How to Elicit Long Lasting Change

Motivational Interviewing (MI) has become a popular approach in promoting client adherence (Alperstein & Sharpe, 2016). Alperstein and Sharpe studied the effectiveness of MI on improving patient adherence, pain, and physical function. They found that there is a significant improvement in the outcomes when utilizing MI.

How do I use this in my practice? Well, pain isn't as simple as doing these exercises. You probably all know that. Often clients will commit to doing them for 1-2 weeks and not understand why they are still in pain when they are inconsistent. Part of this is the lack of education, the other half is MOTIVATION. I have learned that the best way to motivate my clients is to find what motivates them at the deepest levels. Motivational interviewing clients help you get there in a systematic way while placing more agency on the client, this is also great for preventing compassion fatigue and provider burnout.

MI is difficult at first. It almost seems unnatural. With practice, this because a second language. one that is highly effective in not only health care but other sectors as well.

Dr Irwin and Dr Morrow have created the Monarch System, an evidence-based approach to behaviour change through MI, coaching and related techniques. Irwin and Morrow describe MI as allowing for:

• the client to consider themselves
• increased client buy-in 
• no personal mental gymnastics
• tells you what truly motivates them
• expectations management 
• engages the clients as part of the solution. 

The last point is most important for me. Often we overlook the patient as being a key partner in a successful treatment. Involving clients/patients in their treatment plans gives them a sense of responsibility to accomplish the goals. 

Core strategies to MI is OARS (Irwin & Morrow)

    Open-ended questions 

    Affirming/Acknowledging 

    Reflective listening 

    Summarizing 

This strategy allows for positive change talk. 

Here is an image with some key questions to ask clients when motivational interviewing. You can use these questions as a guide or use them word for word. They will help you, help your client what truly motivates them and what they can do to begin the change.

image retrieved from monarchsystem.com

Alperstein D, Sharpe L. The Efficacy of Motivational Interviewing in Adults With Chronic Pain: A Meta-Analysis and Systematic Review. J Pain. 2016 Apr;17(4):393-403. doi: 10.1016/j.jpain.2015.10.021. Epub 2015 Nov 27. PMID: 26639413.

https://www.monarchsystem.com/