Motivational Interviewing

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Motivational interviewing to change a behavior can be used in all therapeutic situations where motivation is central to the change process and where ambivalence exists. Firstly, Miller and Rollnick [26] insist that this interview is a 'way of being' with patients and not a varied collection of psychological techniques used to get people to do what they do not want to. The interview aims at exploring patients' ambivalence in a semi-structured and nonjudg-mental manner. During the motivational interviewing, healthcare professionals select information through reflective listening, use the dissonance in the conversation and facilitate change.

As such, the principles of the motivational interviewing are above all a Rogerian-type [27] empathic communication which aims to help elaborate patients' discrepancies and reinforce their feelings of personal efficacy. Another interesting principle involved here is that of rolling with patients' resistance when they are ambivalent.

A typical ambivalence in our obese patients is that they do not follow their dietary plan when they know perfectly well what they have to do to lose weight. Hence, a discrepancy occurs between a value and behavior. The objective of healthcare professionals is to bring patients to consider another point of view and therefore become actors in their own decision-making: 'What is the least they can change at the lowest psychological cost and greatest benefit?' A major principle involved in motivational interviewing is reinforcing patients' personal efficacy and increasing their faith in change.

In conclusion, therapeutic education is a patient-centered humanistic approach which allows patients to be actors in their own treatment, to improve their quality of life, their success of weight loss and reduce the risk of potential complications. The motivational interviewing and cognitive behavioral approaches are perfect complements to therapeutic education for long-term weight loss maintenance.

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