Diabetes Self-Management Blog

I heard a lecture in Denver last week on Motivational Interviewing (MI). MI is a way to help people change by “exploring ambivalence.” The speaker said people both want and don’t want to make healthy changes. Does that ring true for you?

The speaker was Paul Cook, PhD, a psychologist and Director of the Center for Nursing Research at the University of Colorado. He said MI was developed for smoking and drug addiction treatment (people who “want to quit” but “can’t”). It is now becoming popular for health behavior change in general, because traditional forms of health education and counseling don’t really work.

“People are always ambivalent about change,” Dr. Cook said. If they didn’t want to change, they wouldn’t be talking to you. “But if they don’t want the problem behavior, why are they still doing it?”

I’ve used MI for a few years with clients. I find it works sometimes and not others. Right now I’m working with a woman named Marian who says she wants to quit smoking. She really needs to, as she has emphysema. She is totally committed to stopping, she says, but she just can’t do it.

When I ask Marian what she likes about smoking, or what feels good about it, or what part of her wants to continue, she keeps saying “Nothing.” There must be something keeping her doing it, though. The cigarettes aren’t just jumping off a store shelf into her mouth. “I can’t stop myself,” she says. But who is this self that she can’t stop?

Marian doesn’t acknowledge her ambivalence. I have to try something else.

Are there behaviors you want to change but find yourself continuing? Perhaps you or your doctor want you to eat less fat or less carbohydrate or drink more water or exercise more or take your medicines more regularly. Perhaps you are getting frustrated by how hard it seems to be.

Dr. Cook said that “people behave in ways counter their own interests.” Labels like “noncompliant” increase resistance to change. So do appeals to fear. And knowing what’s good for you doesn’t necessarily help.

Health professionals have used a variety of tactics to promote healthy behavior change, including ordering, threatening, persuading, lecturing, moralizing, criticizing, shaming, sympathizing, and praising. You may have experienced some of these. None of them work to promote change.

MI is different. MI doesn’t try to convince you of anything. Instead, it explores how you see your situation, how you feel about changing or not changing it. An MI practitioner tries to provide acceptance, attention, and support, and maximize a client’s choice and sense of control.

The techniques involve open-ended questions about a person’s situation and behavior. Do they recognize a problem? What would they say the problem is? How do they feel about changing or not changing?

The interviewer is supposed to reflect back what the client has said, including the emotional content and intention behind it. It feels much better to the client than being lectured.

By exploring their own issues, people become readier to change things. Studies seem to show it works.

What do you think? Has ambivalence about change played a part in your life with diabetes, and what have you done about it? When you think about stopping drinking or changing your diet or starting exercise or whatever, do you think about why you like what you’re doing now? According to MI, recognizing those benefits will help you change.

**

I had a good time in Denver. My talk on sex and diabetes was a hit, but the talk on family issues in diabetes was less popular. Not sure why. People did tell me they thought it was an important topic to bring up.

The city of Denver is lovely with lots of fun things to do. People seem really helpful and most of them seem in a good mood most of the time. And prices are low compared to San Francisco. I didn’t see the Rocky Mountains though. I guess they were hiding somewhere.

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