12. Behaviour Change

Motivational Interviewing is a collaborative style of counselling which is both client centred and directed in helping a patient recognise a problem that is an issue for them and they (may) want to do something about.

Do you ever feel that so much of your learning development is dictated by someone else? It could have been you colleague who asked you to come along to a seminar, meeting or exhibition. You went along because it might have been free, convenient or local but then felt that all you ticked were the boxes, the criteria for demonstrating to your Dental Council or Professional Body directed ( dictated ) compliance. Was it meaningful, appropriated, self-directed or motivational? Has it changed your practice and will it bring the benefit of change to your patients? Think about what it is you need to develop your practice and also, on occasion, think outside the box. You might find appropriate and relevant learning from other healthcare associated agencies.

I realised this many moons ago and consequently consider my learning needs require a simpler more self-guided approach, slightly eclectic and occasionally left field. It may seem somewhat esoteric within the dental world but MI – motivational interviewing – is used by many health care professionals and counsellors and social workers to influence change within a person or people. It is designed to create trust, promote autonomy, develop self-mastery and skills and bring purpose and meaning to aims and goals. It helps people to find their motivation, the desire and determination to change.

The 5 principles of MI

1. Express empathy – engage with compassion and reflect listening.

2. Review discrepancies – define the space between where they are and where they should be.

3. Avoid argumentation – conflict triggers resistance.

4. Rolling with resistance – accept that change for the individual maybe challenging and hard to achieve.

5. Supporting self-efficacy – build confidence – guide through approaches and options toward their goal and affirm their progress – make it measurable.

Get going – change talk

Our language  is vital, make change desirable, reflect it’s importance and need in their lives, discuss their abilities and skills and how to hone them confidently, after all it may not be such a long journey to their aim point.

Commitment, building and explorative talk

The rule of importance – grading out of ten ( for example ) the need to change current behaviour.

“What would have to happen for it to become more important for you to change?”

The rule of confidence – grading out of ten how confident are you that you can change?

“What would make you more confident about making these changes?”

Employ open-ended questioning and deploy reflective listening, draw out good reasons to change, use summarising and affirm their choices and decision-making as well as celebrating success.

Journeys beginning

Establish rapport – create belief that you can provide support and guidance.

Assess/measure what needs to change and where the patient is in this process. What can make their own green light turn on?

Help formulate a plan, let them set realistic aims and goals ( you can set some too!) and even a date for completion or review at recall.

Bumps along the way

Ambivalence – listen actively and discover/determine the reasons for current behaviours. Guide to commitment and devise an action plan.

Resistance – occurs when both professional and patient are out of step with each other. Listen carefully a rejoin the patient and regain their commitment to the passage.

Readiness – build confidence and instilling belief – relate their journey to their own previous ones.

Summing up

I have been using MI ( motivational interviewing ) to complement my MI ( minimally intervention ) approach to behaviour change with my clients in dental health. It has brought more greater success from the patient and I do less physically too ( think RSI ). They create and drive their own change, I assist in simple ways to  navigate and facilitate it. Gone are the days where I felt I could physically change dental health in others. I recommend fellow Dental Health Practitioners actively pursue the 3 stage course in MI from the Cancer Society of New Zealand – contact me for further information.

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