Building Competency in Diabetes Education THE ESSENTIALS

11-24 | CHAPTER 11

• Stay away from situations in which the health-care provider argues and the person defends; confrontation often leads to resistance to change. • Ensure that the health-care provider is seen as an advocate. • Emphasize personal ability and responsibility. • Examine past successes and lessons learned.

Support self efficacy

• “What has worked in the past?” • “What would have to change in order for [fill in the blank] to happen?”

1. Express empathy: Help the patient accept that ambivalence is normal. “You want to, but you don’t want to.” Skillful reflective listening is fundamental. 2. Develop or create discrepancy: Seeing discrepancy between the present behaviour and important health goals or recommendations helps the individual discover his/her personal reasons to change. 3. Roll with sustain talk to avoid discord (previously referred to as roll with resistance)*: Arguments are counterproductive. Meeting resistance, such as a comment “Yes, but….” is a signal for the educator to change strategies. 4. Support self-efficacy: Belief in the possibility of change is important. The patient’s personal choice is maintained throughout the process. *In their latest edition of the text, Motivational Interviewing , Miller and Rollick discuss their deconstruction of the word “resistance”, replacing it with the concepts of sustain talk and discord. Sustain talk refers to the target behavior whereas discord refers to the counselor client relationship. Suggesting that the patient is resisting change has a negative and judgmental tone which is counterproductive to the process of encouraging collaboration and acceptance. Patients will naturally engage in sustain talk when viewing the argument in any discussion related to behavior change. Discord occurs on the part of the counselor if they do not roll with the sustain talk. It is not the intent in motivational interviewing to discount or dwell on the reasons for sustaining a behavior, but rather to use the skills of reflective listening and reframing to evoke “change talk” (34,35).