The traditional medical model requires us to tell people what to do, in a very “top down” approach. After all, we are experts in the various health care fields, and we know what is ideal in terms of health behavior, right? The idea is that people will be persuaded because we are convincing and passionate in our communicating the urgency for change. It is quite clear that in many fields, this approach doesn’t work very well. Our patients continue to smoke, remain overweight, consume too much sugar, salt and fat, not exercise as we have advised, and not take medications as prescribed.

An alternative approach is used in Motivational Interviewing. We act more as collaborators, working together to create solutions that work for the client. We think of a “dual expertise”, in which the client is the expert in their own lives and we have the professional expertise. We can behave respectfully toward our clients by helping them to decide if, what, and how they would like to change.

In that sense, MI is common sense. Think about your own experience, either as a patient or in your everyday relationships. Do you like to be told what to do? I know that I certainly don’t! For me, being told what to do makes me want to do the opposite. I prefer to feel that I have changed my behavior because it matters to me to do so. I think that I am much like many of our clients. It really does help to communicate clearly that our clients are competent adults, and that we respect that competence.

MI is not only common sense, it is practical. We are looking for the most effective ways to help our clients make a decision for themselves about change. We can help with this decision making by helping resolve ambivalence about change. Most people are ambivalent about change; even if they are convinced it would be in their best interest. In MI, we assume that this ambivalence is normal, and even healthy. The goal is to help the client resolve ambivalence about change and make a decision in the direction of positive change.

From a practical point of view, this is really the most efficient way of promoting behavior change.

You are welcome to use Dr. Glovsky’s articles in any of your own publications provided you copy the following into the article: “Dr. Ellen Glovsky is a Registered Dietitian and Motivational Interviewing trainer. She is on the faculty of Northeastern University in Boston, MA, where she teaches courses in nutrition, public health and MI. Her website, newsletter, and blog are at Training With Dr. Ellen.

© Ellen Glovsky, PhD, RD, LDN 2012. All rights reserved.