The LAI Conversation: Are Patients Rejecting the Treatment—or the Way We Present It? | LAI Series, Part 2 of 3

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A patient says, “I hate needles,” and the room tightens. Do we hear a hard no, a fear we can work with, or a past experience that needs words before it needs a plan? We get real about long-acting injectable antipsychotics (LAIs) and what the conversation actually sounds like in everyday psychiatric care when I’m excited about an option and my client is unsure.

We dig into motivational interviewing skills that matter in the moment: reflective listening, strategic silence, and affirmations that don’t feel like pressure. I walk through “elicit, provide, elicit” in plain language so we can share why an LAI might help (daily adherence struggles, breakthrough symptoms, clearer monitoring) and then give the decision right back to the person in front of us. We also name the uncomfortable truth that clinician comfort and uncertainty can shape how we present choices, sometimes making an injection sound like a last resort even when it isn’t.

“I need to think about it” gets treated with respect and structure, including what to do when clients Google medications, land on Reddit horror stories, or worry about side effects and long duration in the body. We talk about building a realistic follow-up plan, keeping the door open without standing in the doorway, and what changes when an LAI already has a history from hospitalization. By the end, success isn’t a yes to the injection, it’s clarity: do we understand the concern, the meaning, and what happens next?