Dr. Jonathan Fader Demonstrates Motivational Interviewing Skills
a guy goes to his doctor and
she’s talking to him about smoking and
she’s telling him you know that he
should really quit smoking and tells him
why and explains the risks of smoking
he’s like yeah yeah I know yeah yeah I
know and then she tells him about the
past she tells him about all these
different medicines that he can use to
quit smoking he’s like yeah yeah I know
she asked him if he’s seen these
horrible pictures in the subway of
people’s fingers getting cut off and
said yeah I saw those and then he leaves
the office and she’s really frustrated
he’s really frustrated and then he goes
and he he’s going to pick up his son
from school so he goes to pick up his
son from school and he’s driving there
and he looks down and he realizes
there’s no more cigarettes right he’s
out of cigarettes it’s an empty pack of
of Newports in there so he looks at he’s
like you know what I’m gonna do I’m
gonna go around just drive around the
block of the bodega okay
and I’m gonna buy a pack of cigarettes
so he drives by his son school at the
same time it starts to rain one of those
gray New York days it just starts to
rain he looks in his rearview mirror and
he sees that his son has just come out
of school he just missed him he drove by
him and his son is standing in front of
the school just getting drenched and
shivering out there in the rain he
crumples up the pack of cigarettes and
never smokes again okay no no
intervention beyond that so I’d like you
guys to just to think about that think
about that story for a second as we go
through our talk about thinking about
motivation what motivates people and
what’s our role in that process what I
hope to do this morning is to get you
familiar with motivational interviewing
this idea what is it alright hopefully
when you leave today you’ll have a sense
of what it is and hopefully you have a
sense of how you can take back a few of
the ideas that we’re going to talk about
today and your work and talking to
people about behavior change whether
that’s about diabetes care
smoking safe sex whatever it is whatever
behavior that you’re having a challenge
with in terms of talking to your
patients about changing it okay I was
asked a good question the other day
about you know how why is this important
how is it important in terms of a
discussion about communication I think
it’s actually even more important when
we think about how this is relevant to
our work
and the things that come to mind for me
are well first of all just the research
on what’s effective in terms of getting
people or inviting them into the process
of doing things that are gonna benefit
their health so we’re gonna think about
how talking to people in the way
motivational interviewing may actually
assist in that also you know it’s
related to better clinical outcomes this
technique the other two things will
relate to us that I don’t know about you
guys but I get tremendously frustrated
when people don’t do the things that I
know in my mind are going to be better
for them in terms of their health I
really go crazy about this stuff so it
can be really frustrating and this is a
technique that helps us to work in the
most effective way and hopefully will
minimize our own frustration in these
situations when we’re working with
someone who doesn’t want to change I
start most of my talks referencing an
important theorist you know this is a at
this institution I feel like I should
really come with someone who’s really
done a lot to change our understanding
of how behavior change works someone
who’s really revolutionized the field of
medicine and I think that person is
probably the chef from South Park so
what does the chef from South Park say
about behavior change how does he help
us to understand you know this dynamic
of when we’re telling people what to do
and they don’t listen to us well he said
something I think that refers a lot to
it and it’s about working with
adolescents and he said when talking to
kids look children this is all I’m gonna
say about drugs stay away from them
there’s a time and place for everything
and it’s called College we’re in essence
telling people to do things in our
practice and then they’re going out into
the world and they’re being told not to
do them either by their friends or
family or by other important people in
their life or by themselves so in this
process of motivational interviewing
we’re trying to step out of the role of
telling people what to do okay we’re
trying to step into the role of helping
them find out for themselves why they
may or may not but why they may want to
do it for themselves okay we’re trying
to have that motivation come from the
inside not impose it from the outside a
lot of the the idea of motivational or
an interview
comes from work in other behavior change
theories and was developed around the
same time who here has heard of the
stages of change theory so the idea here
in stage of change is basically two
things there’s a lot of ideas behind it
but mainly we used to think about change
as someone was ready or they weren’t
they come to you in your practice and
they have died they’re uncontrolled
they’re they’re uncontrolled blood
pressure or sugars and they come to you
and and you say well here’s what the
options are and they’re there ready to
do it or not but if you look at it
there’s actually more of a progression
and it’s in the stage change process so
here the stages of change as positive as
posited by her Cheska Andy Clemente so
in pre contemplation someone give them
throw out a problem behavior that you
see in your practice a diagnosis or an
issue that you treat commonly obesity so
someone is morbidly obese and they come
in to see you and you know you say hey
listen I just want to give you some
information about your BMI and tell you
about some of the health risks in pre
contemplation they would say something
that didn’t acknowledge the risk at all
right they may say no need to change
listen I’ve been fine like this for my
whole life I don’t need to change my
grandmother lived to be 156 like this so
I know that I’m good okay in
contemplation they start to talk about
perhaps both sides of it the reason to
change and the reason not to change
right there’s one very common word in
these phrases and that’s the word but
right yes I know my BMI is high but it’s
difficult to get the kind of food you’re
talking about in my neighborhood okay
preparation someone’s trying to change
or trying to come up with a plan to
change but they haven’t yet implemented
it you know I I kind of want to quit
smoking oh you do yeah I’d like to quit
my son goes to college well okay how
old’s your son he’s five so there
there’s a preparation but they haven’t
yet engaged in the behavior in action
they’re actually doing a behavior and
maintenance they’re continuing that
ProHealth behavior relapse they go back
to the the the initial what we’d call
problem behavior we’re really talking
about our own frustration some time in
this process personally when I’m working
with someone who has many health risks
and they don’t change I get very
frustrated and this song helps me to get
in a better perspective about it okay
they are actually in more pain than me
this ambivalence they’re stuck in the
middle and the pain is like thunder so
my first goal is to empathize with that
conflict even before I’m advising or
anything I want understand the conflict
and show them that to the best of my
ability
I can empathize show an understanding
for the feelings surrounding why they
don’t want to do this whatever it is
surgery taking a medicine whatever it is
okay so this is not just an academic
idea the idea of stages of change you
can apply this clinically to your work
how in the following way notice here
that there’s an arrow between treatment
and actions so we talked about obesity
right if someone comes in and they’re
issued they’re working on issues of
losing weight we know what to do right
they say hey help me lose weight what
can I do doc someone threw out what
would you suggest to them exercise good
what else
diet okay some of the hallmarks of the
treatment for a lot of things in primary
care okay so that’s clear connection
someone comes in there in preparation or
action notice there’s an arrow from
treatment to act to action someone comes
and they know what they want to do we
tell them the problem is when someone
comes in and they’re not yet ready pre
contemplation or contemplation and we
tell them what to do there’s this sort
of mismatch there so we use this
technique of motivational enhancement or
motivational interviewing as a way to
try to have them maybe move closer to a
realizing for themselves if they can why
they would want to make a change before
I tell you about what a motivational
interviewing is I’d like to show you a
brief video about what a motivational
interviewing isn’t tell me about the
problem is that you wish to address oh
okay
well I have this fear of being buried
alive in a box
I just I start thinking about being
buried alive and I begin to panic as has
anyone ever ever tried to to bury you
alive in a box
no no but truly thinking about it does
make my life horrible I mean I can’t go
through tunnels or be in an elevator or
in a house anything boxy
so what what you’re saying is you’re
you’re claustrophobic yes yes that’s it
all right well let’s go Kathryn I’m uh
I’m going to say two words to you right
now I want you to listen to them very
very carefully now I want you to take
them out of the office with you and
incorporate them in into your life write
them down
well if it makes you comfortable it’s
just two words most we find most people
can can remember them okay you ready yes
okay here there stop it
stop it yes
sto P no word ID so what are you saying
you know it’s funny
III say two simple words and I cannot
tell you the amount of people who say
exactly the same thing you’re saying I
mean this you know this is not you –
Catherine this is it
stop it so I should just stop it there
you go
I mean you you you don’t want to go
through life being scared of being
buried alive in a box do you mean that
it’s been with me no we we don’t go
there just just up so I should just stop
being afraid of being very alive in a
box you know good go all right so we get
a sense of what we’re not talking about
here and you know what you see there is
what we talk about into the behavior
change literature is the righting reflex
when we tell someone not to do something
there’s a natural psychological process
where they want to voice the other side
of it why they feel there should do it
okay that’s it that’s sort of the
natural process we’re trying to step
away from that we’re trying to pull
ourselves back from giving advice when
it’s not appropriate when someone isn’t
in a preparatory stage of change so this
brings us to the idea of motivational
interviewing the definition that we talk
about is the collaborative
person-centered form of guiding to
elicit and motivation and motivate
change so this is like other forms of
kind of client or patient centered
counseling or communication however it
differs a little bit and we’re gonna
come back to the ways in which it
differs in here in a minute so I’m gonna
take you through the the principles of
it and then hopefully I’ll give you some
examples of how you might be able to use
it in some of the settings you’re in a
couple ideas here that I just like to
talk about in motivational interviewing
we focus on personal risk personal risk
so we talked about obesity someone gave
me the example of obesity what’s a
general general population risk for
obesity okay so car
problems all these different things that
happens to everybody we’re looking for
more what’s the specific risk for the
person in other words how does it affect
their life their self-concept their
relationships things that are only
applicable to them we’re looking for how
it affects work how it affects family
how it affects your self-concept we find
those to be more powerful generators of
change okay in this technique the person
takes the responsibility for changing
not us okay well we take responsibility
for us doing our best to try to help
them to realize why they want to change
we’re certainly giving advice to change
but really when it’s appropriate
right and when someone’s when they when
they’ve got to the stage of change of
preparatory when they’re preparing to
change I’m gonna talk about
self-efficacy and empathy now so
expressing empathy you know my wife was
recently pregnant and she would say
things to me that I found it very hard
to to grasp I remember one time she
elbowed me in the middle of the night
and said I have a foot in my rib it
occurred to me what I should say is you
know oh yeah I had gas one time and so I
understand what that’s like now I don’t
know you don’t know my wife but I
wouldn’t be here having this opportunity
to talk to you if I had said that so
what I what I was trying to do is get to
the feeling of what she was experiencing
okay now it was tempting for me to also
do some kind of well here hey let me
help you which I did like what can I do
to make it better for you but really the
goal of impact of having an empathic
connection with our patients or our
wives that our husbands are sniffing
others partners in this setting is
really to show the person you understand
how they feel which can be very
difficult because in medicine we’re
predisposed to do something about it so
the first step is to show the person you
understand that must be really
uncomfortable it’s so hard to be like
that and have all these other things you
got to do what we find is that the more
empathic we are with our patients the
better the outcomes are from everything
from clinical outcomes to not getting
sued okay this is the kind of the power
in the relationship as people have
already alluded to okay now going back
to the story that we talked about about
the guy who quit smoking one of the ways
in which motivational interviewing
differs from just a client centered
communication approach is we have a
strategy the strategy is to
try to help the patient realize how
their problem behavior is in conflict
with an important goal or value that
they have how their problem behavior
smoking is in conflict with important
goals or values that they have being a
good father okay so we’re asking
questions in order to elicit from them
not to not tell them why they need to
change your behavior but have them tell
us why they believe they need to change
the behavior that’s a fundamental
difference some people refer to this
approach as love with a goal love is
just being empathic and connected but we
have a goal here we have a strategy
we’re trying to ask questions to help
people tell us why they think they need
to change not to tell people look you
need to do this what you’re doing is all
wrong here let me show you why we’re
trying to subtly have people by using
reflective listening and asking
questions realize for themselves that
something is not right so that’s really
the process that what we’re trying to do
here in this technique we’re trying to
simply just avoid arguing with people
you know the goal here is not to every
time I say but to a patient I’m
wondering hey maybe I’m arguing here
we’re trying to step away from that we
know that arguing it elicits more of the
writing reflex of a desire to do the
opposite thing and we’re trying to
simply roll with resistance so you know
this is a thought of a sort of
psychological like IDO rather than to
fight back we’re letting that resistance
go by we’re trying to find creative
methods for letting that resistance go
and then lastly supporting self-efficacy
what we find is that if a patient
believes that you think they can change
they’re much more likely to be able to
do it if they believe in fact that they
could change they’re much more likely to
do it so trying to support the idea of
themselves using affirmation that they
can do it in other words patients come
in and feel very small and so our goal
is to help them see that in fact there’s
a stronger person within I can’t tell
you how many times in addictions in
diabetes people have come in over and
over and realize that you know despite
that they’re trying they feel like
they’re not making a connection to the
outcome in other words they’re not
making an impact so our goal is to find
something that we can reinforce to help
them continue on their path this is what
we’re talking about we’re trying to just
not argue not be pushy with our patients
we’re trying to show them that
we understand their perspective so
that’s really expressing empathy we’re
trying to be optimistic supportive and
hopeful which is supporting
self-efficacy and we’re trying to help
them see the conflict and their problem
behavior and their important goals and
values okay so we’re trying to see help
them have a discussion where they can
possibly see that there’s an
inconsistency and the way they’re
behaving and their important goals are
values
so what’s resistance well you know
frequently when I’m in the room when I
when I was talking to someone or when I
would go in with a resident you know
that we often say you know you should
exercise more and I remember a lot of
times people would say we’ll talk about
their pets and so what’s the one thing
that you would give people advice if
they need to exercise and they had a dog
sure I want my dog no problem doc got it
covered people find all kinds of ways to
resist if they’re being told what to do
they’re gonna find creative ways to get
out of it our goal is for them to come
up and we know that if someone
participates in the plan if someone
comes up with the plan there is a higher
likelihood that they’re gonna get
involved in it and want to do it so
that’s sort of one of our goals
resistance is verbal or nonverbal from
this approach for motivational
interviewing we think of it as expected
and normal if I walk in the room to talk
to a teenager and they’re not sucking
their teeth texting and rolling their
eyes something is very wrong we expect
this from people we don’t walk in the
room and say oh God
we say okay this is what I expect right
this is its kind of the DMV approach
when I go into the DMV right if I expect
that I’m gonna be attended to punctually
and courteously I’m in a big trouble I’m
in really big trouble right so I go in
there say okay this is part of the
process and you know what even if it’s
99% then meaning the person you’re
interacting with their issue it’s still
1% me so I’m gonna use my 1% here’s what
Joan Rivers says about resistance I
don’t exercise
God wanted me to bend over he put
diamonds on the floor
we’re looking for change talk change
talk is anything that we can see in what
the patient says that’s in favor of
change and we’re looking to just roll
with they say diabetes doesn’t exist
all right that’s a conversation I don’t
want to get into honestly right try
having a conversation with someone who
believes HIV was created by the
government I’m rolling with that okay I
don’t like to contradict people’s
beliefs I’m trying to find the part of
their belief that’s in favor of change
their speech what they’re talking about
that favors change okay what important
shapes are symbols do you see in this
logo the arrow raise your hand if you
see the arrow between the E and the X
there’s a white arrow in the negative
space so you know the reason I’m showing
this is because frequently in patient
care this what happens someone comes in
you’ve been treating them for their
diabetes for about a year you’re just
and you know it’s your last year and
residency or just can’t wait to get out
of there and get a job where you’re
actually paid and you’re like alright
this annoying person blah blah blah you
really like them but they’re frustrating
you beyond belief okay well we’re trying
to say here is that even the person that
comes in right who’s morbidly obese
diabetes they they haven’t changed in
the three years in your residency you’re
sitting there seeing them everybody
every single person has a reason to
change
it’s just deeply buried right maybe
deeply buried through four or five
residents before you okay so really what
we’re trying to do is figure out how we
can get that arrow to come out through
our questions we’re looking for change
talk I want to do it I can it’s
important I should I will this is
different from you know from commitment
talk which is I will I’m ready and doing
it now so that’s sort of indicating when
someone says I I want to I don’t
actually just jump on it
I’m trying to get to get them really
more to really prepare for change but
I’m really looking to elicit this change
stop why do they want to do it why why
do they think they could do it why is it
important to them not to me but to them
why do they think they should do it okay
telling people what to do as I said
before it’s kind of dangerous usually
doesn’t help us help people change we’re
looking for the behavior related issue
the arrow right is one an idea or the
hook what could hook them into the
process of thinking about change right
we go back to the smoking father it’s
not lung cancer emphysema these kind of
things it’s really his relationship with
his kids that’s gonna help him to change
is this a good hook my boss gave me
motivation tape it’s a recording of him
firing people probably not so where do
we find hooks in other words where are
the consequences in people’s lives that
if you talk about it with them could
promote change what kinds of things in
their lives
I’d say family is the number one thing
relationships but there’s also a whole
another there’s many many other things
that you can investigate we’re just
trying to not stick with just the
health-related consequence so Hans a 50
year old unemployed man who was an
aspiring artist type he’s diagnosed with
diabetes when he’s 45 complains that he
and his girlfriend always fighting
because he was diagnosed with diabetes
she’s always trying to live at his diet
he tells me he’s trying to cut back on
eating high fat foods but he always
starts to eat them when one of his
paintings gets passed over for an art
gallery so we might stay with some of
the traditional kind of general effects
of this behavior or about diabetes but
in this approach we’re looking for the
things that are related to his personal
life how does it impact the relationship
with the girlfriend what if his diabetes
is control uncontrolled how does he
think it’s gonna affect his artwork
we’re looking for the personal risks for
him so I’ve talked to you about the
spirit of motivational interviewing a
little bit in that we’re trying to
collaborate with people that’s the way
of being and we’re trying to elicit from
them their reason for change and we’re
really the idea here is that and when I
walk into the room with anyone what I
say is sort of similar to what Bill
Miller said look at the end of the day
it’s your choice if and how you’re gonna
change this I’m just here to provide you
some options then a day your your than
the drivers see what I say that
adolescence I said you’re the boss of
your life the end of the day people can
tell you what to do but you’re gonna
still choose okay the the the one of the
most riveting experience of this is what
I did a training in in the California
maximum security prison for youth so
these are kids who violent crime before
the age of 18 and they explained to me
that their daily choices they had lots
of daily choices even being incarcerated
and being in restraints they could spit
they can bite they can throw things at
the guards no matter where
you are you always have a choice right
and so it’s helping people to realize
that it’s their choice we’re trying to
doing as far as the techniques in other
words what we actually do in the room as
a way of trying to help people talk
about their reasons for change and
empathize with how it’s difficult for
them is these these four techniques
so is this an open-ended or a
closed-ended question did you have more
than one alcohol beverage alcoholic
beverage this week closed right it’s
really close it questions the yes-or-no
question it’s also dangerous from an
assessment perspective my doctors had
only one glass of alcohol a day I can
live with that so so it’s it’s sort of
dangerous from that perspective too
however it’s much more dangerous when
we’re talking to people about changing a
behavior that’s difficult to change so
our goal here is to ask questions that
open up the discussion okay so here are
some examples of questions you can ask
in early stage change process pre
contemplation we’re trying to have
people for them tell us why they want to
change here’s some stage some questions
you can ask in preparation to see where
the person wants to go okay what do you
think you should do what’s our next step
around this okay my belief is it’s
always okay to give advice however you
know it’s more effective to give advice
when the person is really on board right
when you’re really harnessing the power
of your advice so that’s our goal and
this technique is to help people to get
motivated to change assess where they’re
at and when they’re ready to change then
we’re gonna start giving advice and even
in giving advice we try to do it in a
motivational remaining way I’ve got some
ideas about what I think might be
helpful for you how would you feel if we
talked about that a little bit if the
person says no to me
I’m very suspect of if I did give advice
if they were gonna use it or not okay
you know affirmations are based on the
idea of the power of positive
reinforcement people know who BF Skinner
is BF Skinner’s the guy who founded sort
of behaviorism and just to give you an
example of the power of positive
reinforcement he was doing a talk at
Harvard to his students on behaviorism
on positive reinforcement and they
decided to play a trick on him
they decided whenever he moved to the
left side of the room they were gonna
nod their head and smile just like some
of you nice people are doing for me a
little bit so what happened what
happened he lectured the entire day from
the left corner of the room the power of
positive reinforcement if you find a way
to affirm your client it doesn’t even
have to be about the problem behavior it
doesn’t have to be about diabetes it
could be about their good parenting it
could be about the fact that they were
on time we’re happy to complain about
when people make us late but when people
come on time how often do we take the
time say thanks so much for coming on
time it helps me to keep my day on track
so I really appreciate that that was
considerate of you
okay so we’re trying to find ways to
affirm them so you know these are all
examples of affirmations the one I like
the best here just so you know is the
last one it must have taken a lot of
courage to come in today knowing you
haven’t met your weight loss goals okay
the idea here is that people have a BS
meter okay about affirmations if you
just say like great job people are gonna
be like and adolescents are the ones
you’re gonna catch you the most of this
certainly I’ve never had an adolescent
pull my card more you know when you say
great job they’re like oh really why so
so you really want to be specific about
your affirmations so I’m sick of this I
do good for a week and then my kids
start getting on my nerves talking back
and crap so I have a few smokes big deal
I go to these cessation meetings I think
it’s helping and then I realized to my
girlfriend everyone comes down I mean I
got into a fight this so it’s some punk
that looked at me hard on the bus got
arrested no one likes me I can’t do
anything right they’re always on my case
I don’t know what you all want from me
I’m just trying to get by patch
nicorette gum it’s not as easy as you
make it sound so in this we’re like
snowed with all this negative stuff here
but we’re trying to do is find one or
two things that we could affirm right
something that they’re doing their
attendance their parenting the fact that
they didn’t get arrested whatever it is
we’re trying to point out specific
things that we saw that we think about
their behavior that’s good so how do we
do this well one ideas reflections
I’m gonna give you three examples of
reflections I I can’t start eating like
that all my friends do I can’t start
eating like that all my friends do so
well we might want to argue with this
right well we might want to say this is
what you should do or here’s how you can
deal with that the first attempt in this
approach is to empathize to listen
reflectively to a lie to put aside our
agenda our scorpion tail for a minute
and a lie with where they are at okay
it’s difficult for you to think about
changing your eating habits because
you’re surrounded by people who don’t
eat in the way I’m suggesting another
technique that we use is the amplified
reflection my girlfriend’s exaggerating
I’m not that overweight okay when
someone says something extreme like this
an option that you have is to take what
they’re saying and slightly exaggerate
it right this comes from paradoxical
intention family system stuff and also
masters and Johnson’s work around people
who’re having difficulty maintaining or
their erection it seems to you that she
has no reason at all to worry about you
it’s possible here that the person is
gonna disagree well actually she has
some reason to worry about okay so what
we’re trying to do here is take the idea
and make it a little bit exaggerated so
that they’ll disagree with us and then
lastly one of the techniques we use is
called the double-sided reflection so
when someone says you know really help
to have a smoke after I found out I
didn’t get the job but then I started
coughing it and my wife gave me the
death stare if you’re not familiar with
that yet just take some time you’ll get
there so the clinician says so on the
one hand you felt that smoking helped
you cope with the disappointing news
that is broccoli everyone broccoli okay
we don’t like to talk about how it helps
however on the other hand you notice you
were coughing again and your wife wasn’t
happy about that we in our double-sided
reflection we talked about the reason
not to change but then the reason to
change okay we’re trying to show people
that their biffle n’t but help them to
see that there’s a part of them that
would like to change even though they’re
resistant
what about confrontation well here’s
what Dylan Thomas said about
confrontation an alcoholic is someone
you don’t like who drinks as much as you
do we’re trying to stop with the
labeling stop with with with scare
tactics here well I guess I do
too much sometimes but I don’t think I
have a problem well you have a BMI of 40
okay it’s the confrontation it’s not so
mean we’re trying to here do is is to
reflect back to them and help them to
see that they have a reason to change so
what you could say here is on one hand
you really don’t want to be labeled yet
a part of you see some reason to change
this my annoying boyfriend is always
telling me why I need to exercise more
often well he has some good reasons for
telling you that it’s a confrontation in
a reflection we’re trying to get to what
the person is experiencing about this
okay you’re really frustrated okay by
him telling you what to do all the time
so you know how I feel about important
theorists right we’ve already got one
and I’m gonna give you another person I
really think is is important here and
that’s Yoda
well what did Yoda say about this whole
process many must be your fear before
banish it you can we’re supposed to in
this technique our goal we’re trying to
do if you so choose to try it is to help
people identify and talk about why they
don’t want to do it Before we jump in
and tell them why they should okay that
frees them up to maybe acknowledge or
talk about how it it isn’t working the
behavior isn’t working and then the last
thing I’ll just say about is summaries
traditionally in interviewing what we do
in terms of summaries is we’d use a
summary to show people that we
understand that and make sure we
comprehend what they’re doing or to
review a plan the difference in this
technique is we also use summaries to
transition so oftentimes what I find is
that we’re very anxious when people
start talking right because we’re like
oh my god here we go we just opened a
can of worms so summaries are a really
nice way to keep the relationship but
help to direct the conversation in a way
that you’re getting back to maybe some
of the consequences of the behavior they
speak of my drinking but never of my
thirst we suck
we’re terrible at talking about the
reasons people love to eat have
unprotected sex again we didn’t go into
this field to have these joyous moments
with people who are talking about
unprotected sex while you’re eating high
caloric food and drinking that’s not why
we did this right we went in there
because we want to talk to people to
talk about Pro how
behaviors however remember the seesaw
the writing reflects the more we talk
about why they shouldn’t do it the more
they want to talk about why they should
do it
so we reverse that process here we talk
to people we make sure that we
understand what drinking does for them
what do they like about eating okay this
is money in the bank what do you like
about smoking why don’t you want to take
your medicine
in other words you know we’re investing
with them we’re saying I hear you’re
part of it then they’re gonna be more
likely to go on the little quest with us
to answer some of our questions about
the negative consequences to this
behavior okay the way I think about this
is you have to eat your broccoli as a
health care professional to get your
dessert we hate talking about this stuff
but we’ve got to eat our broccoli if we
want our dessert if we want people to
talk about why diabetes is bad or why
that helped outcomes are bad we got to
do our part which is to help them we
understand why it’s so difficult for
them if the person is in there and
they’re saying hey I don’t want to do
this and we’re saying you have to do
this those people it’s not that
effective for the people that are really
motivated and you give them all these
things and you say here’s what then
that’s great we’re talking about the
people that aren’t motivated so we’re
trying to help them find more motivation
okay so just in wrapping up I just like
to say and one of the things ways I’d
like to just you know explicitly
affirmed this group is that you know I
don’t know how you ended up here I
really don’t I’m assuming that some of
you were encouraged perhaps by your
program director some of you really find
the stuff important the fact that matter
is that this is an all too much all too
ignored aspect of I think one of the
most important aspects of being a healer
and I just want to say that I’m honored
that the attendance is what it is today
and I really appreciate you guys taking
the time out of your of your days and
your busy schedules and rotations to
think about this it shows your
commitment to really doing the things
that help in in health care so I really
I appreciate that
and I know that your patients eventually
will as you’re working on this stuff so
again I want to thank you for having me
here and I wish you’re really
stimulating and motivated day and good
luck to you
you
you
