How Do You Feel About Change?

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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  • Jeff Murray

    Just finished reading your interesting article and yes Health Professionals use a whole variety of tactics to promote change some with success some without. At my own Clinic we have had great recent success with a new approach fat loss program that has been a roaring success for the majority of patients but others just resist even though they know we have the answer to the problem. We have told each person we will succeed or we would return their money and all they have to do is follow exactly what we say and give it 30 days. Even if they still have cultural or social attachments to the foods that have made them ill we ask that they just give it 30 days. Other barriers we have had have been the failed dietary advice they have had from other government recognised health professionals in our UK health service telling them to continue eating the very same foods that cause the problem but everything in moderation. We found with a bit more time spent on education through consultation , supporting literature, books and more time spent on explaining the relationship between excess and also poor quality carbohydrates on blood sugar this has really helped them understand the problem.
    I was wondering whether you could help me with something else. I was having a further look through the website in the recipe section and I noticed a whole load of recopies of foods that would spike blood sugar and cause the predictable insulin response and blood sugar crash. Maybe you could point me in the right direction or guide me as to why the site is promoting the very foods (Autumn Bran Muffins, Breakfast Bagel Melt etc, the list is endless) that cause insulin resistance and diabetes; it doesn’t seem to make any sense to me. Maybe you agree with me, I don’t know but possible you could shed some light upon this. It certainly isn’t the approach we use at our Clinic.

    Best Regards

    Jeff Murray

  • Diane Fennell

    Hello Mr. Murray,

    Thanks for your question regarding our recipes. All forms of carbohydrate except fiber raise blood glucose level, and many if not most of the recipes on our site include ingredients that contain carbohydrate. (Some of the meat recipes have no carbohydrate, however.) For most people with diabetes, the key to keeping blood glucose level in target range is not to eliminate all carbohydrate from the diet but to moderate it, so they’re getting the nutrients they need from foods such as grains, vegetables, and fruit, but not developing high blood glucose after meals.

    Diane Fennell
    Web Editor

  • David Spero RN

    Hi Jeff,

    Your clinic’s program sounds interesting. My concern would be that while people can do anything for 30 days, will they stick with it after day 31?

    I tend to agree with you about the recipes, but I always advise people to check for themselves what different foods do to their blood glucose. Then you can avoid the recipes that aren’t right for you.