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Summary: Motivate your patients to motivate themselves
Review: Self-determination theory (SDT) is a humanistic approach to motivation which posits that people do best when they feel in control of their own lives. This book provides an overview of SDT and the research supporting it, and goes on to illustrate how health care practitioners can apply SDT toward motivating patients to engage more fully in treatment. My interest in SDT comes from the opposite perspective: having seen how Motivational Interviewing can facilitate change in diverse health behaviors, I was interested in a broader theoretical account of the processes that might be at work. I recommend the book despite some flaws. The brief first section includes a review of the research supporting SDT. I know enough about the underlying literature to recognize that some of the authors' summary statements are not uncontroversial, but not enough to judge just how partisan their approach is across the board. A strong bias is not necessarily a bad thing, but when "partisan" gives way to "shrill," the authors undermine their own credibility. The authors conclude the first section with a few general guidelines and the good news that the behaviors they endorse can be learned. The second section focuses on medical practice. Once again, the authors sometimes undermine an otherwise convincing argument in their zeal to promote SDT. For example, as part of their argument against a behavioral understanding of motivation, they present evidence that response cost in the form of co-pays leads to less use of preventive services - completely consistent with the principles of operant conditioning. This sort of jarring gap in reasoning makes me want to take everything the authors say with a grain of salt. If you buy into the model nonetheless, you will find several detailed, well-written case examples to illustrate what SDT looks like in practice. The third section focuses on mental health practice. It opens with a somewhat bizarre review of current controversies in the field, designed to illustrate how SDT can help close the gap between science and practice in mental health care. The authors make the valuable point that both technical expertise and motivational ability are essential to provision of high-quality care that really helps people change. Case examples illustrate how SDT can inform the practice of theoretically diverse treatments for substance abuse, eating disorders, anxiety disorders, mood disorders, and personality disorders. In my opinion, the authors over-reach in their efforts to promote self-determination theory. However, there is growing evidence that autonomy-supportive interventions of the sort advocated by the authors can lead to better physical and mental health outcomes. Can, and should, SDT inform your clinical practice? Read this book with your critical thinking faculties fully engaged, and decide for yourself. Reviewed by Deborah Van Horn, June 11, 2004.
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