Best Practices for Motivational Pharmacotherapy Sessions

Many patients hope medications will help provide relief; on the other hand, they are afraid medications will harm them. An approach to pharmacotherapy that emphasizes an appreciation of patients’ sociocultural contexts is critical to addressing treatment adherence disparities and improving adherence among all patients. Motivational pharmacotherapy and motivational enhancement therapy can be an effective tool to inspire patients with depression and provide hope they can get well.

The first step is to affirm the patient’s commitment to getting better. Use this time to explain the structure of session.

Assess symptoms/adverse effects primarily using open-ended questions and reflections. Improvements are reflected back to the patient and explored to elicit commitment language and change talk (ie, statements that reflect some resolution of ambivalence).

Focus on adherence successes to build self-efficacy. Collaboratively identify ways of overcoming obstacles to adherence.

Motivational interviewing (MI) is an intervention that at its very core is patient-centered. It lends itself to working synergistically with approaches that take into account the sociocultural contexts in which ambivalence about pharmacotherapy emerges. MI focuses on eliciting and utilizing the patient’s own intrinsic motivation as opposed to imposing outside pressure to facilitate behavior change. It incorporates open-ended questions, reflections, and affirmations to help patients explore their ambivalence about a choice.

The aim is ultimately to assist the patient in resolving the ambivalence, especially by avoiding interactions that impede internally motivated change such as directing the patient to change or prematurely raising concerns about a patient’s behaviors—which can lead to defensiveness.

For more on this topic, see: Harnessing Patients’ Own Motivation to Engage in Pharmacotherapy, on which this slideshow is based.