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Motivational interviewing and the tarp
Posted 8:51 PM, October 29, 2008, by pavila48Today, while reflecting on the moments we will most remember from this incredibly memorable class, I spoke of the poignant connection I saw between the tarp exercise and the technique of motivational interviewing. What I found most interesting about this linkage was the way it was formed: my first experience with motivational interviewing came not with a lecture or a course reading but rather came in watching Joslyn lead a horse over a tarp, an unfamiliar and scary object for such a creature to cross. In fact, I was not even aware of the theory of motivational interviewing that day on the ranch-- I was only aware of the experience I had. So, what exactly is motivational interviewing?
Motivational interviewing, quite broadly construed, is the idea that the role of the physician is not to coerce their patient into making a beneficial change, but to act as an advocate and guide them through a process of self-discovery in which the patient, when ready, makes the decision to change (or engage in a procedure) on their own terms. Why is this important? Because just as when we tried to push the horse to cross the tarp and it pushed back harder, our patients will do do the same and with increased resistance, any hope of establishing commitment to change might be lost. Long story short: a physical push is not that different from a verbal push and pushing patients to change when they are not ready, (whether they speak or not) is counter productive in a setting where we ought to embrace patient autonomy.
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Comment by: allshebe at October 7, 2009 10:15 AM
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I think the above applies to most learning and "self-change" situations. I have been taking dressage riding lessons for years and learned a lot of "wrong" things along the way from instructors who praised getting an "acceptable" response by using the "wrong" steps (did things to force horse into compliance rather than getting willing cooperation). I have had a very good instructor for the past few years, but it has taken me until now to do enough changing within myself to lose some of the braces and tensions that were inhibiting my progress. Sometimes, even when the subject is very motivated, it can take a long time for them to change. You should not get discouraged if your first or your fiftieth attempt appears to fail. You need to be persistent and, eventually some individuals (probably not all) will be in a place where they will be able to change. Reward small efforts profusely.