One of my favorite parts of at least one of the definitions of MI talks about “intrinsic motivation”. This refers to the patient or client’s reason for talking with you about a proposed change in behavior. You may often deal with patients who seem very resistant to the idea of change, and most clinicians find these patients very frustrating. After all, don’t they SEE the need for change? You might even be feeling “What’s WRONG with this person??”
The patient is, however in the room talking with you. In MI we think of this as a form of motivation. Resistance and motivation are “ever changing states of readiness”. Or, resistance is the flip side of change.
Whatever the patient’s reason for talking with you, build on that. Thinking about this in Stages of Change terms, even the patient who is in the precontemplation stage can have some intrinsic motivation, even if it’s only to please you by listening. You then have the opportunity to raise doubt about the way the patient is currently doing things. Your only task, in terms of behavior change, with someone in precontemplation is to stimulate thinking about current behavior and consider whether they ought to change.
So, intrinsic motivation looks at the positive, “half full” aspects of a resistant patient. Remember to affirm the patient for talking with you about this issue, even if you don’t see any signs that they will change. I find that people often think about the conversation with me after they leave my office. If I have been respectful of their right to behavior as they wish, this can stimulate thinking about change.
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