Motivating people to make changes (iii)

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

The previous two installments in this series have introduced the concepts of stages of readiness for change, rapport and empathy and appreciating that the people we work with have their own values influencing the choices they make. This paper introduces two strategies that can help people directly influence the focus of therapy while at the same time enabling you as a therapist to signal areas that are important.

From the outset of a clinical encounter, you as the therapist direct the interaction. This means you have the responsibility for ensuring the person you are working with has opportunities for choice. In order for you to find out what is important to the person, you need to ask about how their health situation is affecting them. This sets the agenda for your session.

One way to do this is to ask them what their reaction is to their diagnosis.

‘Since you found out you have impaired glucose tolerance, what has gone through your mind? Is there anything specific you would like to talk about – or is something else more important to you today?’
Two things to notice about this approach:

  • it focuses the conversation on the person’s needs, not your assumption of what they will need to do (e.g. they may want to talk about how diabetes is inherited and what may happen for their children rather than talk about how to make changes to their eating and exercise patterns
  • by asking ‘is there something else more important to you today?’ it also allows the person to raise something completely unrelated to your original topic but may be getting in the way of this person paying complete attention to the session

Another is to offer a ‘menu’ of options for the person to prioritise. For example, many people who receive a diagnosis of chronic pain have questions about medications, exercise, returning to work, weight changes, relationships and so on. Listing these, and offering several blank spaces that the person can fill with their own concerns, can provide you with an indication of areas the person is ready to look at, meaning you are working collaboratively with the person from the very beginning of your encounter.

The ’24 hour day’ is another way for the person to lead you through their experience of their condition. It can take about 10 minutes, or longer if you want to find out more detailed information, and it provides you with a picture of daily life. I first used this strategy as a new graduate occupational therapist, but was re-introduced to it recently when I read Health Behavior Change: A Guide for Practitioners by Stephen Rollnick, Pip Mason, and Chris Butler.

What you do is invite the person to tell you about a typical day and how their health affects what they do and how they do it. Once again, it’s important to ask whether this is what the person wants to talk about.

‘I’d like to learn more about how your diabetes is affecting your life. Can I ask you to take me through a typical day and tell me how you live with your diabetes, or is there something else you’d like to talk about?’

As the person goes through their day, from waking up to finally going to bed and sleeping, clarify how important each activity is and how the decision was made to prioritise this activity versus another. This process helps identify values that are guiding the decisions this person makes, helping you later in your therapeutic process. This shouldn’t come across as an interrogation, but with a spirit of curiosity and exploration. You’ll know you’re doing this right if you do less talking than the person!

Knowing about values will help you identify disparities between what the person does and what they want to achieve. Often we don’t immediately realise that behaviours we do are in opposition to what we want in the long term – for example, while we satisfy our immediate craving for chocolate, we are acting in opposition to our long term desire for optimal weight! The desire for chocolate may be a means to reduce negative emotions, which it does – but our negative emotions may be reinvigorated when we step onto the scales in a fortnight’s time…

The next post will be about some ways to weigh up the good and not so good things about making a change.

Some interesting readings: Active listening in Scatmania’s Blog – from 2006, but a good summary of some of the skills.

An assessment tool you can use to establish your skills in active listening Active listening in medical consultations: Development of the Active Listening Observation Scale (ALOS-global) Thijs Fassaerta, Sandra van Dulmena,François Schellevisa, and Jozien Bensinga (2007) Patient Education and Counseling
Volume 68, Issue 3, November 2007, Pages 258-264

Date last modified: 1 March 2008

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