Having learned the technique during a primary health care masters
degree 5 years ago, I feel very disconcerted by the application of
motivational interviewing as a method. I don’t doubt that it is more
effective than confrontation or other methods, for enabling behaviour
change at least in substance use - not least smoking. My problem is not in
its public health utility. Rather, my problem is primordial: in its being
utilitarian. I question the very roots of such a public health. By what
rights, I ask myself, do I set out in advance to change someone else’s
behaviour (without the conflict of whether that person is harming someone
else in the process)?
My experience of participatory learning and action (PLA) with drug
users suggests that motivational interviewing is a grotesque shadow of
what it could be: providing information and developing motivation for
change within a context of a client becoming fully conscientised to the
factors affecting their behaviours and relationships - their substance use
only being a subset of these; taking a role as ‘facilitator’, not in pre-
determined (societally) targeted goals as a ‘guide/ manipulator/
facipulator’, (let alone ‘director’ as this article suggests) but in
enabling self-motivated and controlled change based on fully empowered
choice. Hence, sustained substance use may not count as failure, where
other factors of causal import, or which lend confidence in a belief in
self-efficacy, are being effectively acted on by a previously marginalised
person. Indeed, they may even be spontaneously sharing these lessons of
growth with their peers prior to any substance use change.
For me, the root issues relate to empowerment. Motivational
interviewing is in my opinion a paternalistic, covertly political health
distortion (which incidentally, I apologised for inflicting on my ‘client’
after my obligatory practicum was over and have avoided using since).
Competing interests:
I am a perpetual and ardent supporter of authentic, politically relevant primary health care and participatory development, as opposed to traditional public health and community development.
Competing interests:
No competing interests
12 November 2005
Ditch Townsend
South East Asia Director - The Leprosy Mission International
Rapid Response:
Motivational facipulation
Having learned the technique during a primary health care masters
degree 5 years ago, I feel very disconcerted by the application of
motivational interviewing as a method. I don’t doubt that it is more
effective than confrontation or other methods, for enabling behaviour
change at least in substance use - not least smoking. My problem is not in
its public health utility. Rather, my problem is primordial: in its being
utilitarian. I question the very roots of such a public health. By what
rights, I ask myself, do I set out in advance to change someone else’s
behaviour (without the conflict of whether that person is harming someone
else in the process)?
My experience of participatory learning and action (PLA) with drug
users suggests that motivational interviewing is a grotesque shadow of
what it could be: providing information and developing motivation for
change within a context of a client becoming fully conscientised to the
factors affecting their behaviours and relationships - their substance use
only being a subset of these; taking a role as ‘facilitator’, not in pre-
determined (societally) targeted goals as a ‘guide/ manipulator/
facipulator’, (let alone ‘director’ as this article suggests) but in
enabling self-motivated and controlled change based on fully empowered
choice. Hence, sustained substance use may not count as failure, where
other factors of causal import, or which lend confidence in a belief in
self-efficacy, are being effectively acted on by a previously marginalised
person. Indeed, they may even be spontaneously sharing these lessons of
growth with their peers prior to any substance use change.
For me, the root issues relate to empowerment. Motivational
interviewing is in my opinion a paternalistic, covertly political health
distortion (which incidentally, I apologised for inflicting on my ‘client’
after my obligatory practicum was over and have avoided using since).
Competing interests:
I am a perpetual and ardent supporter of authentic, politically relevant primary health care and participatory development, as opposed to traditional public health and community development.
Competing interests: No competing interests