All professional psychology is about helping people to make and sustain successful changes in their behaviour, to prevent, solve or at least alleviate problems. This is particularly true in the field of health promotion and illness prevention. Most people do have some idea of changes they should make to their lifestyle to enjoy and protect better health (although there is an abundance of misinformation, typically peddled by snake oil sales people). The problem for most people is not a lack of information but of motivation.
This problem does plague all areas of professional psychology. We may have the best evidence-based procedures for solving an anxiety disorder, or improving cooperation within an organisation, or achieving best athletic performance, or quitting smoking, but, unless our clients are motivated to try our suggestions, and to stick to them, we have done them little lasting good. Most university programs focus on evidence-based procedures, which certainly deserve major attention, but pay little or no attention to some of the other ingredients required for successful behaviour change.
This need for a broad approach to facilitating successful behaviour change has been increasingly recognised (Bothelo, 2004; Rollnick, Mason & Butler, 1999) and key ingredients for change have been identified (see Table 1). The keys to increasing motivation and bringing about successful behaviour change in clients involve consideration of the following issues.
- Self-efficacy is the best predictor of engagement in health-protective behaviour so should be the main intervention target.
- Autonomy is important to people older than two years; the more we seem to tell people what to do, the more we invite resistance.
- People arrive at different stages of readiness for change and we should know how to tailor our approach accordingly and facilitate progress along this dimension.
- The basic procedure for building and maintaining motivation is useful goal-setting, something most health professionals get wrong (see Table 2).
- Relapse is what normal people usually do. Roberts and Marlatt (2004) have developed effective guidelines for preventing relapses and managing them when they inevitably occur.
- There is strong evidence that the nature and quality of the psychologist-client relationship is a major determinant of the success or otherwise of the intervention. All professional psychologists need good counselling skills.
- Ethically we should be using evidence-based procedures wherever available. We should be able to show that what we offer our clients is likely to work, unlikely to harm, and is cost-effective.
- Psychoeducation respects the client’s autonomy and can facilitate adherence to goals, even when they are challenging. It is not the universal panacea some hope
for (can there be a single obese person who does not know they need to eat more sensibly and be more physically active?), but it is an important ingredient.
- Recognition of the magnitude of successful change programs should encourage you to resist requests from clients, employers, third party payers and governments for magical, instant, low cost and undemanding interventions. Insist on your right to do a good job.
By Dr Bob Montgomery FAPS
Clinical and health psychologist
Copyright InPsych 2006