Using Motivational Interviewing to Promote Patient-Centered Care

In many ways, the field of psychiatry has shifted towards a model of patient-centered care.

On Saturday, April 29th, at the inaugural Psych Congress NP Institute In-Person meeting held in Boston, Saundra Jain, MA, PsyD, LPC, and Andrew Penn, MS, PMHNP, presented their session “Mastering the Art of Deprescribing” before an audience of psychiatric nurse practitioners, advanced practice providers, and other mental health care professionals.

Ahead of their presentation, Psych Congress Network connected with Dr Jain and Penn to discuss some key highlights from their session, including the many uses of motivational interviewing to establish trust and a collaborative relationship with patients.

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Read the Transcript

Andrew Penn, MS, PMHNP: Saundra, one of the things that stood out to me yesterday is that in our conversation about deprescribing is it really reflects how we've changed as a profession towards patient-centered care.

Back in the old days, it was, "Do what you're told, and this is the medication you're going to be taking." If patients said, "Well, I don't want to take that," we dismissed that. And really, I think these active conversations that we're having with patients about what they're taking and for how long really reflected change in the way we think about patient care. What are your thoughts on that?

Saundra Jain, MA, PsyD, LPC: I think you're exactly right, Andrew. We think about in the 1980s and how we interacted with patients and the alcohol use disorders, substance use disorders, it was pretty demeaning.

Penn: My way or the highway.

Dr Jain: Authoritarian. You didn't say this to patients, but in the break room, people would be talking about liars, not reliable historians, not in touch with reality of the degree of impact of their substance issues. Then it began to change where, by listening deeply and really being present with another human being, a clinical psychologist was able to really talk about, they're just honest, interesting, curious people, not unlike you and I.

Penn: That's right.

Dr Jain: Somehow, it's just very freeing to engage with somebody in that kind of conversation, not only for us as providers, but for our clients, our patients.

Penn: That's right.

Dr Jain: Because when we feel like--and I usually ask people this--"Imagine the last time you saw your clinician for any health condition, and they told you what you needed to do." Well, I can tell you, I just, "Not doing it." Right? I might not say that, but I'm thinking it.

Penn: You're stubborn?

Dr Jain: Imagine. No. But there's something about the collaborative conversation, communication, if you will, in motivational interviewing, the acceptance that I'll meet you where you are.

Penn: That's right.

Dr Jain: That we will walk together. There really is this giving a sense of hope that I may not have all the answers.

Penn: That's right. That's right.

Dr Jain: But together we'll do it. And all of a sudden, the resistance and the digging in-

Penn: It drops.

Dr Jain: It just melts away.

Penn: That's right. That's right.

Dr Jain: People become just more willing to talk about their fears, talk about their anxieties.

Penn: That's right.

Dr Jain: How they feel stigmatized.

Penn: That's right.

Dr Jain: Things just change from there. That's why I think motivational interviewing is not just for deprescribing.

Penn: Oh, no, no.

Dr Jain: It's for-

Penn: It's such a useful tool.

Dr Jain: Every conversation we have.

Penn: Absolutely. I always tell my students that, "Your patients are assessing you more than you're actually assessing them. And what they're assessing you for is different than what you're assessing them. They're assessing you to see if you're safe to talk to."

Dr Jain: That's right.

Penn: And if you are somebody who can engage with these conversations, or if you're going to judge them and cast them out of your office. It's so important to broadcast this idea that we are somebody that they can have these challenging conversations with, and that we'll work it out together.

Dr Jain: Love that.

Penn: So we've enjoyed chatting with you today and want to encourage you to take a look at the Psych Congress Network for more resources to help you with your patient care.

Saundra Jain, MA, PsyD, LPC, is an Adjunct Clinical Affiliate, School of Nursing, at The University of Texas at Austin. She is focused on wellness and the impact of positive psychology on client outcomes. In 1992, she launched a private practice of psychotherapy where she currently provides services for a wide range of mental health issues. Dr. Jain is a co-founder of the WILD 5 Wellness Program, which combines five elements of wellness (exercise, mindfulness, sleep, social connectedness, and nutrition) along with positive psychology practices into a prescriptive, simple wellness program. She is co-author of two well-received workbooks written for those interested in improving their mental wellness - KickStart30: A Proven 30-Day Mental Wellness Program and LiveWell90: A Proven 90-Day Mental Wellness Program. Dr. Jain is active in peer-to-peer education especially in the disease states of depression, bipolar disorder, anxiety disorders, and ADHD. Another strong clinical and educational interest involves differential diagnosis of major psychiatric disorders. She serves as a member of the Psych Congress Steering Committee providing direction regarding educational gaps/needs for healthcare practitioners in the world of mental health. Dr. Jain obtained her master's degree from the University of Houston-Clear Lake and a Doctoral degree from Southern California University for Professional Studies; she is a Licensed Professional Counselor. She demonstrated professional versatility by obtaining an MBA from Texas Woman's University. She was selected for a Postgraduate Clinical Fellowship at the University of Texas Medical Branch, Galveston, Texas where she trained in the Division of Child and Adolescent Psychiatry.

Andrew Penn, MS, PMHNP, is a Clinical Professor in the University of California, San Francisco, School of Nursing where his teaching has received the UCSF Academic Senate Distinction in Teaching Award, among other recognitions. He has practices as a psychiatric/mental health nurse practitioner, treating veterans at the San Francisco Veterans Administration Hospital. As a researcher, he collaborates on psychedelics studies of psilocybin and MDMA in the Translational Psychedelics Research (TrPR) lab at UCSF. A leading voice in nursing, he is a cofounder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses.org), advocating for the perspective of nurses in psychedelic therapy, he has published on psychedelics in the American Journal of Nursing, Frontiers in Psychiatry, and The Journal of Humanistic Psychotherapy. An internationally invited speaker, he has lectured at SXSW, Aspen Health Ideas Festival, the Singapore Ministry of Health, and Oxford University and can be found at Andrewpennnp.com