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#157 Motivational Interviewing with Sabina Kahn · OT Potential Podcast | Occupational Therapy CEUs

0:00
SPEAKER_00: At the heart of rehab therapy is often behavior change.
0:05
SPEAKER_00: That powerful lever is how therapy is able to deliver such long-term life-altering results.
0:11
SPEAKER_00: But let's be honest, behavior change is hard.
0:15
SPEAKER_00: I know that I, for one, have sat in a therapy office as a patient pledging to do my home exercise program and then totally failed to actually do it.
0:25
SPEAKER_00: Motivational interviewing is an evidence-based approach that helps us get at the why behind what makes behavior change so difficult.
0:33
SPEAKER_00: It surfaces the real challenges so the therapist and patient can work through them together.
0:39
SPEAKER_00: And it gives us five specific skills to use in that process.
0:43
SPEAKER_00: In today's course, we are joined by Sabina Khan.
0:46
SPEAKER_00: Sabina literally wrote the book on motivational interviewing for OTPT and SLP.
0:52
SPEAKER_00: Today she'll share what she has learned, will role-play motivational interviewing in action, and will help you start putting this process to work in your own practice.
1:01
SPEAKER_00: We have a lot to cover today, so let's dive in.
1:07
SPEAKER_00: Welcome to the OT Potential Podcast.
1:10
SPEAKER_00: I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you.
1:18
SPEAKER_00: You are probably listening to this podcast on a free podcast platform.
1:22
SPEAKER_00: But to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform.
1:30
SPEAKER_00: You can go to OTPotential.com to learn more.
1:34
SPEAKER_00: Okay, here we go.
1:37
SPEAKER_00: As I mentioned at the top, joining us today is Sabina Khan, PhD EDD OTD.
1:44
SPEAKER_00: Dr.
1:44
SPEAKER_00: Sabina Khan is a women's health and health equity researcher, author, educator, and health tech strategist based in Miami, Florida.
1:52
SPEAKER_00: With over a decade of clinical and academic experience, Dr.
1:56
SPEAKER_00: Khan's work spans the intersection of occupational therapy, women's health, and digital innovation.
2:02
SPEAKER_00: Her research and teaching center on trauma-informed care, maternal health, and health technology as a pathway to equitable and personalized care delivery.
2:11
SPEAKER_00: She has become a leading voice in advancing the role of occupational therapy within emerging and interdisciplinary practice areas.
2:19
SPEAKER_00: Dr.
2:19
SPEAKER_00: Kahn holds a PhD, a Doctor of Occupational Therapy in OTD, and a Master of Science, and recently completed her Doctor of Education with a specialization in executive leadership at the University of St.
2:34
SPEAKER_00: Augustine for Health Sciences.
2:36
SPEAKER_00: As a financial disclosure, we mentioned that Sabina literally wrote the book on this topic.
2:41
SPEAKER_00: It is called Motivational Interviewing for Rehabilitation Clinicians: Strategies for Behavior Change and Client Engagement.
2:49
SPEAKER_00: Sabina receives a royalty from these sales.
2:52
SPEAKER_00: That being said, I still believe Sabina is the best person to speak to this topic today.
2:57
SPEAKER_00: And we plan to equip you with a baseline understanding of this treatment technique.
3:02
SPEAKER_00: So without further ado, we will patch Sabina into our live studio.
3:06
SPEAKER_00: Welcome to OT Potential, Sabina.
3:08
SPEAKER_00: It's so great to have you.
3:10
SPEAKER_00: Hi, Sarah.
3:10
SPEAKER_00: Thank you so much.
3:11
SPEAKER_00: It's a pleasure to be here.
3:13
SPEAKER_00: I am so excited for this conversation today.
3:16
SPEAKER_00: The material feels so helpful.
3:19
SPEAKER_00: And for me, it feels like it helps specifically with something that I was terrible at as a clinician, which was collaborative goal setting.
3:30
SPEAKER_00: Like I felt like in school I had this idea that I would show up and see patients and they would tell me what was meaningful to them and have like a clearly stated purpose that I would tie my goals to.
3:46
SPEAKER_00: And then you show up in the hospital and no one's thinking about that.
3:49
SPEAKER_00: And no one's really thinking about purpose and values and motivation when they're starting a therapy session.
3:58
SPEAKER_00: But motivational interviewing feels like this toolkit to have to open those conversations.
4:05
SPEAKER_00: It feels like the tool set that I didn't have.
4:07
SPEAKER_00: Like I thought it would just come naturally, but you really need this tool set to draw out these conversations.
4:13
SPEAKER_00: So I can't wait to learn about the logistics of it and what you've learned about it.
4:17
SPEAKER_00: Before we get into the logistics, though, I would just love to start with your story and how you found motivational interviewing and how'd you come to find it and then be the person who wrote the book on it?
4:31
SPEAKER_01: Yeah, absolutely.
4:33
SPEAKER_01: You know, Sarah, have you ever worked with a patient who knew exactly what they needed to do to get better?
4:41
SPEAKER_01: And this doesn't even have to be in a client or patient situation, even like a family member who might know the value behind exercise, for instance.
4:50
SPEAKER_01: Or maybe if you did work with a client or patient, they had that education, they had those resources, maybe there was an excellent treatment plan, and then they still didn't do it.
5:01
SPEAKER_01: And then as clinicians, I think that our immediate reaction in those situations is often, well, why not?
5:10
SPEAKER_01: We've explained everything to you, we've given them, for example, the tools that maybe they need.
5:15
SPEAKER_01: They know what they need to do.
5:18
SPEAKER_01: But this is the question that I think really fascinated me.
5:21
SPEAKER_01: What if the problem isn't lack of knowledge?
5:25
SPEAKER_01: What if the problem is that we've just been approaching behavior change from the wrong direction?
5:31
SPEAKER_01: And I think that question specifically became the foundation of my interest in motivational interviewing.
5:39
SPEAKER_01: Because if knowledge alone changed behavior, we would all be exercising every day.
5:46
SPEAKER_01: We would all be getting eight hours of sleep, we'd be eating perfectly balanced meals and following every single recommendation that our own healthcare providers are giving us.
5:57
SPEAKER_01: But of course, we don't.
5:59
SPEAKER_01: And that's because human behavior is far more complex than just knowing what it is we are supposed to do.
6:07
SPEAKER_01: We have these psychological, emotional, environmental factors, contextual factors that are influencing our decisions.
6:17
SPEAKER_01: And then we often have this disconnect between intention and action.
6:23
SPEAKER_01: And that I think is what initially sparked my curiosity.
6:27
SPEAKER_01: So throughout my clinical work, I became increasingly interested in why a patient struggles with behavior change, even when they genuinely want to improve.
6:39
SPEAKER_01: So you might have someone, let's say if you have a condition, they have a stroke and they desperately want to regain independence, but they're just not engaging in that home exercise program.
6:52
SPEAKER_01: Or if you have someone who has chronic pain, who wants to return to their daily activities, but is understandably fearful of exacerbating their symptoms.
7:04
SPEAKER_01: I know I've definitely been in those situations where I've heard things like that from someone who I've been working with.
7:10
SPEAKER_01: And I started recognizing that these were not necessarily situations involving a lack of motivation, which I think oftentimes is our default thought process when we're in these situations and encounter these individuals.
7:26
SPEAKER_01: Often these situations really involved ambivalence or diminished self-efficacy or competing priorities, or maybe a disconnect between our clinical recommendation and what their personal values are.
7:43
SPEAKER_01: So I would say that's where motivational interviewing really resonated with me because in rehab, we are incredibly skilled at identifying impairments and developing interventions and addressing functional limitations, but then we spend so much less time exploring the underlying psychological processes that are influencing whether someone is actually ready to engage in those interventions.
8:14
SPEAKER_01: And OT is particularly well positioned to address this because our profession is fundamentally rooted in occupation and autonomy and client-centered care.
8:27
SPEAKER_01: And as I started exploring motivational interviewing more deeply, I realized how naturally it aligned with our professional philosophy.
8:36
SPEAKER_01: But I also noticed that we have this gap because much of the foundational literature focuses on substance use and behavioral health and broader health behavior change.
8:49
SPEAKER_01: And those are incredibly valuable.
8:51
SPEAKER_01: Those particular applications are valuable.
8:53
SPEAKER_01: I wanted to translate the principles into the everyday realities of rehab practice.
8:58
SPEAKER_01: So, what does MI or motivational interviewing sound like for someone who is refusing adaptive equipment or someone who has stopped participating in therapy because maybe they lost confidence in their recovery?
9:12
SPEAKER_00: I uh am loving this topic already because I love behavior change so much and I think about it a lot.
9:19
SPEAKER_00: Um and a lot of the times, as I'm thinking about it, I'm my own case study too.
9:25
SPEAKER_00: I'm like, I totally relate to what you're saying.
9:28
SPEAKER_00: Like, knowledge does not translate to action.
9:32
SPEAKER_00: Uh, we're going role play later in this episode because I'm an OT right now, and I am that patient where I have all the knowledge and I just can't do what I want to do.
9:45
SPEAKER_00: And I'm like, I can't even tease it out.
9:47
SPEAKER_00: I don't know if I'm too close to it.
9:49
SPEAKER_00: And I think that's so much of our work as OTs is like it feels like knowing what to do is the easy part, and then implementing it, that's like 95% of the effort.
10:05
SPEAKER_00: And motivational interviewing feels like it gives you like a tool set to dig into what is the really hard part.
10:12
SPEAKER_00: Like, how do you actually implement things?
10:15
SPEAKER_00: I would love to hear your crash course on motivational interviewing.
10:22
SPEAKER_00: I did not learn it in school, like I hear other therapists talking about it, and I'm like, what is that?
10:27
SPEAKER_00: That sounds helpful.
10:28
SPEAKER_00: Like, I'm starting from kind of zero, like uh starting from not knowing anything about it.
10:36
SPEAKER_00: What's the five-minute crash course?
10:38
SPEAKER_01: Yeah, absolutely.
10:40
SPEAKER_01: So at its core, motivational interviewing is a collaborative, goal-oriented communication approach that helps people to explore and strengthen their own motivation and commitment to change.
10:56
SPEAKER_01: And I always emphasize that motivational interviewing is not about persuading someone or convincing someone or somehow talking them into doing what we think is best.
11:10
SPEAKER_01: It's genuinely about helping individuals articulate their own reasons for change.
11:16
SPEAKER_01: So one of the foundational concepts is called ambivalence.
11:21
SPEAKER_01: So ambivalence is really that experience of having these competing thoughts or feelings about changing a behavior.
11:31
SPEAKER_01: So let's say if we were working with an older adult who maybe had experienced several falls and now we're recommending some type of device.
11:41
SPEAKER_01: Maybe we're recommending a walker.
11:43
SPEAKER_01: And that individual understands that okay, using this walker might improve their safety.
11:49
SPEAKER_01: But then at the same time, they associate that with aging or dependency or a loss of autonomy.
11:58
SPEAKER_01: So then they're experiencing these two competing motivations.
12:04
SPEAKER_01: On one hand, they want to remain safe, but they also want to preserve their identity as someone who is independent.
12:11
SPEAKER_01: And I think that this is where we sometimes misunderstand patient resistance.
12:18
SPEAKER_01: So what we're interpreting as resistance may actually be a very normal expression of ambivalence.
12:26
SPEAKER_01: Motivational interviewing helps us to explore that ambivalence rather than immediately trying to eliminate it through persuasion.
12:36
SPEAKER_01: So there's four fundamental processes in motivational interviewing.
12:41
SPEAKER_01: And the first is engaging.
12:43
SPEAKER_01: So this is establishing rapport, developing that trust, and then creating that strong therapeutic alliance.
12:51
SPEAKER_01: The second is focusing.
12:54
SPEAKER_01: So this involves collaboratively identifying what specific change or behavior we are going to address.
13:03
SPEAKER_01: And then we have evoking.
13:05
SPEAKER_01: So this is really the heart of MI, where we are eliciting the person's own reasons, their own desires and abilities and motivations for change rather than imposing our priorities onto them.
13:21
SPEAKER_01: And then we have planning.
13:23
SPEAKER_01: So planning is where we help translate that motivation into an achievable, personally meaningful action plan when the individual is ready.
13:36
SPEAKER_01: And then another important component of motivational interviewing is ORS.
13:41
SPEAKER_01: So ORS O A R S stands for open-ended questions, affirmations, reflective listening, and summaries.
13:52
SPEAKER_01: So these are really the core communication skills that support the whole MI process.
13:59
SPEAKER_01: So for example, if you have someone that says, Hey, I haven't been doing my exercises because I'm exhausted when I get home.
14:14
SPEAKER_01: And that's not necessarily a bad recommendation.
14:17
SPEAKER_01: But with MI, we might first respond by saying something along the lines of, well, it sounds like by the time you get home, you feel completely depleted.
14:26
SPEAKER_01: And trying to fit one more thing into your routine feels overwhelming.
14:31
SPEAKER_01: So that would be an example of that reflective listening.
14:35
SPEAKER_01: And then notice that that changes the interaction.
14:39
SPEAKER_01: So instead of immediately trying to solve the problem, we're acknowledging that individual's experience.
14:47
SPEAKER_01: And then we might go on to ask, well, given everything you're managing, where do you see room for your recovery goals and your daily routine?
14:54
SPEAKER_01: So that person has an opportunity to begin generating their own ideas.
15:00
SPEAKER_01: And then I would say another important distinction is change talk versus sustained talk.
15:07
SPEAKER_01: So change talk is a language that favors movement toward change.
15:13
SPEAKER_01: So for example, I really want to be able to cook dinner for my family again.
15:17
SPEAKER_01: Sustained talk is language that supports maintaining the current behavior.
15:22
SPEAKER_01: So for example, but I'm worried that using my arm more will make the pain worse.
15:29
SPEAKER_01: So both of those are important, both of those are meaningful.
15:33
SPEAKER_01: Our job is not to argue against that sustained talk, it's to understand it while strategically eliciting and strengthening the individual's own change talk.
15:46
SPEAKER_01: And then I'd say the last thing I want to mention is this concept of the writing reflex, which I think is extremely relevant to rehab.
15:53
SPEAKER_01: So as clinicians, we have this natural tendency to identify problems and immediately try to fix them.
16:02
SPEAKER_01: But when we become overly directive, we can inadvertently create this discord in the therapeutic relationship.
16:11
SPEAKER_01: So that person that we're working with starts defending why they can't or don't want to change.
16:18
SPEAKER_01: And then the clinician ends up making all the arguments for change.
16:23
SPEAKER_01: So MI encourages us to recognize that dynamic and instead support the person's autonomy.
16:29
SPEAKER_01: And I think that's one of its most powerful features.
16:33
SPEAKER_01: We are not abandoning our own clinical expertise.
16:37
SPEAKER_01: We're using our expertise in a way that creates space for that patient's own motivations, their values, and their decision making.
16:48
SPEAKER_01: So it's not about, in the end of the day, making someone agree with us, it's about helping them move toward change for reasons that are important and valuable to them.
16:59
SPEAKER_00: That was very helpful.
17:01
SPEAKER_00: I was writing all this stuff down.
17:03
SPEAKER_00: I'm already like, okay, I need to put this into a blog post just so I can see it and look at it over and over.
17:08
SPEAKER_00: So uh for people listening, uh, hopefully I'll have a blog post for us with these key elements.
17:15
SPEAKER_00: Two things came to my mind that I want to ask you about, and then I want to ask you just what has surprised you about as you've uh dove into the research about this.
17:27
SPEAKER_00: My two questions are I think a lot about client-generated goals.
17:33
SPEAKER_00: Like my understanding in goal setting is that you're more likely to achieve a goal that you set versus a goal that was given to you.
17:44
SPEAKER_00: Is that one of the, is that what I'm hearing is kind of one of the cores, is like helping the client generate their ideas for how to move forward.
17:55
SPEAKER_00: Is that right or not quite right in motivational interviewing?
17:59
SPEAKER_01: So the goal setting process is meant to be collaborative.
18:03
SPEAKER_01: So it is meant to be this joint collaborative process between, and I say patient and client interchangeably.
18:10
SPEAKER_01: So excuse me if I use one more than the other.
18:12
SPEAKER_01: But if you are working with a client specifically, yes, you want that goal to be something relevant and meaningful to that client.
18:21
SPEAKER_01: They're more likely to work towards a goal that's important and meaningful to them.
18:26
SPEAKER_01: Just like we've learned, that's really the heart of what we do in OT, identifying what is meaningful to that person.
18:32
SPEAKER_01: So motivational interviewing really does align very beautifully with our natural way of practice in the sense that, yes, it is a collaborative process between the therapist and the client, but the it's really tied to the client's values.
18:46
SPEAKER_01: So what is meaningful to them, what is important to them.
18:48
SPEAKER_01: And a and a big part of that is that self-reflection piece.
18:52
SPEAKER_01: So self-reflecting on not just what needs to change and why it needs to change, but you know, how?
18:59
SPEAKER_01: How can we make this change?
19:01
SPEAKER_01: What is going to be realistic?
19:02
SPEAKER_01: What is going to be sustainable?
19:04
SPEAKER_01: And most importantly, ensuring that it does align with their values.
19:09
SPEAKER_00: I've also been thinking a lot about like peer-to-peer support versus expert-to-patient support.
19:18
SPEAKER_00: And almost like picturing myself showing up differently in a session, like when I come in as an expert, or when I'm coming in more as a peer.
19:26
SPEAKER_00: Not that I'm abandoning my expertise as a therapist, but I think you just position yourself differently when you're thinking of peer-to-peer.
19:36
SPEAKER_00: Is that a helpful framework to overlay onto motivational interviewing?
19:41
SPEAKER_00: It feels like when you go in, you're like, oh, I want to act more like a I don't want to totally give up my expertise, but I want to show up as more of a peer where I'm listening more and engaging from like that equal, like equal standing with the patient.
19:58
SPEAKER_00: Absolutely.
20:00
SPEAKER_01: Of course, I think, I think both paths are useful.
20:04
SPEAKER_01: And it really depends on the moment and what the moment calls for and what that client needs.
20:10
SPEAKER_01: So I think naturally when we talk about that peer-to-peer lens, of course, everyone likes something that is relatable, relevant, someone who's been through the experience before.
20:21
SPEAKER_01: These are all things that can really speak to an individual and help drive that motivation as well when they know that, okay, you're not outside of this box, you've been in their shoes, or you are someone who is trying to see eye to eye with them.
20:35
SPEAKER_01: So I definitely think a part of this best practice and utilizing this technique is understanding what's what the situation calls for and when that client needs more of that expert in the room and is looking for that advice.
20:49
SPEAKER_01: Whereas where they just need that support from more of that peer perspective as well.
20:56
SPEAKER_00: That helped me a lot understand the basics.
21:01
SPEAKER_00: I'm curious to hear from you.
21:03
SPEAKER_00: I imagine as you were writing the book, you just read so much about this topic.
21:08
SPEAKER_00: And as you went deeper, what surprised you about what you found or felt like little nuggets that would be helpful for therapists?
21:17
SPEAKER_01: Oh, that's a really good question.
21:19
SPEAKER_01: I I think one of the most surprising realizations was just how deeply ingrained the writing reflex is in the rehab process and in rehab practice in general.
21:33
SPEAKER_01: I don't necessarily think that it's a criticism of therapists.
21:39
SPEAKER_01: I think it's a reflection more so of how we're trained.
21:42
SPEAKER_01: So, as you mentioned earlier, we're trained to be clinical problem solvers.
21:46
SPEAKER_01: We're trained to recognize impairments and then identify barriers and then to intervene.
21:53
SPEAKER_01: And that is an essential part of what we do.
21:57
SPEAKER_01: But sometimes our clinical expertise.
22:00
SPEAKER_01: Expertise can unintentionally overshadow the client's own expertise in their lived experience.
22:08
SPEAKER_01: So I can give you an example of that.
22:11
SPEAKER_01: Let's say if you do have a client that says, you know, I'm not doing my home exercise program because I just don't have the time.
22:19
SPEAKER_01: And immediately our brains start generating those solutions, right?
22:23
SPEAKER_01: So we start thinking about, okay, well, let's look at the time of day.
22:26
SPEAKER_01: Maybe we can pinpoint a time of day that would work for this person.
22:30
SPEAKER_01: Or could we break the program maybe into these shorter sessions?
22:34
SPEAKER_01: Maybe we can help utilize some apps to set reminders on their phone.
22:40
SPEAKER_01: And these are all reasonable suggestions.
22:44
SPEAKER_01: But what if that real barrier isn't time itself?
22:48
SPEAKER_01: What if they're discouraged because they don't think the exercises are going to help them?
22:52
SPEAKER_01: What if they're afraid of pain?
22:55
SPEAKER_01: What if the exercises just feel completely disconnected from what they actually want to achieve?
23:02
SPEAKER_01: In that moment, we may be trying to solve a logistical problem when that underlying barrier is actually psychological or motivational.
23:14
SPEAKER_01: And I think that's where motivational interviewing really changes our clinical reasoning.
23:21
SPEAKER_01: So it encourages us to distinguish between a knowledge deficit, a skill deficit, and an environmental barrier, and also genuine ambivalence about behavior change because those require very different interventions.
23:42
SPEAKER_01: I'd say the other thing that really stood out to me was how seamlessly motivational interviewing can be incorporated into existing rehab practice.
23:52
SPEAKER_01: So I think sometimes people hear MI and envision this lengthy counseling session, but motivational interviewing doesn't have to be this added 30-minute intervention to our schedule.
24:07
SPEAKER_01: It can be integrated into an evaluation, into a treatment session or discharge planning.
24:14
SPEAKER_01: It could be one reflective statement that we end up using.
24:17
SPEAKER_01: It might be one carefully chosen, open-ended question.
24:22
SPEAKER_01: It might be taking a moment to explore the client's confidence before developing a home program.
24:29
SPEAKER_01: And I think that's very important because we're practicing in healthcare environments where time, productivity, and efficiency are real considerations.
24:40
SPEAKER_01: And we don't want this to be another burden to clinicians.
24:44
SPEAKER_01: So it's really to make the conversations that we're already having more therapeutically intentional.
24:51
SPEAKER_01: And I think the biggest takeaway for me was realizing that communication isn't merely something that accompanies intervention.
25:00
SPEAKER_01: It can be an active therapeutic ingredient in the rehab process itself.
25:06
SPEAKER_01: So the words that we choose, the way we respond to hesitation, and the degree to which we support autonomy can shape the therapeutic interaction.
25:19
SPEAKER_01: And I think that's something worth paying much more attention to.
25:24
SPEAKER_00: Yeah, now I'm looking back and being like, oh, I had a false understanding of motivational interviewing because uh my own story was, or I was like, oh, I didn't learn it, so I'm not doing it.
25:38
SPEAKER_00: When in reality, as I hear the ingredients, I'm like, oh, but I was still using ingredients strategically sometimes.
25:44
SPEAKER_00: Like we've all asked an open-ended question, but motivational interviewing sounds like this um framework we could step into more fully and draw more time from.
25:54
SPEAKER_00: But yeah, that just integrates so seamlessly into what we're already doing.
26:00
SPEAKER_00: Now that we've learned the basics of it and heard some more nuggets about it, I would love to take five minutes and just try it on air, just roleplay and do it if you're up for that.
26:15
SPEAKER_00: Yeah, absolutely.
26:16
SPEAKER_00: Let's do it.
26:17
SPEAKER_00: I'm also going to ask about who's a good fit, but I'm going to come back to that afterwards.
26:21
SPEAKER_00: I have some questions in the comment about that.
26:23
SPEAKER_00: So we'll get to that after we role play.
26:27
SPEAKER_00: So here's a situation I'm in, which I would have thought wasn't a fit for motivational interviewing because I'm in a therapy session or situation where I'm highly motivated.
26:41
SPEAKER_00: Like I had a vision change after my pregnancy.
26:45
SPEAKER_00: This was 10 years ago, and something just fundamentally changed.
26:49
SPEAKER_00: I couldn't get anyone to like believe that my vision changed.
26:53
SPEAKER_00: And I had to fight, fight, fight to finally, it took like two years to get to the right doctor.
26:59
SPEAKER_00: And I got this uh diagnosis at the time, but she didn't give me anything to do.
27:05
SPEAKER_00: Like I just got a diagnosis.
27:07
SPEAKER_00: And then fast forward to about a year ago, an OT opened a vision therapy practice in my town.
27:15
SPEAKER_00: And I was like, oh, I know I would be a good fit.
27:17
SPEAKER_00: I got myself back to a neuroophthalmologist.
27:19
SPEAKER_00: I paid a ton of money.
27:20
SPEAKER_00: I finally got into her.
27:22
SPEAKER_00: I'm like, I've been waiting a decade to see a vision therapist uh because I can't drive on the interstate.
27:29
SPEAKER_00: Like when things move too fast, I just feel like I'm going to pass out.
27:34
SPEAKER_00: It's really impeded my driving.
27:36
SPEAKER_00: So I'm super, I was so motivated and I want to support her because she's an OT.
27:43
SPEAKER_00: During the session, we do all these specialized exercises.
27:47
SPEAKER_00: They're really hard.
27:49
SPEAKER_00: I feel like I'm good at that part.
27:51
SPEAKER_00: But then throughout the week, I'm supposed to do these exercises.
27:56
SPEAKER_00: And I'm also, I'm just someone who I have to take visual breaks.
28:01
SPEAKER_00: Like if I don't, I feel sick.
28:03
SPEAKER_00: But Sabina, I do not do my exercises and I do not take breaks.
28:08
SPEAKER_00: Like I am so motivated to change this.
28:11
SPEAKER_00: I'm doing all these hard things, but I'm not doing the easy things in my day.
28:17
SPEAKER_00: And I've been going for like three months, and I keep trying to like do these tricks for myself to do them, and I can't get myself to do them.
28:26
SPEAKER_00: What is wrong with me?
28:29
SPEAKER_01: It sounds like you're managing a lot during the day as well.
28:34
SPEAKER_01: And it sounds like on one hand, you're very motivated to get your vision where it needs to be, but on the other hand, you're struggling.
28:43
SPEAKER_01: Um, do you see that the struggle is coming more so from lack of time, or where exactly do you find it to be the hardest for you when it comes to carrying out those exercises during the day?
28:58
SPEAKER_00: I've like set the timers for myself.
29:02
SPEAKER_00: I have visual cues, but I just I don't like to come away from my work.
29:10
SPEAKER_00: Like if I'm in it, I don't want to step away and the timer never goes off when there's a natural pause.
29:16
SPEAKER_00: I know about myself that I do like piddle, I definitely piddle time.
29:23
SPEAKER_00: Like I know there's time.
29:24
SPEAKER_00: I could not like check the news or like I could not do the piddling activities.
29:31
SPEAKER_00: Like I know that I could take those out and do exercises instead, but I like can't match up the timing.
29:38
SPEAKER_00: Like the timer doesn't go off when I'm like piddling around.
29:41
SPEAKER_00: It always goes off when I'm like actually trying to do something.
29:46
SPEAKER_00: And I just can't, I can't figure out how to align like the rest when I'm like naturally resting in my workday.
29:54
SPEAKER_01: Does that make sense?
29:56
SPEAKER_01: I see what you're saying.
29:57
SPEAKER_01: So part of you recognizes that the exercises might help, but another part of you is really struggling with the time that you have in trying to manage those exercises and finding that right time to do that.
30:15
SPEAKER_00: I just can't do it.
30:17
SPEAKER_00: Like I know I can only focus for like 30, 40 minutes, and then I kind of drift, but it's not, it's not on.
30:27
SPEAKER_00: I don't know.
30:28
SPEAKER_00: For some reason, I can't switch over to fully resting.
30:31
SPEAKER_00: Like I just end up staring at my screen anyway.
30:34
SPEAKER_01: Yeah, you've been putting effort into your recovery, and I can tell independence is really important to you.
30:42
SPEAKER_01: What would being more, what would being more independent and in you doing those exercises allow you to do that you are having difficulty with right now?
30:55
SPEAKER_01: So if you were to find the time to do those exercises right now, what would allow you to do that might be difficult right now?
31:03
SPEAKER_00: I know it would help.
31:05
SPEAKER_00: I can tell on days when my eyes are feeling better and I know that I'm better at driving when I'm in that, when I'm in that state.
31:14
SPEAKER_00: I also I hate when I'm like, don't look away from my screen during the day and I feel sick going when I go home.
31:21
SPEAKER_00: Like I when I get go home, I want to be really engaged with my boys.
31:26
SPEAKER_01: I want to do some kind of oh, go ahead.
31:29
SPEAKER_01: Yeah, saying so.
31:30
SPEAKER_01: You're recognizing that doing those exercises could help you return to something important to you and meaningful to you, like driving, for instance.
31:41
SPEAKER_01: And given everything else that you're managing, where you're trying to find the right time for those exercises, what do you think might be a realistic first step?
31:52
SPEAKER_00: I was just thinking, this just like came to me as I'm talking.
31:57
SPEAKER_00: I have like a blocker on my screen for like social media and news stuff.
32:02
SPEAKER_00: And I know you can customize what the saying is that pops up on your screen when you hit that wall.
32:10
SPEAKER_00: And I wonder if I could customize it to say, go rest your eyes.
32:16
SPEAKER_00: Like usually I'm going to like the news or social media when I'm naturally ready for a break.
32:22
SPEAKER_00: And once I do that, could I see a message on my screen that's like, go rest your eyes instead of looking at the news?
32:31
SPEAKER_00: I think I could do that.
32:32
SPEAKER_00: So then I'm getting the message when I'm ready to rest.
32:36
SPEAKER_01: Yeah.
32:36
SPEAKER_01: So using the blocker that you're mentioning might be more manageable.
32:41
SPEAKER_01: What makes you think using that could work?
32:46
SPEAKER_00: I think pairing it with when I'm not my brain's like ready for a rest.
32:53
SPEAKER_00: Cause I think I go there when I'm like, okay, I'm I can't do any more intensive work.
32:58
SPEAKER_00: I need something mindless.
33:01
SPEAKER_00: So I think it hits at the right time.
33:03
SPEAKER_00: And I'm always like, the screen like always startles me when it comes up.
33:07
SPEAKER_00: Like it just grabs my attention.
33:09
SPEAKER_00: And I think, especially if I customize the message that it said, I think it would really grab my attention.
33:16
SPEAKER_01: Yeah, yeah, that makes sense.
33:18
SPEAKER_01: What do you think would be a reasonable amount of time to start with if you were to set that blocker?
33:26
SPEAKER_01: Like what would be doable for you right now?
33:29
SPEAKER_00: Yeah, three to five minutes.
33:31
SPEAKER_01: Okay, yeah, three to five minutes on a scale from zero to 10.
33:36
SPEAKER_01: How confident are you that you think you would be able to follow through with that for three to five minutes?
33:42
SPEAKER_00: Seven?
33:43
SPEAKER_00: I think if I stepped away from my computer, if I physically get away from my computer, then I can definitely stay away for three to five minutes.
33:51
SPEAKER_00: It's if I get up and move.
33:54
SPEAKER_01: Okay, yeah.
33:55
SPEAKER_01: And seven is a great starting point.
33:58
SPEAKER_01: And why a seven instead of let's say a four or five?
34:02
SPEAKER_01: What makes you say seven specifically?
34:04
SPEAKER_00: Well, I'm not giving myself a 10 because I know I failed at things in the past.
34:10
SPEAKER_00: I'm not giving myself a lower number because it seems like such a good fit in my workday.
34:18
SPEAKER_00: Like I can just already see it, I can visualize it working.
34:23
SPEAKER_01: Perfect.
34:23
SPEAKER_01: You're already identifying reasons that this feels achievable.
34:29
SPEAKER_01: Would it be helpful if we reviewed which specific exercises you'd want to prioritize during that block time?
34:37
SPEAKER_00: Yes.
34:39
SPEAKER_00: I know I want to go outside and let my eyes diverge, but also team work together.
34:49
SPEAKER_00: And I can totally visualize myself doing that.
34:52
SPEAKER_00: This was really helpful.
34:53
SPEAKER_00: Sabina, you're good at this.
34:56
SPEAKER_00: Oh, thank you.
34:56
SPEAKER_01: Yeah.
34:57
SPEAKER_00: So I solved my problem.
34:59
SPEAKER_01: I didn't immediately try to, you know, really make any corrections or recommendations.
35:05
SPEAKER_01: So I think the key is really just to ask more of those questions and help the person self-reflect on what it would mean for them if they made those changes.
35:15
SPEAKER_00: Wow.
35:16
SPEAKER_00: And that was an interesting experience for me because I've actually like thought about this problem for months and I haven't hadn't really had ideas of what to do.
35:26
SPEAKER_00: But as I was saying it out loud to you, I had like ideas pop to my mind.
35:31
SPEAKER_00: I wonder if it was just saying it aloud.
35:33
SPEAKER_00: Whereas before I was just like thinking of it and being like, what's wrong with me?
35:38
SPEAKER_00: Yeah, something powerful happens there.
35:42
SPEAKER_00: Okay, this is awesome.
35:43
SPEAKER_00: I can't wait to reflect on this and change my life uh and take visual breaks.
35:50
SPEAKER_00: Now that we've role-played, I want to ask who's a good fit for this kind of interviewing?
35:56
SPEAKER_00: Before I would have said, not me, because I'm really motivated.
35:59
SPEAKER_00: So it's not just about motivation.
36:02
SPEAKER_00: I'm going to, I want to also tack on a hard question to that.
36:06
SPEAKER_00: In the comments, someone also asked about nonverbal patients.
36:11
SPEAKER_00: So if you could answer the question overall, and then let's spend a little bit of time just talking about nonverbal, what parts could be used with a nonverbal patient?
36:19
SPEAKER_01: Yeah, so I'd say I think the clients who stand to benefit the most are those who are experiencing some degree of ambivalence about behavior change.
36:31
SPEAKER_01: And honestly, Sarah, we encounter that in almost every rehab setting.
36:37
SPEAKER_01: So if you take someone who is managing chronic pain, they want to become more active, but they're apprehensive because they don't want their symptoms to get worse.
36:47
SPEAKER_01: Or if you take someone who just was satisfied some neurological condition, they want to regain independence, but maybe they've experienced repeated setbacks and now they're beginning to doubt their ability to improve.
37:02
SPEAKER_01: Someone might understand the importance of managing their symptoms, but then they struggle to maintain consistent routines.
37:10
SPEAKER_01: So in all of these situations, the individual might genuinely actually want to change, but there are competing motivations or barriers that are influencing their behavior.
37:24
SPEAKER_01: So that's really where motivational interviewing becomes more valuable.
37:29
SPEAKER_01: And then also being able to distinguish between a clinician's priority and that patient's priority as well.
37:37
SPEAKER_01: So we might be focused on improving, for example, upper extremity strength because we know it's important for functional recovery.
37:45
SPEAKER_01: But maybe that individual might be thinking, hey, I just, you know, want to be able to hold my grandchild again.
37:53
SPEAKER_01: So both goals might be relevant, but they operate at different levels of personal meaning.
37:58
SPEAKER_01: So it's really about connecting those clinical objectives to something that actually resonates with that person.
38:05
SPEAKER_01: So when it comes to who it's appropriate for versus not appropriate for, if someone is experiencing, let's say, a medical emergency, there's any type of acute safety crisis, we need to intervene appropriately.
38:18
SPEAKER_01: So that obviously would not be a moment for an extended exploration of ambivalence with significant cognitive impairments.
38:28
SPEAKER_01: We may need to adapt our communication strategies depending on that person's cognitive and in the situation you just brought up, their communication abilities.
38:40
SPEAKER_01: So we can still preserve elements of autonomy support, but a formal motivational interview and conversation may not always be feasible the traditional way.
38:52
SPEAKER_01: The other thing that is important is that not every participation barrier is motivational in nature.
39:00
SPEAKER_01: So sometimes someone might want to change, but they don't have the resources.
39:06
SPEAKER_01: They don't have the environmental support, they don't have the physical capacity or knowledge necessary to follow through.
39:13
SPEAKER_01: So I think we need to be also careful not to over-psychologize really what might actually be more of a structural or functional barrier.
39:25
SPEAKER_01: So, for example, if someone can't afford transportation in therapy, motivational interviewing is not going to solve that transportation problem, right?
39:32
SPEAKER_01: And so we're not going to go into this into that conversation necessarily if that's what that barrier is, because that requires a different intervention.
39:42
SPEAKER_01: So MI, it is a valuable component in our clinical toolkit.
39:47
SPEAKER_01: It's not going to be that universal solution.
39:50
SPEAKER_01: So it is going to be more most appropriate when there is that valuable or meaningful behavior change target and an opportunity to explore the person's readiness and their motivation and ambivalence as well.
40:06
SPEAKER_00: And I would have thought it's so interesting for myself to be like, I don't feel ambivalence, but my like actions were that of ambivalence in this therapy situation.
40:19
SPEAKER_00: Like, um, I just think it gets so complex.
40:24
SPEAKER_00: I mean, behavior change is just so complex.
40:27
SPEAKER_00: Like, there's all kinds of ways that that can show up.
40:30
SPEAKER_00: But it sounds like it's a good fit if you have a goal that you're just kind of getting on, that this is a process that you can go through.
40:40
SPEAKER_00: Thinking of um pediatric client, there's both pediatric clients.
40:46
SPEAKER_00: Like, I could actually I could see my kids loving motivational interviewing.
40:50
SPEAKER_00: Like I could see it being a good fit for kids.
40:53
SPEAKER_00: Someone also asked about pediatric patients that are nonverbal.
40:58
SPEAKER_00: As you were writing the book, uh, did you read anything about the pediatric experience or using MI with patients that were nonverbal?
41:08
SPEAKER_01: I would say it you can definitely modify how you carry out motivational interviewing for someone who is nonverbal.
41:16
SPEAKER_01: For example, the same way you would try to encourage communication with someone who's nonverbal using any other type of tool.
41:24
SPEAKER_01: So, like communication boards, for instance, to try to elicit their responses, for instance, could be helpful in that conversation piece.
41:32
SPEAKER_01: I think the principles behind motivational interviewing can still be utilized.
41:37
SPEAKER_01: You can still have those open-ended questions and still utilize the affirmations and still elicit that self-reflection piece and summarize back to them, but um it just goes back to your toolbox, right?
41:50
SPEAKER_01: And then the type of tools that you have to help facilitate that conversation with when you do have a nonverbal client.
41:58
SPEAKER_01: I had some great co-authors, and I had um two who did co-author a particular chapter in this book that touched upon adolescence.
42:10
SPEAKER_01: But yes, there is research on the efficacy of motivational interviewing for pediatrics as well as for adults.
42:17
SPEAKER_01: So I definitely am an advocate for you utilizing it as well when you're trying to strive behavior change at home, as you mentioned with your children.
42:27
SPEAKER_01: But yeah, so so it can be used both for PEDs, um, the pediatric population as well as the adult population.
42:34
SPEAKER_00: And as we said, towards the top, like there's like the basic components are just so helpful.
42:42
SPEAKER_00: And you could pull out any of those.
42:44
SPEAKER_00: Like we can always reflective listen or ask an open-ended question.
42:48
SPEAKER_00: Like you may not do the full structure, but it feels like components would be helpful with basically any client that we have.
42:58
SPEAKER_00: You mentioned how this gets can get interwoven into what we're already doing.
43:03
SPEAKER_00: And I just want to ask a little bit more about the logistics of that, kind of go through the treatment process.
43:09
SPEAKER_00: And I want to ask about goal setting specifically.
43:14
SPEAKER_00: Um, in our supporting research, there's this really great article called Motivational Interviewing to Facilitate Goal Setting in Rehabilitation.
43:22
SPEAKER_00: This just came out this year.
43:24
SPEAKER_00: I really loved this article.
43:25
SPEAKER_00: I actually recommend people read it.
43:27
SPEAKER_00: The intro actually really validates what I said at the beginning: like, behavior, the communication to collaboratively set goals is very difficult.
43:37
SPEAKER_00: Like it just is.
43:39
SPEAKER_00: And this article says that as PTs and OTs, we probably just didn't get sufficient training in this goal setting process.
43:49
SPEAKER_00: And motivational interviewing is a tool that we could use to help with that.
43:54
SPEAKER_00: How does motivational interviewing help us set goals?
43:58
SPEAKER_00: Like, what does that look like?
44:00
SPEAKER_00: Look like.
44:00
SPEAKER_00: Help me wrap my mind around using it in that part of the process.
44:04
SPEAKER_01: Yeah, absolutely.
44:05
SPEAKER_01: We're constantly developing short-term goals, long-term goals, SMART goals, functional outcomes.
44:14
SPEAKER_01: We're very good at making those goals measurable.
44:18
SPEAKER_01: MI challenges us to ask a deeper question.
44:23
SPEAKER_01: Are we measuring what matters clinically, or are we measuring what matters to that person?
44:30
SPEAKER_01: And ideally, how do we bring those two things together?
44:34
SPEAKER_01: Because a goal can be perfectly structured from a documentation standpoint and then still lack personal relevance.
44:44
SPEAKER_01: So if we were working with someone, let's say after an injury, we might write a goal focused on improving upper extremity function to complete dressing tasks with a certain assist level.
44:56
SPEAKER_01: And that's completely appropriate for a rehab goal.
44:59
SPEAKER_01: But let's say that person is more concerned with being able to get dressed so that they can attend a particular social function.
45:07
SPEAKER_01: That personal context is going to change the meaning of the goal.
45:12
SPEAKER_01: It might also change how we prioritize and structure the intervention, especially if that particular social function is coming up rather quickly.
45:21
SPEAKER_01: Motivational interviewing helps us to explore those underlying values before we move into the mechanics of the goal development.
45:31
SPEAKER_01: So I think that is critical because a goal's clinical relevance and its motivational salience are not necessarily the same thing.
45:42
SPEAKER_01: So something can be clinically important without being particularly compelling to that individual.
45:51
SPEAKER_01: MI helps to bridge that gap.
45:53
SPEAKER_01: So it also encourages us to explore readiness and self-efficacy.
45:59
SPEAKER_01: So you might have someone who can identify a meaningful goal, but feel completely incapable of achieving it.
46:07
SPEAKER_01: So before we establish an ambitious rehab plan, we might want to ask, well, how confident do you feel about taking this first step toward that goal?
46:17
SPEAKER_01: For example.
46:17
SPEAKER_01: So if their confidence is very low, that's going to tell us something important.
46:22
SPEAKER_01: Perhaps we need to grade that activity.
46:25
SPEAKER_01: Maybe we need to identify smaller achievable steps or address a specific concern.
46:32
SPEAKER_01: So that's where I think MI works very well alongside structured goal setting.
46:38
SPEAKER_01: Smart goals provide specificity and measurability.
46:43
SPEAKER_01: Motivational interviewing helps to establish that personal meaning, readiness, and commitment.
46:50
SPEAKER_01: And I don't see that any of those as competing models.
46:55
SPEAKER_01: I really see them as complementary.
46:57
SPEAKER_01: There's also emerging research that looks at the feasibility of integrating MI into rehab goal setting that's encouraging.
47:06
SPEAKER_01: But I would distinguish feasibility from effectiveness.
47:10
SPEAKER_01: So we still need more research to really determine whether MI-informed goal setting really leads to measurable improvements in occupational performance as well as in adherence and long-term participation.
47:23
SPEAKER_00: So I practiced in rural Nebraska where I live now.
47:27
SPEAKER_00: And a very common goal that people had related to their ADLs was I would be working with an older gentleman and he would want to get back to having coffee at McDonald's with his friends.
47:41
SPEAKER_00: I think what I'm hearing is like my clinical goal would be like an upper extremity dressing goal.
47:49
SPEAKER_00: But if I tease out this part of like, oh, he's doing that because he wants to go to coffee at McDonald's.
47:55
SPEAKER_00: Am I writing that?
47:56
SPEAKER_00: I'm just trying to like picture what my paper looks like with the goal on it.
48:00
SPEAKER_01: Absolutely.
48:00
SPEAKER_01: Really understanding the motivation behind that goal, right?
48:04
SPEAKER_01: So why are they striving to engage in that goal?
48:08
SPEAKER_01: Is this just something they want to do or is there a specific uh reason behind it?
48:13
SPEAKER_01: Is there something immediate coming up that they want to attend, right?
48:16
SPEAKER_01: And that can help us gauge their motivation, how willing they are maybe to engage in a particular activity or exercise?
48:24
SPEAKER_01: Like if that's something they're motivated to attend three days from now, then maybe that's something we want to prioritize over a different area that we were perhaps considering.
48:34
SPEAKER_01: Um, so really understanding what is important to them, what is valuable to them, what is meaningful to them.
48:39
SPEAKER_01: And yeah, and those examples also understanding the timeliness of it as well.
48:44
SPEAKER_00: Yeah, it gives you a timeliness and it gives a patient a marker when the goal's been achieved.
48:49
SPEAKER_00: Like I think lots of times our clinical goals don't have the satisfaction of like a celebration moment, but putting that meaning or putting it on a separate event gives it that.
49:02
SPEAKER_00: I want to ask too about okay, so I can totally see it being interwoven into goals.
49:08
SPEAKER_00: Interwoven into treatment, what does that look like?
49:12
SPEAKER_00: In this paper uh that I read on goal setting, the motivational interviewing component usually happened in the second session, uh, which I was like, oh, I can totally picture that.
49:23
SPEAKER_00: But by that point here in the US, we're already into treatment.
49:27
SPEAKER_00: Like, what does MI look like when you're in the treatment phase?
49:31
SPEAKER_01: Yeah.
49:32
SPEAKER_01: So I don't think motivational interviewing has to necessarily be the separate intervention, as we said.
49:38
SPEAKER_01: So it can be embedded into the therapeutic encounters that we're already having.
49:43
SPEAKER_01: So whether that is during the evaluation, whether that is during the intervention piece.
49:48
SPEAKER_01: And I think that's really particularly important in rehab settings, specifically where clinicians are managing productivity requirements.
49:56
SPEAKER_01: Because let's be realistic, we have productivity requirements, and that is sometimes a barrier to the types of interventions that we can actually employ in sessions.
50:04
SPEAKER_01: Also, complex caseloads, limited treatment time, right?
50:08
SPEAKER_01: So if we're talking about in an initial evaluation, we can use MI consistent questions to explore what matters most to the person.
50:18
SPEAKER_01: So instead of just asking them, like, what are your goals for therapy or what are your goals?
50:22
SPEAKER_01: We might uh word it, if therapy were really successful for you, what would be different in your everyday life?
50:29
SPEAKER_01: And then that question would reveal so much.
50:33
SPEAKER_01: During treatment, you can still use, as you've mentioned and highlighted, reflective listening when you have a client who expresses hesitation or frustration.
50:43
SPEAKER_01: If you're working with that individual who we mentioned earlier, for example, who has chronic pain, and they say, Hey, I know I need to be more active, but I'm afraid that if I move too much, my pain is gonna get worse.
50:57
SPEAKER_01: Our immediate instinct might be to provide education about pain neuroscience or graded activity or the importance of movement.
51:06
SPEAKER_01: And that education may absolutely be indicated, but rather than immediately moving into the educational component, we could first acknowledge your ambivalence and say part of you wants to become more active, but you're worried about exacerbating your symptoms.
51:22
SPEAKER_01: That's a simple reflection, but it demonstrates that we are listening to both sides of that person's experience.
51:32
SPEAKER_01: And then we can go on to ask, well, what activities are you most hoping to get back to?
51:36
SPEAKER_01: So we're linking that conversation to occupational participation.
51:41
SPEAKER_01: Another strategy is sometimes called the illicit provide illicit.
51:46
SPEAKER_01: So this is helpful when we need to share clinical information.
51:48
SPEAKER_01: So we begin by eliciting what the person already knows.
51:52
SPEAKER_01: So, what have you heard about how gradually increasing activity can influence chronic pain?
51:58
SPEAKER_01: Then we ask permission to provide information.
52:00
SPEAKER_01: Would it be okay if I shared a little bit about what we know from rehab research?
52:05
SPEAKER_01: After offering that information, we elicit their response.
52:08
SPEAKER_01: What do you make of that?
52:09
SPEAKER_01: How do you think that might apply to your situation?
52:11
SPEAKER_01: So that structure would respect their autonomy while still allowing us to fulfill our responsibilities as clinicians.
52:19
SPEAKER_00: That's so helpful.
52:20
SPEAKER_00: Why have I never heard that before?
52:22
SPEAKER_00: I'm going to use that all the time.
52:23
SPEAKER_00: Okay, that's all very helpful.
52:26
SPEAKER_00: I had a great anecdote in the comments, too, about um someone who had a patient who was showed up to therapy just like very angry each time.
52:36
SPEAKER_00: And she was able to like dig into what was driving that.
52:41
SPEAKER_00: And it was about his sadness and not being able to do the things that they used to do.
52:45
SPEAKER_00: Like, uh, that's another, I can just see how helpful motivational interviewing would be in a use case like that when there's just something that you can't quite figure out what's going on.
52:58
SPEAKER_00: We're getting close to the end of the time, but I really want to ask you about how technology interfaces into this.
53:04
SPEAKER_00: Like, I can just see like a technology platform taking the fundamentals of it and trying to like create a program that uses motivational interviewing.
53:16
SPEAKER_00: I can also just see it being done virtually.
53:19
SPEAKER_00: Like, where do you see technology intersecting here in ways that are helpful or not helpful?
53:26
SPEAKER_01: Oh, that's a really good question.
53:29
SPEAKER_01: What I would say is we would want to distinguish between several things here.
53:33
SPEAKER_01: So we have technology assisted MI, there's clinician-delivered MI through a virtual platform, which I think you described, and then there's fully automated or AI-delivered MI.
53:46
SPEAKER_01: And so each of those represents very different levels of technological involvement.
53:51
SPEAKER_01: So when we look at virtual MI, where there's a trained clinician delivering MI through telehealth, I think there's clear potential advantages.
54:00
SPEAKER_01: It can expand accessibility for people who face, for example, transportation barriers.
54:05
SPEAKER_01: If someone lives in an underserved community or has difficulty accessing in-person rehab services.
54:12
SPEAKER_01: So I think OT has a particularly interesting perspective here because we are so focused on the person's natural environment.
54:21
SPEAKER_01: But virtual delivery isn't also without limitation.
54:24
SPEAKER_01: So I think it's inherently, when we talk about MI, it's a relational process.
54:29
SPEAKER_01: So we're not just exchanging information here.
54:32
SPEAKER_01: We are attending to the person's emotional responses, their tone, hesitation, their language, subtle interpersonal cues.
54:43
SPEAKER_01: And some of those nuances can be more difficult to interpret through a screen.
54:47
SPEAKER_01: When we uh start talking about AI-delivered MI, I think that conversation becomes much more complex.
54:54
SPEAKER_01: There's a fundamental distinction between simulating empathy or empathic language and then establishing a genuine therapeutic alliance.
55:04
SPEAKER_01: So I think AI may be able to generate reflective statements and ask open-ended questions and identify certain patterns in language, but I don't think that automatically means it's demonstrating the clinical judgment or the relational responsiveness that's associated with high-quality MI.
55:24
SPEAKER_01: But that being said, I do see tremendous potential for AI as an adjunct tool.
55:28
SPEAKER_01: So I think AI could be used to help someone reflect on their goals, maybe between appointments with a clinician, or it can help support that self-monitoring and re-inforce behavior change plans, or maybe help individuals identify particular barriers maybe to participation.
55:46
SPEAKER_01: And then also with clinical um or clinician education, I think there's exciting opportunities there as there as well.
55:56
SPEAKER_00: Part of me is like I don't love the fact that on all episodes I have to now be like, what's technology's role going to be here?
56:08
SPEAKER_00: But that feels like the reality that we live in.
56:11
SPEAKER_00: And what I love about MI is it is so human, so personal.
56:16
SPEAKER_00: Like I've just been reflecting so much on like the pinnacle of therapy is just like looking another person in the eye and supporting them.
56:23
SPEAKER_00: Like that, and this is a framework that really helps us do that, even what we the role-playing we did.
56:31
SPEAKER_00: Like that felt so personal and not something that I could do with a chat.
56:37
SPEAKER_00: Um, so it's really a unique gift that we can offer our patients to give them that space and support them in this way.
56:46
SPEAKER_00: We've talked about so many things today.
56:49
SPEAKER_00: This has been so helpful.
56:52
SPEAKER_00: What are some of the final thoughts that you want to leave us on today, Sabina?
56:58
SPEAKER_01: So I think if there's one thing I'd want anyone to remember, it's that if you have a patient, a client who's not following through with treatment, it's not necessarily someone who doesn't care.
57:11
SPEAKER_01: And I think that distinction is going to be incredibly important as we work with people.
57:17
SPEAKER_01: I think because it's very easy, especially in a busy clinical environment, to interpret inconsistent participation as a lack of motivation.
57:26
SPEAKER_01: And we might think, hey, I've explained the importance of this intervention.
57:30
SPEAKER_01: I've given them the tools and the exercises, I educated them about benefits, why aren't they doing it?
57:36
SPEAKER_01: But understand that behavior change rarely is that straightforward.
57:41
SPEAKER_01: So there may be ambivalence, there may be fear, there may be that diminished self-efficacy, or like we mentioned earlier, competing demands, environmental barriers, or a lack of perceived relevance.
57:53
SPEAKER_01: And so there can be a lot of factors that are in play.
57:57
SPEAKER_01: And I think sometimes one of the most sophisticated clinical talk that we can demonstrate is also knowing when to stop talking and start listening.
58:06
SPEAKER_01: Because I think that's also a huge part of using am I effectively?
58:10
SPEAKER_01: Because before we can really facilitate any valuable, meaningful behavior change, we have to be able to understand what makes that change meaningful to that person.
58:24
SPEAKER_00: Yeah, I think a novice therapist thinks it's their job to give solutions.
58:30
SPEAKER_00: And an expert therapist knows that listening is a lot of the times more powerful.
58:37
SPEAKER_00: And I love that reminder today and this framework for to help us do both listening and open-ended questions and help patients generate their own ideas.
58:49
SPEAKER_00: I think this was so helpful, so practical.
58:52
SPEAKER_00: I can see us using it with so many pay, so many of the patients we see.
58:57
SPEAKER_00: Thank you so much for teaching us today and for all that you shared and all your work on this topic.
59:02
SPEAKER_00: It's just all been so helpful.
59:04
SPEAKER_00: Thank you so much, Sabina, for the time today.
59:07
SPEAKER_01: Thank you so much for having me.
59:08
SPEAKER_01: This was a wonderful conversation.
59:10
SPEAKER_01: I loved it.
59:11
SPEAKER_01: I appreciate it.
59:12
SPEAKER_01: If anyone has any questions about this, you can always feel free to reach out to me.
59:20
SPEAKER_00: Thank you for joining us on the OT Potential podcast.
59:23
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59:33
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59:40
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59:49
SPEAKER_00: Okay, I want to thank you for joining us today, and we'll see you next time.