Interventions

ENHANCING MOTIVATION

Patients are often ambivalent about making changes in their lives. We use a variety of strategies to enhance patient motivation and “elicit change talk” to promote positive behavior change. These strategies are particularly helpful before assigning homework in order to ensure patient readiness and agreement.

Strategies that can enhance patient motivation include:

• Ask permission to provide psychoeducation or feedback about patient’s behavioral health symptoms
• Discuss the treatment rationale or ensure patient input in treatment
• Ask questions about the pros and cons of behavior from the patient’s perspective
• Ask questions about patient readiness for change

Ineffective strategies to attempt to enhance patient motivation include:

• Decide on treatment course without asking for patient input or preferences
• State the benefits of changing a behavior or the negatives of maintaining a behavior only from a paternalistic perspective, and
• Drop the focus on a distressing symptom or behavior and move on prematurely to a new concern

ASSIGNING HOMEWORK

After providing adequate psychoeducation to the patient about their behavioral health symptoms and about the intervention, we then need to structure the encounter in a way that will be most beneficial to helping the patient learn new skills, all while staying within our time limit. To do this, we focus on setting specific goals, teaching and illustrating therapeutic skills, detailing homework, and anticipating obstacles.

To adequately assign homework, we should work with patients/clients to sequentially:

• Set specific goals and action plans in collaboration with the patient
• Ensure the patient will be successful by predicting obstacles and planning realistic strategies to overcome them, and
• Explain how to evaluate whether the plan was successful or not

Less helpful ways to assign homework include:

• Identify a goal or activity without creating a specific action plan that covers the necessary steps the patient will need to do so, or
• Set an unrealistic goal or action plan

REVIEWING HOMEWORK

Patients will be more likely to complete their action plans if the provider reviews them at the start of each encounter, discusses the patient’s satisfaction with their efforts, and troubleshoots any obstacles. This discussion of successes helps patients acknowledge and feel good about their accomplishments, even if they are still not functioning as well as they were since their behavioral health symptoms began. Reviewing homework also reinforces for the patient the link between their efforts and improvements in behavioral health symptoms and functioning.

A thorough homework review will do the following sequence:

1. Ask the patient what they have accomplished, or how satisfied they were with themselves and their efforts
2. Give appropriate praise for patient efforts
3. Emphasize the relationship between the patient’s efforts and their symptoms improving
4. Ask patient about challenges with the previous homework or activities, and
5. Help the patient consider what they could do differently next time

An ineffective review of homework will:

• Ask open-ended questions about the past week
• Move on too quickly to schedule new plans without addressing any difficulties from last homework
• Encourage patient to drop an activity if they didn’t accomplish, or
• Encourage patient to redo homework that they didn’t accomplish without addressing any difficulties