Monday, May 20, 2013

Practicing Motivational Interviewing Requires Compassion

Motivational interviewing (MI) is a collaborative, goal-oriented method of communication with particular attention to the language of change.  It is intended to strengthen personal motivation for and commitment to a change goal by eliciting and exploring an individual’s own arguments for change.”  -- William Miller, Steve Rollnick, 2012

Miller & Rolling described MI as one style of helping others make changes in their behavior (I believe this has more recently been revised to include broader range of change than just behavior). It contrasts with the more typical directing helping style where the practitioner tries to install knowledge or motivation. It is similar to a guiding helping style where the practitioner collaborates with the client to explore and experiment with changes.

However, a practitioner who uses an MI style goes beyond just guiding when he or she tries to solicit from the client his or her desires and reasons for engaging in the health promoting behavior.

There are two aspects of MI that are significant and often overlooked. These are:

  1. Responding to the client as a person who is competent rather than someone who needs to be rescued or is incapable of making welfare or health promoting decisions.
  1. Compassion; motivational interviewing is not something one does to someone, does in order to get to some goal of the health care provider, or does as part of selling the client on something.  MI is intended to help the client and for the client.
It’s on compassion that I wanted to share the following. It may help to spend a few minutes reflecting upon your client as a person and less so about their problems.

1.         Close your eyes

2.         Think about someone you’re working with now

  • Now think…              - she was once young too
  • Think how…             - she once had dreams
  • Think how…             - she had ups and downs in her life
  • Think…                    - of her joys and happiness
  • Think how…             - her successes must have felt
  • Think how…             - she must have had pain & heartache
  • Think of her…           - strengths
  • Think…                     - she has faults

3.             Now ask yourself, is she really any different from you

Thursday, May 16, 2013

International Symposium on Motivational Interviewing

I recently attended the 3rd International Symposium on Motivational Interviewing (MI) held in Melbourne, Australia. The speakers covered topics such as MI directions, how we learn MI, the kind of challenges practitioners face when using MI, amongst other matters. Technical therapeutic definitions aside I though Stephen Rollnick gave a beautiful and uplifting talk explaining the “Spirit” of Motivational Interviewing.

The “Spirit” of Motivational Interviewing

MI is more than the use of a set of technical interventions. It is characterized by a particular “spirit” or clinical “way of being” which is the context or interpersonal relationship within which the techniques are employed.

Motivational Interviewing has been a utility I have been using in practice for a good number of years now and attending this Symposium has only reaffirmed the value of MI. 

Follow the link below for a concise overview of Motivational Interviewing

Monday, May 13, 2013

DSM-5 Like it or hate it's what we have

The imminent new edition of the Diagnostic and Statistical Manual of Mental Disorders 5 may hurt confidence in psychiatric diagnosis. The update includes new diagnoses and perhaps, controversially, reductions in thresholds for old ones that will possibly inflate the already strained boundaries of psychiatry. How the new edition will sustain robust research in the field is now a hotly debated concern. But more so, it’s entirely possible that following the DSM 5 may lead to over-diagnosis and as one consequence over-medication.

It should be said that it’s with fortune that some of the DSM 5’s more contentious proposals were eventually dropped under external pressure. These included, amongst others  “psychosis risk”, mixed anxiety/depression, internet and sex addiction, cumbersome personality ratings.

I for one would have preferred further delay in the roll-out of this edition and have the APA more properly field test this edition increasing much needed opportunity for quality control.

Tuesday, May 7, 2013

Teach a Man to Fish…Will He? The fallacy of expected change

Teach a Man to Fish…Will He? The fallacy of expected change

We often talk about bringing about change. We embrace Transtheoretical models of behavior change, we assess people’s readiness to act on new and healthier behavior, we provide strategies for change, we guide the people through stages of change – but, and this is a big but; one of our most profound errors of social intelligence is the assumption that if we provide someone with a vehicle for change, they will not only accept it, but undertake to make it.

How many times, for example, we in good faith extended a hand to someone, only to have them slide right down the same slippery slide that you just dragged them up from? This isn’t just the territory of enablers and agents trapped in a cycle of addiction. It’s a frustration regularly visited upon many of us by our kids, co-workers, friends, spouses, partners, and the family pet.

In fact this may be the fallacy of expected change.

Change comes to the willing. The willingness to change is based on a very simple reckoning.

In it’s most simple form - It’s when the consequences of our behavior outweigh the value of that behavior to us, it is an invocation of change. There is no guarantee that this change will happen, but, before it can even be considered, the conditions of potential change - consequence outweighing value must be met.