- Clients come to you for advice – not a shopping list.
- Clients and staff can be equally challenging and frustrating.
- There are similar problems with staff and clients who agree to do something and then don’t.
- Difficult clients are only there for a short time; difficult staff are there all the time.
THESE were some of the comments made by the two leaders – Dr Rory Allott, a clinical psychologist,and Paul Earnshaw, a psychological therapist – of the “motivational interviewing” programme on the Saturday of the SPVS congress in May.
The two psychologists frequently speak on this topic in the medical world, particularly in the NHS, and this was their first attempt to introduce the concept to veterinary surgeons.
The joint presentation discussed two styles of consultation – guiding and directing –with the aim of improving client understanding of what needs to be done and increasing compliance with recommendations made.
“What actions do you take to manage your own failings and improve the responsiveness of clients?” they asked at the outset, and went on to describe “motivational interviewing” as “a directive but gentle and non-confrontational style of consultation that helps to build clients’ intrinsic motivation for change by exploring and resolving ambivalence”.
They quoted Henck Van Bilsen, a clinical psychologist who, back in 2006, described it as “a way of talking to people without pissing them off”.
Acknowledging that vets would already be doing some of it, they said that motivation for change was enhanced by elicitation rather than persuasion.
Principles of motivational interviewing were to: (1) express empathy, (2) develop discrepancy (support clients to review arguments for change in relation to things that are important to them), roll with resistance (avoiding argumentation) and support self-efficacy (the client is responsible for change and must feel able).
The speakers introduced OARS, which they said were the core skills and strategy required, where the O is for open questions such as “What do you like about…?”; A for affirmations (for example, “You do alot for your dog”); R for reflective listening (“You don’t see any point in worming…”); and S for summaries (which they called “the change bouquet”).
“It needs a genuine recognition that someone is doing something right,” they said.
In summary, they explained that motivational interviewing is a way of responding to people who are contemplating a change but are not quite ready for it (as, for example, with giving up smoking or drinking).
It has been proven effective in bringing about changes in human behaviour across a range of behaviours and has been demonstrated “to improve adherence [compliance] to health interventions”. It uses OARS to elicit talk about change from people but requires listening for and responding to talk about change.
“Guiding people to plans is more effective than simply giving them a plan to follow,” they concluded.
- More information on motivational interviewing is on the website www.motivationalmatters.co.uk.
