One of the most important points in using Motivational Interviewing in health behavior change counseling is the idea of empowering the patient or client. While the practitioner may be the authority in diagnosing what the patient should change, the patient is the authority in deciding what is most important and possible in the context of his or her life. Rather than adopting “the practitioner is the expert and the patient will be taught” approach, MI assumes a “dual expertise” between patient and practitioner.* MI assumes that patients have all the answers they need, and our job is to help them find these answers. As clinicians, we step back from being the experts to collaborate with patients in finding their own answers.
Although clinicians have ideas about what each patient ought to do, we must respect their ultimate right to choose a course of action. While remaining invested in their positive outcomes, we accept that the “what” and “when” decisions of lifestyle changes belong to the patient alone, not the practitioner. While we absolutely care what happens to them, we respect and accept our patients’ decisions about health behavior change. As my colleague, Gary Rose, says, we have “no preconceived ideas about the patient’s timetable for initiating action or the specific nature of this action.”
In my work as a nutrition therapist with patients who have eating disorders and other problems with food, I find myself having very strong opinions about what my patients should do. For instance, when I am working with a patient with active bulimia or uncontrolled diabetes, I have very clear clinical recommendations about what the patient should do; and I explain them fully. However, my MI training helps me to respect my patient’s right to choose whether to continue to live with her problem and whether or not to change.
As an MI trained clinician, my job is not to force change, but rather to help the patient clarify her goals and values and to examine how closely these jibe with her behavior regarding food and her health related outcomes. By empowering our patients to change, MI clinicians successfully bypass the (at times) counterproductive force of authority traditionally associated with our roles.
* Stephen Rollnick, William Miller, and Christopher Butler. Motivational Interviewing in Health Care, Guilford Press, 2007.
