought nothing much of it, but today I feel the hairs lift on the back of my neck at the thought of ‘motivating’ people. Motivation can come from an external force – but how sustainable and deep is the motivation that comes from a loaded gun pointed to the head?

So, how do we introduce a new concept to someone who is doing what they have always done, and landing up with the same result – and a result they apparently don’t want?

Prochaska and DiClemente describe what they call the ‘transtheoretical’ model of behaviour change. They note that people typically move through several phases as they adopt a new behaviour:

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

At every point there is a chance of relapse, and people may not spend either much or any time in every phase

This model is great in helping us think about how we engage with the people we work with. Guess what? Some people we work with are nowhere near ‘Action’ phase – they’re thinking ‘What? Who me? You think I should do what?’

Unfortunately, most of our training in health care provision assumes that:

• the people we will be working with are ready to receive our knowledge/expertise
• we know more than they do (about what they should do)
• their health status is the most important thing in their lives (well, we health is important, don’t we?)
• all they need is for us to tell them what to do and they will go away and just do it

And if they don’t – they’re ‘resistant’, ‘not motivated’, ‘noncompliant’, ‘nonadherent’.

In other words, they should really be listening to us, because we know best.

Even with the best interpersonal skill in the world, if we believe we have the wisdom and the person we are working with doesn’t but needs it, we are putting ourselves one-up, and our client or patient will know it.

How do our patients/clients show us they are not ready for action?

They may

• say ‘yes but’ to any suggestions
• become silent
• become angry
• deny they have a problem
• interrupt
• avoid making a commitment
• not come back to see you
• pretend they are doing what you suggest, but actually do nothing

I’m sure you’ve seen any and all of these!

And how do we respond if we notice these things happening?

• try very hard to convince with logical arguments
• become prescriptive and judgemental ‘you should’
• become frustrated and talk about ‘that difficult patient’
• give them the bare minimum and think ‘I’ve offered it, they have to choose to take it’
• get very tired and emotionally exhausted

Perhaps we need to think about their response in a different way – could we think instead that the person is just not ready for what we are suggesting, and that we need to understand where they are coming from.

If we think about behaviour change as lying along a continuum from ‘not at all ready’ to ‘chugging along nicely thank you’, one of our first jobs is to identify where this person is in relation to the behaviour change we think is important. Then our job is simply to help the person move one stage along that continuum. That’s all. Some people may indeed take off and just do it, while others may not. Provided we don’t close the door on that person ever moving forward, we can feel satisfied that we have done what we can do.

It’s maybe a little more complicated than that…

Instead of first identifying where this person is in relation to the behaviour change we think is important, what might happen if we asked the person what they think they could do next. Or ask them whether they would like to find out what we can offer (before we go right ahead and offer it!).

And how we go about it may also be worth thinking through.

What would happen if we really tried to understand the good things about their current behaviour? And what they think might be drawbacks of making any changes?

What if we used our empathy and those listening skills we learned about waaaaay back in our training, and reflected to the person at multiple levels just what we understand about them?

Do we leave it there?

No – there is no way I am going to endorse someone continuing with destructive behaviour! I will, however, ask permission to tell them what I know before I provide it, then ask them what they think about what I say.

And I also ensure that they know both my position, that they have a choice that is entirely up to them, and if they decide that now is not the time that they haven’t completely blown their relationship with me.

‘nuff said for now – the next installment will go into more detail on ways to establish rapport and develop those really important interpersonal skills.

Prochaska, J. O., & DiClemente, C. C. (2005). The Transtheoretical Approach: Norcross, John C (Ed); Goldfried, Marvin R (Ed).

Some great references:
Motivational Interviewing: Preparing People for Change (2nd edition) (Miller/Rollnick) (April 2002)

Health Behavior Change: A Guide for Practitioners Stephen Rollnick, Pip Mason, and Chris Butler

Motivate Healthy Habits (Rick Botelho)

Date last modified: 1 March 2008