Motivational Interviewing with Kelly Fradin, MD
Updated: Aug 12, 2020
This weekend I reached out to Kelly Fradin, MD, a pediatrician, writer and public health advocate. I was interested to learn more about motivational interviewing and how we could apply these techniques in our daily lives.
What is motivational interviewing?
Motivational interviewing is a counseling style designed to facilitate behavior change. It asks open ended questions and explores individual goals rather than by telling someone what to do. You begin by finding out where someone is in relation to the problem. Individuals can be anywhere along a continuum of readiness to change and you don't know where they are until you ask! The goal is to engage in discussion, focus on the problem, evoke thoughts and feelings about the change, and take concrete steps towards planning.
The continuum of stages:
Pre-contemplation- people don't really believe there is a problem.
Contemplation- individuals think maybe there is an issue, but they are not ready to plan to change it.
Preparation- they acknowledge a problem and may be researching or making a plan to address it.
Action- they are taking steps toward change though they may need assistance and support.
Maintenance or Relapse- they have made a change and are trying to keep up the new habit or they have gone back to old habits.
Why do doctors use it?
This technique is respectful and empowering to use with our patients. It's also evidence based and more likely to work while also saving time.
As an example, let's look at one of the most common topics we address - weight loss. I could charge into a room, look at a chart and give a nonspecific plan – ‘you need to eat well and exercise.’ Or I could ask how the patient feels about their weight. Their response to this question - whether they think they are at a healthy weight or whether they have tried many things to lose weight and just can't figure it out - will take our conversation in entirely different directions.
If the patient is in the pre-contemplation stage- not sure there is even a problem - discussing specific strategies is tone deaf and unlikely to lead to success. Instead, I can provide education about how their weight may be impacting their blood pressure, sleep or joint pain. But if someone is already taking action towards a goal and struggling, I can learn more about what they are doing and help them in a much more specific way. In this way, motivational interviewing acknowledges that the person is the decision maker and that change is hard.
How can I use motivational interviewing techniques in my every day life?
Recently I've heard so many people struggling with loved ones who are making different choices regarding their behaviors related to Covid-19. In reference to mask-wearing, motivational interviewing would encourage you to take a step back and ask open ended questions. "What is your understanding of coronavirus transmission?"
Over and over I have seen that listening often leads to surprising insights. Maybe you will learn something about where they are in their journey towards mask-wearing and be able to help them along. Often we want our loved ones to change (whether it's screen-time usage, substance use, exercise, etc.). Using these techniques is an empathetic way to see where they are and provide targeted and supportive comments. These techniques help us remember that it is not about us, whether it's the doctor or the concerned family member, it's about the person contemplating change.
Kelly Fradin, MD
Dr. Kelly Fradin is a pediatrician, writer and public health advocate based in New York. Originally from North Carolina, she attended Harvard College and Columbia College of Physicians and Surgeons before completing her Pediatric residency at the Children's Hospital at Montefiore. She spent several years as an Assistant Professor at CHAM, with a practice specializing in academic complex care - helping the families manage the care of children with multiple complex medical issues.
Now Dr. Fradin works in a public health capacity advocating for students with chronic conditions in New York City schools. She shares evidence based parenting advice and education about children's health on Instagram and her advice has been featured by many publications including Business Insider, Glamour, PopSugar, Babylist, and KevinMD. She's written a book on Parenting in a Pandemic with information parents need to know to help make the best decisions they can and help their family through coronavirus times.