Anstiss, T. (2009). Motivational interviewing in primary care. Journal of Clinical Psychology in Medical Settings, 16, 87-93
Anstiss (2009) provides an introduction to motivational interviewing and describes ways it can assist in the healthcare setting. The growing burden of chronic and long-term illnesses throughout the world ; this surge is caused by an ageing population and advanced technology that keeps people alive loner with chronic conditions and disabilities. Furthermore, the authors cite Centers for Disease Control and Prevention (CDC) statistics that assert that by correcting only four behaviours—tobacco use, poor diet, lack of exercise, and use of alcohol—up to 40% of such chronic conditions could be avoided. The authors make the case for evidence-based Motivational Interviewing (MI) as a useful tool for improving chronic care. The essence of MI is to improve patient/caregiver interactions, improve patient understanding of their conditions, and provoke healthful behaviors, ranging from being compliant with medications to developing healthful habits (smoking cessation, better diet, exercise, etc.). The essence of MI is that it is collaborative between patient and caregiver, while still keeping the patient as the primary decision-maker. Anstiss summarizes the skills needed for MI as “Express Empathy; Develop Discrepancy; Roll with Resistance; and Support Self-Efficacy” (p. 89), plus the acronym R.U.L.E.: Resist the righting reflex; Understand the patient’s dilemma and motivations; Listen to and Empower the patient” (p. 89). Anstiss asserts that MI complements other treatment approaches rather than competes with them. In the healthcare setting, Anstiss claims that MI improves integrated chronic disease management; contributes to team-building; assists in integrating evidence-based care with patient-centered care; helps integrate physical and mental health care; assists with integration of treatment and prevention; integrates treatment with wellness and wellbeing; helps integrate clinical and self-care; and can assist with detecting and treating substance abuse in primary care settings.
Critique of Article
This article has the goal of persuading readers to consider learning about and possibly adopting MI as part of their practices, particularly with to aim of better managing chronic care and, ideally, preventing chronic conditions by building patient awareness of how their actions contribute to their conditions. The authors briefly explain that the Chronic Care Model is empirically informed and tested, and provide references to studies supporting that assertion. In the discussion of what MI is and how it works, extensive references are provided, which reassures the reader that the claims made are well supported by evidence. The explanation of MI core skills, principles, tools, and strategies is necessarily brief, but clearly presented. While insufficient to allow a practitioner to immediately start using MI, the descriptions are complete enough to offer a sense of how MI operates in practice. Of particular importance is the issue of listening to the client. Anstiss describes two types of client utterances of particular importance: change talk in which the patient expresses interest in and willingness to change; and resistance which expresses patient resistance or suspicion of changes. Though not of critical importance to the topic, the discussion of the difference between MI and cognitive based therapy (CBT) was interesting. Perhaps the most successful aspect of this article was the set of suggestions (noted above) on how MI can be used to improve a clinical practice. Those eight suggestions provided good insight on how useful MI could be to clinicians in practical situations. The type of issues that MI addresses are those which most contribute to improved chronic care and better patient-caregiver interactions. Overall, this paper is well written and useful. One point that was not included and which would be helpful is information on where readers can learn the skills of MI.
Anstiss, T. (2009). Motivational interviewing in primary care. Journal of Clinical Psychology in Medical Settings, 16, 87-93. DOI 10.1007/s10880-009-9155-x