Why is my patient skipping their HEP?

Have you ever heard of ambivalence??

Have you ever experienced uncertainty about making a change in your life?

Think for a moment, a time when you wanted to change something, but you were unsure about it or even how to go about it. This is ambivalence.

Can you count how many patients you’ve worked with that don’t exercise at all? How many of them have said, “I know I need to exercise more, but I just can’t seem to find the time.”

This is when the alarm bells should be ringing.

Suppose you've ever had a patient who has expressed their desire to incorporate more exercise into their routine (change talk).

In that case, if they aren't following through on this, they are experiencing ambivalence.

Ambivalence tends to be this weird conceptual thing, but it comes down to the patient's disconnect between their values and actions. They want to add more exercise into their routine, but they don't want to add more activity into their routine. Their actions show their true values & priorities. Right now, they aren't valuing or prioritizing exercise.

So, what can you do about it?

You and your patient/client can sit with the ickiness & uncertainty about it by talking about it.

• "Describe to me how things are going with adding more exercise to your routine?"

• "What challenges, if any, are you facing right now with this?"

• "What is GOOD about NOT changing?"

• "What is bad about changing?

These questions give a voice to that ambivalence. It provides the patient/client a chance to express (quite possibly for the first time ever) reasons why they aren't going about their new (or old) desire for change.