Have you ever left a medical appointment with the feeling that the professional didn’t really understand why you were there? Or maybe you weren’t even the one who decided to make the appointment but felt pushed into it by someone else. Chances are you ended up feeling some resistance, stopped the treatment halfway through, or looked for someone else who might be able to help you.
We now know that taking into account a patient’s motivation and expectations is essential for making appropriate clinical decisions, achieving successful treatment, and ensuring that the patient leaves satisfied (Tringale M et al., 2022). Unfortunately, there are still many situations in which healthcare professionals either don’t consider this, or don’t put it into practice effectively (Olde Hartman T C et al., 2011). In fact, this seems to happen more often in specialist consultations (Singh Ospina N et al., 2019). Could it be that, as our sense of control and expertise over a problem increases, we sometimes pay less attention to the actual person we are supposed to be helping?
Patients usually seek help based on their expectations about the therapist’s ability to address their main reasons for coming (Farr J et al., 2021). Their eventual satisfaction, therefore, depends on how far the professional has been able to meet those reasons (Sørum S et al., 2025). These motives can be internal (e.g. intense pain drives me to want to fix my health problem) or external (e.g. since I can’t work anymore, I don’t feel valued by the people around me, so I want to be able to return to work).
One of the theories that has most thoroughly studied the impact of motivation on health intervention outcomes is Self-Determination Theory (SDT). This theory distinguishes between autonomous motivation, which includes forms of regulation in which the person genuinely chooses and values the behavior, and controlled motivation, which covers regulations guided by external pressure (rewards/punishments, demands) or internal pressure (guilt, shame, self-criticism). Research consistently points in the same direction: autonomous forms of motivation are more beneficial than controlled forms for long-term maintenance of desired health behaviors (Ntoumanis N et al., 2021). In addition, SDT proposes three basic psychological needs that should be supported: autonomy (feeling that one has a choice in treatment decisions), competence (feeling confident and capable of carrying out the behaviors required for change), and relatedness (feeling close to and understood by the therapist). When these needs are met, more autonomous motivation is likely, which in turn supports the long-term maintenance of health behaviors (Eigeland J A et al., 2025).
In line with SDT, Motivational Interviewing (MI) has been proposed as a useful approach to support patients in adopting health-enhancing behaviors (Bischof G et al., 2021). According to the MI framework, people with unhealthy behaviors are not fundamentally unmotivated to change. Rather, their problematic behavior is, at least to some extent, in conflict with their self-concept, values, or life goals, and they may have subjectively good reasons against changing. If this ambivalence is not recognized, well-intentioned medical advice is often perceived as a threat to patients’ freedom of choice and tends to lead to non-adherence. MI addresses ambivalence without pressure, reducing reactance and supporting autonomous rather than controlled motivation. By aligning the conversation with the SDT needs (autonomy, competence, and relatedness with the therapist), MI helps elicit the patient’s own reasons for change instead of imposing external ones. MI does not force decisions; it accompanies the person in resolving their ambivalence, which improves adherence and supports long-term change (Bischof G et al., 2021).
Based on what we know from research, which we have very briefly summarized here, at UMSS we invite you to keep the following points in mind for your next consultation.
If you’re going as a patient:
- Arrive with your goals clear and say them at the beginning. Communicate them respectfully, but make sure the therapist understands your expectations and your reasons for coming.
- Ask for shared decisions and options that fit you: What alternatives are there to help me reach my goals?
If you’re the therapist:
- Start by asking about the patient’s reasons and expectations. Ask why they came and what they hope to achieve. Let them talk without interrupting, and negotiate priorities if time is short. Record “reasons/expectations/goals” in the clinical notes.
- Communicate respectfully and with genuine understanding. Validate their perspective and present the available options. Explain the rationale for each option and avoid controlling language (“you must / because I say so”). Aim to align your proposal with the patient’s values and motives.
- Use MI to work with ambivalence and strengthen the patient’s own reasons for change. Use numerical scales of importance/confidence (0–10) and agree on small steps that match their perceived competence.
- Turn motives into an operational plan and follow-up. Translate the patient’s motives into concrete progress markers (e.g. “walk 15 minutes without increased symptoms within 24 hours”, “return to work part-time”), and close the session with a “teach-back”: “If you had to explain at home what we’ve talked about today, how would you put it?”
BIBLIOGRAPHY:
1. Tringale M, Stephen G, Boylan A-M, Heneghan C. Integrating patient values and preferences in healthcare: a systematic review of qualitative evidence. BMJ Open [Internet]. 2022;12(11):e067268. Available from: http://dx.doi.org/10.1136/bmjopen-2022-067268
2. olde Hartman TC, van Ravesteijn H, Lucassen P, van Boven K, van Weel-Baumgarten E, van Weel C. Why the “reason for encounter” should be incorporated in the analysis of outcome of care. Br J Gen Pract [Internet]. 2011;61(593):e839-41. Available from: http://dx.doi.org/10.3399/bjgp11x613269
3. Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, et al. Eliciting the patient’s agenda- secondary analysis of recorded clinical encounters. J Gen Intern Med [Internet]. 2019;34(1):36–40. Available from: http://dx.doi.org/10.1007/s11606-018-4540-5
4. Farr J, Surtees ADR, Richardson H, Michail M. Exploring the processes involved in seeking help from a general practitioner for young people who have been at risk of suicide. Int J Environ Res Public Health [Internet]. 2021;18(4):2120. Available from: http://dx.doi.org/10.3390/ijerph18042120
5. Sørum S, Lockertsen V, Rivenes Lafontan S. Patient experiences of seeking specialized mental health care in Norway: A qualitative study. J Prim Care Community Health [Internet]. 2025;16(21501319251350601):21501319251350601. Available from: http://dx.doi.org/10.1177/21501319251350601
6. Ntoumanis N, Ng JYY, Prestwich A, Quested E, Hancox JE, Thøgersen-Ntoumani C, et al. A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health. Health Psychol Rev [Internet]. 2021;15(2):214–44. Available from: http://dx.doi.org/10.1080/17437199.2020.1718529
7. Eigeland JA, Moffitt RL, Sheeran N, Loxton N, Jones L. Modelling the associations between the physician-patient relationship and patient outcomes via self-Determination Theory variables in chronic disease management. Int J Behav Med [Internet]. 2025; Available from: http://dx.doi.org/10.1007/s12529-025-10371-0
8. Bischof G, Bischof A, Rumpf H-J. Motivational interviewing: An evidence-based approach for use in medical practice. Dtsch Arztebl Int [Internet]. 2021;118(7):109–15. Available from: http://dx.doi.org/10.3238/arztebl.m2021.0014