Saturday, October 30, 2010

Motivating Motivation

[Originally posted on on Oct. 29 2010]

Everyone concerned with addiction recovery knows the importance of motivation.  As Darlene, a heroin addict portrayed in Dr. Lonny Shavelson’s wonderful book Hooked, tells her psychiatrist, “You can talk at an addict until you’re blue in the face, but if they don’t want to get clean, they’ll tell you to f**k off.”  Almost every treatment modality works if the patient is motivated;  nothing works at all if the patient isn’t.  

A group of counselors and researchers grouped under the umbrella label of Motivational Interviewing has been working for a couple of decades on cracking the secret of motivation, and they’ve shown a series of positive results.  Their latest success comes in the highly challenging area of weight loss.  

Weight control is probably more difficult than getting free of alcohol and other addictive drugs because abstinence is not an option.  You can very well live without alcohol and other addictive drugs, and abstinence creates a bright line that can guide your every step.  But you can’t live without food, and threading your way through the maze of conflicting nutritional advisers can defeat the most dedicated mind.  

Doctors, the researchers noted, frequently talk to their patients about weight.  But how the doctor talks to the patient makes a crucial difference.

Doctors who assumed the traditional role of authority, who used a confrontational approach, who appeared to judge the patient, or who pushed unasked-for advice, had no positive effect whatsoever on patients’ motivation, the study found.  Their weight was almost exactly the same as patients whose doctors never raised the issue with them.  In other words, doctors who used the conventional authoritative approach were wasting their time.  

By contrast, doctors who used an approach based on Motivational Interviewing fired up their patients’ motivation, and such patients registered a weight loss of 3.5 pounds at follow-up three months later.

A basic principle of Motivational Interviewing is that real change in feeling and behavior can only come from the patient, not from the doctor.  The key to success, therefore is to elicit and to support the patient’s own inner desire to change.  The doctor accepts the patient’s shortcomings without judgment.  The patient’s successes, no matter how small, merit recognition and praise.  The physician does not pose as an authority, but as an ally and collaborator.  

Dr. Kathryn Pollak, Ph.D. of Duke University, lead author of the study, commented that the physician’s traditional role as expert dispenser of pills or advice has its utility in treating acute distress, but is ineffective in changing patients’ attitudes and motivating long-term, sustainable behavior change.  

“When it comes to behavior change, the patient is the expert, not the doctor.  The whole point is to help the patient solve the problem himself.  Doctors have to see the difference between behavioral counseling and the rest of their job,”  Dr. Pollak said.

The study appears in the October issue of the Journal of Preventive Medicine.

LifeRing groups are abstinence-based, but the Motivational Interviewing approach is deeply congruent with the LifeRing pathway to recovery from alcohol and other drug addiction.  The strategic pathway to recovery is empowerment of the sober self, which means recognition and support of the recovering person’s own inner desire to change.  I’ve written about this approach in detail in my book
Empowering Your Sober Self, for those who wish to know more about it.

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