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Self-Determination Theory in the Clinic

Self-Determination Theory in the Clinic: Motivating Physical and Mental Health

Copyright Date: 2003
Published by: Yale University Press
Pages: 224
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  • Book Info
    Self-Determination Theory in the Clinic
    Book Description:

    Self-determination theory is grounded in the belief that people work best and are happiest when they feel that they are in control of their own lives. This invaluable book explains the ramifications of the theory and provides clinical examples to show that it can be used to motivate patients undergoing treatment for such physical or psychological issues as diabetes management, smoking cessation, post-traumatic stress, obsessive-compulsive disorder, and depression.The first part of the book provides historical background to self-determination theory, showing that it is humanistically oriented and has three decades of empirical research behind it. In the process, the authors discuss why humanistic psychology fell out of favor in academic psychology; why "self-help" and New Age books have such perennial popularity; and why it is so important for authorities to support patients' sense of self. The remainder of the book presents many specific case examples to describe the theory's application.

    eISBN: 978-0-300-12866-6
    Subjects: Psychology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-viii)
  4. PART I Self-Determination Theory:: Concepts and Evidence

    • 1 Self-Actualization, Society, and Scientific Psychology
      (pp. 3-12)

      The termself-actualizationcatches people’s fancy. It is an alluring idea indeed that we are born with a natural tendency toward growth and goodness and that the only thing standing between our potential and us is an empathic and positive atmosphere. It’s a good bet that, of all the material taught in college psychology courses, self-actualization is one of the few concepts that eventual nonpsychologists actually remember! Odds on this bet are made even better given that the psychology sections of today’s large bookstores are filled with popular titles emphasizing self-actualization themes. But it’s not just nonpsychologists who take to...

    • 2 Self-Determination Theory and Its Supporting Research Base
      (pp. 13-27)

      An important tenet of operant behaviorism, the model that dominated within academic psychology for several decades, is that behavior is repeated because it is reinforced and terminated because it is not reinforced or because it is punished. Behaviorists of the first half of the twentieth century insisted also that reinforcements needed to be defined independently of behavior, as distinct external commodities or consequences that follow on termination of the particular behavior. From this perspective, we should not expect to find organisms persisting in behavior that does not lead to tangible external rewards or that leads instead to punishments. And yet,...

    • 3 Autonomy Support and Behavioral Internalization: Promoting Ownership of Non-Enjoyable Behaviors
      (pp. 28-40)

      To summarize the story so far, in Chapter 1 we discussed the transformation of scientific psychology in the 1960s. We observed that following the overthrow of the behavioristic worldview, the cognitive approach won out over the humanistic approach as the dominant paradigm in scientific psychology, largely because it embraced (while humanism rejected) quantitative methodologies. We also observed that humanistic theory has much to recommend it and can correct the reductionistic biases that the cognitive approach inherited from the behaviorists. Specifically, humanistic theory resonates best with lived human experience, in which the search for self-integrity and selfownership is a daily issue....

  5. PART II Self-Determination Theory Applied to Medical Practice

    • 4 Self-Determination Theory and Physical Health
      (pp. 43-64)

      Each year in the United States, more than 40 percent of deaths are premature, and they are attributable to tobacco use, diet and activity patterns, alcohol abuse, and infections such as HIV (McGinnis and Foege 1993). Tobacco alone is considered responsible for more than four hundred thousand deaths each year (roughly one in five deaths). Prospective studies have shown that 82 percent of all cardiovascular events occurring in middle-aged women (Stampfer et al. 2000) are caused by smoking, unhealthy diet, and lack of exercise and that most cancers are largely attributable to lifestyle factors rather than genetic factors (Lichtenstein et...

    • 5 Facilitating Health Behavior Change: The Case of Tobacco Dependence
      (pp. 65-82)

      Health care practitioners face the daunting challenge of encouraging patients to take their medications, to refrain from unhealthy behaviors such as smoking, to engage in healthy behaviors such as exercising, and to undergo unpleasant preventive procedures such as screening mammography. To illustrate how difficult these challenges are, consider that many practitioners have trouble simply getting their patients to show up for scheduled appointments! Clarifying how practitioners can facilitate healthy patient behaviors is thus an extremely important matter, which, if accomplished, would likely improve patients’ health and satisfaction, increase practitioners’ feelings of competence, and decrease health care costs, all in one...

    • 6 Supporting the Internalization of Chronic Disease Management: The Case of Diabetes Mellitus
      (pp. 83-106)

      In the previous chapter, we provided a concrete illustration of how to apply SDT in a clinical setting, addressing the question of how to help motivate a patient to stop smoking. In that example, the health professional was trying to support the patient’s motivation tostopdoing a particular behavior: lighting up cigarettes. Because the patient was tryingnotto do something that she stronglywantedto do in the immediate moment, we might say that ‘‘selfdenying’’ motivation was required to successfully enact her intention.

      In this chapter, we consider a case in which patients need tostartdoing a...

  6. PART III Self-Determination Theory Applied to Mental Health Practice

    • 7 Self-Determination Theory and Mental Health
      (pp. 109-125)

      Something’s gone awry in the area of clinical psychology, and it seems to boil down to one thing: clinical scientists and clinical practitioners often fail to listen to one another. This would astound and disappoint early figures in the history of clinical psychology.

      In describing Morton Prince, who founded theJournal of Abnormal Psychologyin 1906, for example, R. W. White states, “He began to realize that it was impossible to think of abnormal psychology as a free-standing body of knowledge. Logically, it implied an accepted base as to what was normal in human life, from which base the different...

    • 8 Facilitating Psychological Change: The Case of Substance Abuse Disorders
      (pp. 126-141)

      Of all the scientifically supported treatments for mental disorders, motivational interviewing for substance abuse problems is most closely related to self-determination theory. Indeed, the prescriptions of this technique and of SDT are in many cases almost identical. We already discussed several aspects of motivational interviewing in Chapter 6. In this chapter we focus on this technique, review the evidence that it is effective, and point out the clear connections between it and SDT. Although the principles of motivational interviewing are meant to apply to all behaviors (just as SDT’s are), the application of motivational interviewing to alcohol problems has been...

    • 9 Supporting Self-Determination in the Treatment of Anxiety and Eating Disorders
      (pp. 142-164)

      In this chapter we focus on anxiety disorders, but because there are important areas of overlap between techniques targeting anxiety and those targeting eating disorders, we also mention eating disorders, especially bulimia nervosa (the binge-purge syndrome). Our goal is to cover the demonstrated effective therapeutic approaches to anxiety disorders while showing that these therapies are most effective when practiced in an autonomy-supportive way. Further, although the therapies are quite structured and even prescriptive, they are quite consistent with SDT at their core.

      Generalized anxiety disorder is a syndrome characterized by persistent experiences of worry and physical tension. The worry and...

    • 10 Supporting Self-Determination in the Treatment of Mood and Personality Disorders
      (pp. 165-183)

      In the early nineteenth century, the French psychiatrist Jean-Etienne Esquirol described depression in much the same way that we would characterize the condition today. Here’s what he said in 1811: “There are individuals who fall into a state of torpor and mental depression. They complain of want of appetite . . . there is a kind of compression in the head, which prevents them from fixing their attention or arranging their thoughts . . . they become indifferent and filled with gloomy ideas, and desire or even invoke death.”

      Esquirol had it essentially right almost two centuries ago. You might...

  7. Conclusion
    (pp. 184-186)

    We hope that we have shown that the self-determination theory approach to promoting health motivation works and that its principles are worth integrating into the routine care of clients. Self-determination theory is in basic agreement with other prominent approaches to behavioral change, such as motivational interviewing (Miller and Rollnick 2002) and the stages of change model (Prochaska et al. 1992). With its emphasis on the support of the individual’s autonomy, SDT is also consistent with important precepts concerning the ethical delivery of health care (Beauchamp and Childress 1989). Yet SDT goes beyond these approaches by offering an elaborated theory of...

  8. References
    (pp. 187-198)
  9. Index
    (pp. 199-208)