Introduction
What Is It?
Recently, I heard about Motivational Interviewing from a couple of sources. Because of the title, I didn't pay much attention. My experience in 40 years of practicing dentistry and experience with the client/person-centered approach developed by Carl Rogers, PhD, his colleagues, and Arthur Combs, PhD, convinced me that only the individual motivates him/herself. Other people can help and can be adjuvants or healing catalysts that can provide information and create conditions that help the person motivate him or herself, but they don't motivate others. I assumed that MI was one of those selling approaches sales people use to manipulate people into buying what they are selling.
So I ignored Motivational Interviewing. Then I heard about it a couple of other times and decided to check it out on Google. This quote popped up on an early page I visited:
What is Motivational Interviewing? Motivational Interviewing is a form of collaborative conversation for strengthening a person's own motivation and commitment to change.
It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change.
It is designed to strengthen an individual's motivation for and movement toward a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion.
This quote took care of my cynicism about what the term Motivational Interviewing (MI)1 was about. It was exactly what I believe about motivation.
So I read further on Google.
I read about the originator of Motivational Interviewing, William Miller, PhD. His early training was in client-centered therapy and cognitive-behavioral approaches. He used this training as a professor at the University of New Mexico Department of Psychology and Psychiatry in working with people with addictions. Through this experience, he found that the person-centered approach was much more effective in improving outcomes than the traditional approaches that were "highly authoritarian, confrontational, even demeaning, relying on a heavily directing style of counseling." I read about his discovery of a way to counsel that mirrored Rogers' and Combs' work in that it relied on the person's own motivation for change instead of confronting them and making them defensive. This is an approach that trusts the client to discover their own reasons for change.
I was hooked, so I read further and found a book, Motivational Interviewing in Healthcare by Dr. Miller, Steven Rollnick, PhD, and Christopher Butler, MD. I ordered it. The first sentence in the Preface hooked me even more: "This book is for any health care practitioner who spends time encouraging patients to consider behavior change."
The authors believe that many of the health care encounters between practitioner and patient or client involve resolving health problems that are caused by patient/client lifestyle choices. Often the practitioner's counseling style (or lack thereof) results in the patient resisting their best efforts. The authors believe that an atmosphere of trust, respect and caring can help facilitate health behavior change in patients or clients. They apply the words "elicit" and "evoke" to describe the counselor approach to help the patient/client make choices that are best for themselves. They believe that the Motivational Interviewing (MI) method provides a way to have these person-centered conversations with patients/clients about changing their health behavior. This is dentistry in spades.
I kept reading and with each passing chapter a question pressed more and more insistently: "How in the world did I miss this? I have been using and advocating person-centered approaches for almost 40 years and I was not aware of this. Its philosophy is very similar to mine and what I wrote about in In a Spirit of Caring in the early 1990's."
After I read the last chapter, I went back to the internet to find information on Dr. Miller and his e-mail address. When I found his address, I sent an e-mail asking him how he developed MI and how or if Carl Rogers' work had influenced him. He replied quickly and related his experience of counseling people with addictions that I quoted above. He said that a major part of his counseling training was in the client-centered approach. He added that one of his big regrets was never meeting Carl Rogers or being in a workshop with him. I relayed to him the work I had done in applying the person-centered approach to dentistry and my experience with Carl Rogers and his colleagues and Art Combs. I told him I was flabbergasted that I had missed MI. I asked him what he knew about the use of MI in dentistry, but he said that he wasn't aware of much. With further research, I have found this to be mostly true, but reports about and interest in MI in Dentistry are increasing (Gao, et al., 2013).
Since this conversation, Dr. Miller has been very helpful in answering my questions about MI. I have read extensively, including the third edition of Motivational Interviewing by Miller and Rollnick, watched videos on MI and I have attended both a 2-day introductory and advanced MI workshops. I am also giving workshops on Motivational Interviewing in Dentistry.
Dr. Miller first wrote about Motivational Interviewing in 1983 in the journal Behavioral Psychotherapy. As of the writing of the third edition of Motivational Interviewing, published in 2013, there are more than 1,200 publications on this method and 200 randomized clinical trials. There are more than 2,500 MI trainers teaching in 45 different languages. A Google Scholar search turned up 30,000 articles on MI - 5,000 new articles in 2011 - and 40 books on MI. MI is evidence-based.
You can see why I am flabbergasted that dentistry, except in sporadic cases, has missed this way of "helping people change." Why do I like MI? It fills a long standing helping relationship gap in dentistry and health care by giving a behaviorally sound structure on how to interview patients and help them change unhealthy behaviors.
If you are familiar with my writing, you know that I have a strong belief in the importance and effectiveness of person or patient-centered approaches. MI is person-centered. And, while Carl Rogers and his colleagues have had a profound effect on counseling and the helping professions (and me), their strong belief in using a non-directive approach is difficult for dental professionals to understand and use. It is like a foreign culture and language to them. MI's emphasis on guiding and a more structured approach is more dental-professional-friendly. Also, it is more readily available through its network of MI trainers. My Rogerian, person-centered friends quibble about this guided, more structured approach, but I think it is a perfect fit for dental professionals. MI also gives structure and skills to the person-centered approach I wrote about in my book In a Spirit of Caring.
Properly applied, using MI and the person-centered approach can significantly enhance your dental practice - especially relationship-based dental practices. Veteran relationship-based dental professionals already use many of these skills and approaches in their dental practices. For them, MI and the person-centered approach will give them a spirit and a structure for what they have intuitively learned to do.
All of these experiences have strengthened my commitment to write this book: Motivational Interviewing in Dentistry: Helping people become healthier. The subtitle comes from the subtitle of my dental practice newsletter, Adjuvant: Helping people become healthier. The word "adjuvant" refers to "one that helps or facilitates" (Mish, 2002). My definition of adjuvant is "a healing catalyst; someone or something that helps people become healthier."
As you read this book, you will discover why I chose this subtitle. To me it well describes the people in dentistry who are adjuvants, and are becoming healing catalysts for their patients and clients. They are committed to helping people become healthier.
This subtitle closely parallels Miller and Rollnick's subtitle for the third edition of their Motivational Interviewing: Helping people change.
Here is what I plan to cover in this book:
- the history of person-centered approaches in dentistry,
- an overview of MI,
- why its use is transformative for dentistry,
- the communication styles of guiding, directing, and following,
- how to use reflective listening,
- how to recognize change talk,
- how to respond to discord and conflict,
- the three core skills of asking, informing and listening,
- how to recognize when to use the guiding and following style of MI instead of directing,
- how to use the skill of eliciting/providing/eliciting (E/P/E) information,
- how to avoid the righting reflex and the expert/savior trap,
- the role of ambivalence in patient's behavior
- and other aspects of MI
I will write about how MI can be used in dentistry and a dental practice. For example, it can be used in dental schools to help students learn how to relate to and interview patients and counsel patients, how hygienists can use MI to help their patients change destructive oral hygiene habits, how dentists can use MI in their initial interviews of patients and to help their patients change health behaviors for the better, and how dentists can help...
