Welcome to the second part of “Motivating Lasting Change”. I’m Dr. Kristin Reyher. And in this section, we’ll be talking about how we can improve our communication with clients. We spoke in the last section about evidence based communication and the fact that we know that the way we talk with our clients stimulates different responses from them. When we talk in a persuasive style or when we blame them, we stimulate psychological reactants, and they think of reasons why they want to maintain the status quo and not make the changes we might be suggesting.
However, when we invite them to consider different options, when we give them autonomy of their own decisions, they often speak in a way that they’re ready to change– something we call change talk– uncovering within themselves reasons why they might want to change, why they might want to do things differently. Let’s think about some of the ways we’ve been used to speaking with clients and what some of the responses we might hear from them might be. If we say to a client, you really need to change this, they might respond with, but we’ve always done it this way. I’m not ready to change. I want things to stay the way that they are.
If we say to them, I really think your best option is to do this thing, they might think, well, that won’t work in my home. They might push back against us and find lots of reasons why what we think is their best option is not going to work for them. And if we say, you really should be trying out this new approach, we might invoke in them ideas about this doesn’t make sense. I don’t understand where you’re coming from. I really don’t want to listen to you, and I don’t want to make the changes you’re suggesting.
However, if we change our interaction style, if we ask more open questions, if we look to the positives that our clients might have for change, and find out what their ideas and their motivations are, our conversation is likely to flow much better, and their responses might be very different. Consider instead saying, what are your thoughts on this change? And you might get a response like, well, I’m a bit worried. But I’ve heard other people are doing it. I might be able to make that change. Or you could ask, what could be a positive of this sort of change? Getting them to think about what would be the good things that might happen if they made the suggested change?
Well, they might say, I guess I would save money. You could approach it like this. Are there any benefits to integrating these new ideas? And your client might respond with, well, I guess I might be able to better keep track of my animal’s health if I did some record keeping, if I thought a little bit more about how things were going to go, what was going to change as the year runs through. These are the sorts of ways we can change the conversation and get them to open up a little bit and consider some of the positives and some of the other ideas that they might be willing to think about and willing to change.
Sometimes a client genuinely doesn’t perceive a problem, and they’re not that interested in changing even though you might use positive and evoking communication methods to engage them on the topic. As mentioned earlier, when we consider complex change, we go through several distinct stages in the change process. To move from pre-contemplation, when we’re not aware or not interested in the change, even to contemplation when we’re considering the pros and cons of a change, we must first perceive that our current behaviour is not congruent with our desired values.
In working with clients about antimicrobial stewardship, they might have to find a way to accept that their existing medicine’s practice is not exactly where they want to be with how they use medicines and how they keep their pets healthy. This inconsistency in our life between our goals and our behaviour is what we call discrepancy. Recognising this discrepancy is a critical part of moving through the stages of change. It’s only when you perceive this inconsistency that you become open to the pros and cons of changing. To help clients who are in pre-contemplation moved to contemplation, we need to develop some discrepancy. But this idea of developing discrepancy raises the question, discrepancy with what?
It’s the person’s own goals and values and linking to these which helps to build intrinsic motivation to change. We’re helping to point out this inconsistency between their own values and their behaviour. And it’s important that it’s their values, not our values. Because if we’re seeking to impose our own values rather than invoking theirs, it simply won’t work. It’s important to remember that you usually don’t need to point out the inconsistencies between people’s goals and their behaviour. In fact, it may not be helpful to say, don’t you see how your behaviour is defeating these goals? Instead, you let your client connect the dots rather than telling them.
For instance, with a farmer, you might say, on the one hand, you’re proud to implement best practise with your herd. But on the other hand, you’ve seen that others are managing their medicines rather differently to you. What we need to do is to explore their own goals and values. Seek to understand what our client does want. What are their goals? What are their hopes for the future? These may be different than our hopes for their operation or for their pets. But we really need to key in to what their hopes and goals are. And then we listen. We might not jump in and say something quickly, but we’re listening to what they’re saying.
Where is their current behaviour in conflict with the goals that they tell us that they have for their animals and for their life? And how – and the changes that we might think are important facilitate meeting these goals. And we use open questions, we use reflections to explore these sorts of things with our clients. We don’t tell them what they need to do. We just open it up for them and let them connect the dots for themselves.
Feedback and information can be useful, but only when your client has a sense of choice, a sense of self-confidence that they can put in place any recommendations, and when they feel a sense of trust and respect and connection with you in their conversation. A careful assessment and feedback process can provide some objective information that you can discuss with your client. The feedback and the information you provide is not given as evidence of what your client should or must do. These conclusions must also always be left to the client.
Your role is just to stimulate a discussion where the client feels comfortable enough to explore these ideas and ideally to move one step closer to change by being able to consider this new information as a value. It’s only with choice, respect, and confidence that your feedback and information will have meaning anyway. Once it does, this should naturally help them to progress towards contemplation and through the stages of change. In the next section, we’ll talk about some difficult conversations you might have with clients and sum up the things that we’ve learned about evidence based communication and the way we can have a better connection with our clients in order to stimulate more responsible use of antimicrobials.