Motivational interviewing and the tarp

Today, 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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