Motivational Interviewing

Words Matter:

A few weeks ago, I found myself stressed about a recent client interaction. This person has pretty severe dizziness tremors and imbalance. The client has been to doctor after doctor trying to get a diagnosis to understand why there are experiencing these systems, and seek to get better.

I could hear the suffering in their voice.

“I just want answers. I just want to get better”

After having pretty severe symptoms that derailed participation in an important life event, there was a desperation, and hopefulness present in their voice that tore at my heartstrings.

I could hear the suffering in their voice. I wanted their symptoms to be gone. I wanted to use the tools I have as a Physical Therapist who specializes in vestibular rehab to alleviate and improve their symptoms. I could barely imagine how it felt to spend 8-10 hours in a severe dizzy episode severely imbalanced and unable to walk.

Sympathy is signifying a general kinship with another’s feelings, no matter what kind.1

Empathy refers to vicarious participation in the emotions, ideas, or opinions of others; the ability to imagine oneself in the condition or predicament of another.1

Compassion implies a deep sympathy for the sorrows or troubles of another coupled to a powerful urge to alleviate the pain or distress or to remove its source.1

Pity is sorrow aroused by the suffering or ill fortune of others, often leading to a show of mercy.1

I knew they needed empathy and compassion in action. But how could I deliver the level of empathy and compassionate care they desperately needed while still address the specific objective set out for their treatment session? I found myself striving desperately to convey as much information as I could to help them understand what was happening. I didn’t want to be just another practitioner they have encountered that did not provide answers or solutions. I wanted to have them recognize all the ways our treatment would be helpful. “I wanted… I wanted… I wanted…” so many things for this person.

While my intentions were good my delivery and profound straining were all wrong. What they needed most was someone to be fully present at the moment with them. Complete non-striving! Non-striving is a core principle of mindfulness. This means being fully present at the moment without any need to chair it. It simply means being present without any agenda.

NO AGENDA?!?

So do we want our health care practitioners to approach our exam or office visit with no Agenda????

Of course, we all do. Think about the last time you were at the doctor's office. They enter the room check your breathing, check your heart rate, check lymph nodes, a tap here, a prod there, ask a series of questions about your symptoms, give you a diagnosis, and a couple of minutes to think about which treatment plan you would like to consider. Then, they are off. I have often thought that the rehab world was different, but not by much. We see a medical diagnosis, enter the room with a series of specific questions, tests and measures, and begin laying out what their treatment plan may look like. Yes, we do ask the client if the treatment plan sounds okay, they are still in a whirlwind and they look at the rehab professional (PT, OT, SLP, etc) as the one with all the answers. So nine times out of 10 they are agreeable.

But do we know what really they want or need?

Yes, we discuss goals. We discuss activity and participation limitations. We discuss what things are most important to them, etc. But do we know what brought them to our clinic at that moment in time? What motivated them or their family to seek care now?

It may have been a brain injury or discharge from the hospital etc., but oftentimes, people leave the hospital or the doctor's office with orders and show up because that is what they were told would be the next step.

What are we having them take the next step towards?

This was the question that hung over my head after my interaction with my client, discussed above.

There was a reason they came to me that day, and I wanted to help them, but I am not sure I truly heard them. This broke my heart.

Now the interesting part about this interaction, as it was not that remarkable or different than any previous clients with which I’ve worked.. The symptoms were similar as well as the pending differential diagnosis, the intervention, the education, etc. All of it was relatively routine for my day. The client even left with a very positive demeanor and was excited to start treatment.

But I was unsettled.

I knew immediately after leaving, that my approach needed an overhaul. Could the client interviewing education, and recommendation be approached in a way that could prove empowering and self-efficacious for my clients?

So how can this be approached?