November 2015

Dear Friend,

I have been doing a lot of traveling conducting MI trainings. I've been enjoying the travel for the most part.  Still, every once in a while, the airlines are obnoxiously inconsiderate and their employees are rude and thoughtless.  I love what I do for a living, but the travel part might just make me want to stop!

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Motivational Interviewing is Respectful to the Client/Patient

During a recent MI training I conducted a participant commented that it seemed to her that I was saying that part of the basis for the approach is respect for the patient. I was honestly thrilled to hear her say that, as it is a very important aspect of MI and it was great for me to hear that she “got it”.  Here are my thoughts about some of the ways in which MI is respectful to the patient.

• One way is in the spirit of collaboration. This means that the relationship between practitioner and patient is on an equal footing.  Rather than the top-down, medical model where the clinician is the expert and the patient will be taught, we make it clear that we will work together to arrive at solutions to the problem at hand.
   
• Another aspect that is respectful is the way in which we make it clear that the patient is the expert in their own life.  We make every effort to be clear that we may know what the ideal behavior change would be, but the patient knows what will work best in his or her own life. We communicate this by evoking ideas from the patient and guiding him or her to decide what will work, or even if the patient thinks that any change is possible.
   
• The concept of asking permission before we change the subject or interrupt, or most importantly, before we give advice, is another way to showing respect.  In MI, you must have the patient’s permission before you give advice.  You have permission if the patient asks for your advice, if you ask permission to give advice or if you express the advice by emphasizing the patient’s autonomy and his or her freedom to make decisions about change.  
   
• When we let the patient know that we accept their decision about if, when and how they will change will communicate respect.  Note that this does not mean we agree with the decision. The smoker with lung disease who decides to continue to smoke may leave you feeling anxious or even angry, but it is the patient’s decision.  I work with eating disorder patients, and, believe me, some of my patients make me very uneasy!  Still, it is my job to let them know of my concerns, and that I accept their decision and will continue to work with them if they wish. This, to me, is the ultimate in respect.