Motivational Interviewing (MI) is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. MI is a method that has been subjected to clinical trials for a wide range of behavior-change problems. MI works by activating the patient’s own motivation for change and adherence to treatment. The starting point for MI is that motivation for change is actually quite malleable and is particularly formed in the context of relationships. The way in which patients are approached can substantially influence their motivation for personal behavior change.
The Spirit of MI
The “spirit” of MI has been described as collaborative, evocative, and honoring of patient autonomy.
Collaborative: In place of the uneven power relationship in which the expert clinician directs the passive patient in what to do, there is an active collaborative conversation and joint decision-making process. This is regarded as particularly important. Ultimately, it is only the patient who can actually make the change.
Evocative: Often healthcare seems to involve giving patients what they lack, be it medication, skills, or insight. MI seeks to evoke from patients that which they already have, to activate their motivation and resources for change. It respects that each patient has personal goals, values, aspirations, and dreams. Part of the art of MI is connecting health behavior change with what patients care about: their own values and concerns.
Honoring patient autonomy: MI also requires a certain degree of detachment from outcomes—not an absence of caring, but more of an acceptance that people can and do make choices. Healthcare professionals can inform, advise, and even warn, but in the end it is the patient who decides to take action or not. Recognizing and honoring that autonomy is a key element in effecting behavior change. Human nature frequently resists being coerced and instructed on what to do.9
Further information on Motivational Interviewing can be found at www.motivationalinterviewing.org and in the book especially written for the dental practice: Health behavior change in the dental practice.9 The evidence base for successful behavior change is continually expanding, and adopting current science will tip the balance in favor of success, bringing greater satisfaction to both the healthcare professional and the patient.