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Preaching” to the patient or client,[link widoczny dla zalogowanych], telling them about heart disease, the many cancers, peripheral vascular disease and other dangers associated with tobacco use, may work for some practitioners with some clients. But chances are it will not be the most successful strategy for most clients to stop smoking and to STAY STOPPED.
There is a substantial body of knowledge now available on how and why people change behaviours. Unfortunately, practice does not always follow the theory.
We Health Professionals all tend to think that everyone should stop smoking because of the dangers associated with the activity, and that all smokers should think the same way too.
When I first started working with groups of people who wanted to quit, I was surprised to find that better health, or prevention of disease, were not always the primary reasons for quitting.
From the point of view of someone changing their behaviour, or we as Health Professionals assisting others to change behaviours, it does not really matter what the reasons are for making the behavioural changes. What does matter is that there are reasons. Also, those reasons need to be IMPORTANT for the client making the behavioural change, and the client will need to have CONFIDENCE that they are able to make the change.
The Health Professional can be helpful working with the client on these aspects of “IMPORTANCE” and “CONFIDENCE”, and in helping the client get READY to make the behavioural change.
MOTIVATIONAL INTERVIEWING
"Motivational Interviewing is a treatment developed within the addictions field which has gained widespread acceptance because of its applicability to any client who is ambivalent about change."
“Motivational Interviewing” was first published by Miller and Rollnick in 1991. (My copy is the second edition dated 2002). The techniques used in Motivational Interviewing take into account the “Stages of Change” model of behaviour change espoused by Prochaska and DiClemente. (A link to a further discussion on "Stages of Change" is given in the resource box at thge end of this article)
Although the initial work done by Miller and Rollnick was with users of hard drugs,[link widoczny dla zalogowanych], the successful techniques they use can be applicable to any one at all wishing to make behaviour changes, and to make those changes permanent.
Unfortunately,[link widoczny dla zalogowanych], many Health Professionals do not have the time for the long consultations that Miller and Rollnick spent with their patients. A discussion on behaviour change could be a brief part of a consultation on some other issue with a General Practitioner for example.
“Health Behaviour Change” by Rollnick, Mason and Butler was published in 1999 to address these needs. It is a paperback publication which I would highly recommend to any one working with clients who would like to, and/or who need to change behaviours.
Practitioners skilled in Motivational Interviewing,[link widoczny dla zalogowanych], will use open questioning techniques regarding certain behaviours with their clients to elicit appropriate responses. Many of these responses will be decisions made by the client regarding certain aspects of the behaviour(s) being discussed.
So, the process does not involve an “expert” telling someone what they should do. Rather it is a skilled facilitator obtaining “logical” and “rational” answers to questions. Because these answers (decisions), have been made by the client. The client is much more likely to take ownership of the decisions and act upon them, than if they were being told what they should do by a Health Professional.
A decision made by the client to move even through just one of the stages of change is success. For example, if after a Motivational Interviewing session with a client who was ambivalent about making any behavioural changes, that client decided to start thinking about, “perhaps it may be a good idea to think about making a decision to stop smoking”, then the client has succ