Bruce A. Berger, PhD, Professor Emeritus, Auburn University Harrison College of Pharmacy
Fifteen years ago, William Villaume and I developed our sense making approach to motivational interviewing (MI) based on Brenda Dervin's sense making theory.
Our approach removed all the acronyms developed by Miller and Rollnick’s original approach because health care professionals (HCPs) found them to be confusing due to their lack of training in psychology, needed to understand the acronyms.
Our approach focuses on something powerful and simple: Patients make sense of their illness, treatment, and relationships with their HCPs based on how they interpret what is happening to them. MI was developed to target patients who are ambivalent or resistant to health behavior change (medication taking, weight loss, tobacco cessation, etc.). We found that patients who are ambivalent or resistant to health behavior change developed sense making that was corrupted by either missing information or misinformation. One patient might feel OK and decide, therefore, not to take his cholesterol medication (missing information) while another patient might decide not to get a flu shot because she heard the shots can give you the flu.
“Any strategies that have a chance to succeed with patients who are ambivalent or resistant to change must maintain and reinforce connection with the patient in the face of the patient's pushback.”
In his book, Social, Matthew Lieberman shows through fMRI studies that our brains are wired for connection. Connection is as vital to humans as food and water. Disconnect from the patient and they stop listening and the relationship becomes painful to them. Any strategies that have a chance to succeed with patients who are ambivalent or resistant to change must maintain and reinforce connection with the patient in the face of the patient's pushback. Any strategies that immediately threaten connection (persuasion, discounting of the patient's sense making, strategies that cause face loss, etc.) are bound to fail and cause disconnection, especially in these patients. So, what must be done?
In both the second edition of our book (Motivational Interviewing for Health Care Professionals: A Sensible Approach, APhA Publishing, 2021) and in our 8-hour accredited eLearning program (comMIt) with APhA, we teach pharmacists and other health care professionals how to stay connected to the patient by exploring a patient's sense making through asking open-ended questions and creating a caring and respectful dialog rather than simply dictating to a patient why his thinking was wrong (a monologue).
“Patients must feel like the way they think is respected and that they are safe in expressing their sense making.”
Through a case base approach, we help pharmacists and other HCPs learn how to identify either missing information or misinformation that is preventing the patient from adhering to a medication regimen, losing weight, getting vaccinated, etc. This is done in a caring and respect way so that patients don’t end up pushing back even. Learners are taught how to be open to and welcome differences in the way patients think and behaviors that could assist their health and well-being. Patients must feel like the way they think is respected and that they are safe in expressing their sense making.
The comMIt eLearning program will greatly enhance your ability to connect with your patients, improve adherence to health behaviors, and do so in time-limited environments.