| Key clinician behaviors: |
- Collaborative and supportive approach:
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- Communicate respect for and acceptance of the patient and their feelings.
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- Establish a nonjudgmental, collaborative relationship.
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- Express empathy through reflective listening.
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- Compliment rather than denigrate.
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- Support self-efficacy and optimism – Focus on patient strengths to foster hope that is needed for change.
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- Provide support throughout the process of recovery.
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- Discuss behavior change, but affirm that change is up to the patient.
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- Note discrepancy between the patient's goals or values and current behavior, helping them recognize the discrepancies between where they are and where they hope to be.
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- Avoid argument and direct confrontation – These are core characteristics of power struggles.
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- Roll with resistance – Adjust to, rather than oppose, patient resistance.
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| Key strategies: |
- Ask open-ended questions. They allow for more expansive responses. For example, ask "What do you like about smoking?" instead of "Do you like smoking?" Use "How" and "What" questions and try to avoid "Why" questions, as these can sound judgmental.
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- Listen reflectively. This involves demonstrating that you have heard what the patient has said by periodically repeating or paraphrasing what they have said.
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- Summarize. Periodically summarize what has transpired in a particular visit, including discrepancies that are presented.
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- Affirm. Support and comment on the patient's strengths, motivations, intentions, and progress. For example, "It seems as if you would really like to quit smoking, but see that it might be difficult."
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- Elicit self-motivational statements. Have the patient voice personal concerns and intentions, rather than try to persuade them.
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- Assist with planning. Ask questions to help the patient make a behavior change plan (identifying the change that they want to make, reasons for doing so, first steps, obstacles, and solutions).
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