Motivational Interviewing

OliveJewel

MyPTSD Pro
Anyone familiar with the technique of motivational interviewing? My addiction recovery program uses it but also teaches it to us to use with others. Apparently it is the basis for CBT. It is intended for people who are in a state of ambivalence about their ability to change. If people are convinced that they can or can’t change then it is not as effective. Supposedly it can be applied to not just counseling but also medical practice, classroom management, parenting, and even lobbying lawmakers about climate change.

I asked my T if she had heard of it and she said, “Oh yeah,” like it was common knowledge, and led me to believe she probably utilizes it, and upon reflection I could see that. She’s an addiction counselor and MI was originally developed to treat alcohol dependence.

I am curious if you are familiar with it and if you have learned the techniques. I am interested in getting trained in it. For my program we are supposed to practice it and then write about it. I will write about my experience.

Before I do I will explain my understanding of it at this point. MI is a style of communication which seeks to validate the other and direct them toward action. This is different from Carl Rogers’ non-directive interviewing approach. The style is based on questioning rather than directions (even though the goal is direction—suddenly I’m thinking of police questioning 🤨—Anyway, I guess it makes sense that there would be times that a counselor (or teacher, or doctor, or parent, or lobbyist) would want to direct the other person, particularly when the person is ambivalent about changing negative coping behaviors.)

The questions proceed as follows:
1) engagement with the other—who are they, develop rapport, affirm their existence and values.
2) what is a big concern of theirs (addiction, anxiety (though apparently if there is any mental illness or personality disorder this style is less effective, so not even that great for PTSD).
3) why do they think this is a problem.
4) how do they think they might resolve it

This is my very basic understanding and apparently it’s a nuanced process which involves particularly not fighting the other’s resistance to change.

I tried it with my son yesterday. We talked about anger and how some people lash out at others instead of coping with it on their own. It’s hard for me to describe the conversation in detail. I tried very hard to focus on asking him questions rather than “sharing my wisdom” 😅. I also tried to focus on affirming his strengths and values. The conversation was supposed to last about 15 minutes, ours was about 10, and I noticed that after 5 I wanted to stop but kept going. The conversation happened organically based on events prior to the conversation. He was calm and I was calm. I forgot to thank him for it at the end. I liked that way of communicating and it made me want to learn more or get trained.

It’s important for me to point out that when my sons were young I was unable to train them to cope because I didn’t know how to co-regulate so my son is behind on learning that. So even though my goal is for him to be able to cope with his anger on his own, he still needs co-regulation that he didn’t get before and that he needs now at age 14–and I’m so much better at that now than ever before, and he has come a long way.

Last night I went out with a friend, who happens to be a trauma therapist, and she was sharing with me some of the struggles with her partner and I tried to dip into motivational interviewing mode, but found that I wanted so much more to make statements of affirmation and validation. I suspect that my mind-body recognized that my friend is not ambivalent about her situation and that there is no need for me to motivate her, but rather just support her or just listen to her, which is closer to Rogers’ non-directed listening. And furthermore, I don’t have to have unconditional positive regard for her, since she is my friend (even though thats kind of my fallback, due to decades of codependency) I can have conditions with her, certain expectations. For example I can expect her to not ignore me or not tease me and if she were to do those things I can withdraw my concern for her.

I do tend to mix up therapeutic with friendship, but hopefully I’m separating them now. I’m starting to see how friendship is an extraordinary type of relationship compared to teaching and parenting and professional and medical and political and community.

Wow I really wrote a lot. If you are still with me I’m curious if Motivational Interviewing is something you are aware of or have pursued an interest in.
 
I was taught MI over a boot camp-style weekend, which I realize is probably not an ideal way of learning it. But I used it every week for more than two years while I ran online groups for the study.

I still use it in my current online group occasionally and it's served me very well as I take counseling classes.
 

Friday

Moderator
And furthermore, I don’t have to have unconditional positive regard for her, since she is my friend (even though thats kind of my fallback, due to decades of codependency) I can have conditions with her, certain expectations. For example I can expect her to not ignore me or not tease me and if she were to do those things I can withdraw my concern for her.

I do tend to mix up therapeutic with friendship, but hopefully I’m separating them now. I’m starting to see how friendship is an extraordinary type of relationship compared to teaching and parenting and professional and medical and political and community.
So. Much. This.

Completely aside from everything else? THIS = Very, very well done.

Apparently it is the basis for CBT.
Nope! Not without a time machine 😉

MI was first described in 1983. CBT developed out of Rational Emotive Behavior Therapy (which developed out of -shudder🤢- Behavior Therapy), & Cognitve Therapy, in the 1950s-60s, with Cognitive Distortions etc. cannon & textbook with decades of clinical use worldwide…by 1977.

Of course, there are countless (named) methods based on variations of the Socratic Method (manipulating others by asking leading questions)… which is thousands of years old. Which both MI & parts of CBT fall under. But as far as the evolution of CBT (branch) or CBT (method)? You’re looking at a marriage/evolution of BT (1950s), REBT (1950s), & Cognitism (1960s). Whilst MI didn’t join the scene until the early 80s.

Supposedly it can be applied to not just counseling but also medical practice, classroom management, parenting, and even lobbying lawmakers about climate change.
Yep. Leading Questions designed to make a person convince themselves of something they would be just as likely to argue as agree with (flip a coin) if someone else said it to them? Not only works on the ambivalent but also on anyone who doesn’t have a secure sense of self… the young, the distraught, the desperate, as well as often disparate individuals within a group setting (not true teams, who have dual identities of both individuals within the group as well as a group identity)…for example? Not just classrooms but groups like juries (who answer the question for themselves in their own heads, regardless of what the witness says, and predisposes them for/against the witness based on the congruency of the witness’ answer. It’s part of why “leading the witness’ is disallowed in many if not most countries, and is described as ‘tainting the jury’ -or similar phrases describing the bias one creates- in a whole lot of ‘em.). Politicians, by nature, tend to have very porous identities (as they attempt to meet the needs of themselves/their own ambitions, their constituents, their party, their committees, their donors, etc.) so are VERY susceptible to influence & manipulation… at least professionally.

It’s not my preferred way, or even on the list TBH, to lay a path for others to follow… but it’s an effective one.
 
@OliveJewel or @Friday or anyone who is familiar, could I ask a question? I don't know anything about MI, though I've re-read it a few times, but you mentioned the addiction recovery. I don't want to screw up/ add to another's path in a negative way, but what I just read from David Burns was (part) was the person (or myself also, as Gabor Mate says we all are addicted to something) is to play Devil's Advocate- an important part is listing and a rapport with another or yourself where you actually argue contrary. My Big Question is, he says the biggest harmful thing (harmful as in preventing recovery or leading to relapse) is to use questions that 'help', that are leading. 😕 That is, he says no, don't motivate the person 'towards' what you would deem recovery, that is the biggest factor in 'failure' rate. (???) I have always believed a person (any person) has to come to their own reasons for change. And that it's important to acknowledge what one is getting out of something (Burns says it reflects many wonderful things about the person). Mind you, I am relating the experience of internal choice more to my own decision re: no suicidality, and the addictions I stopped.

Also, shouldn't one strive for positive unconditional regard in relationships and friendships? (Doesn't mean you don't have boundaries or conflict or communication or negotiation)?

I think I'm totally confused???..😕

Thank you.

ETA I suppose I have a belief too where I don't believe in anything that is ~manipulative (I'm sorry I know that's not the right word- maybe leading), even if "I" think it's a better choice (because it's not my life to live). But of course it's helpful to motivate children or for even for adults to feel better about themselves. But I would (just personally, only speaking for me), I encourage what I see/ know is their strengths. I wouldn't want to put a 'thought' in their head, specifically?

Or like, I don't want someone to 'feel' heard or understood, I want to hear them and understand and communicate it so they do. (?) Which I suppose I can't always but maybe understand better than I did before. Like the Socratic Method for that purpose.
 
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OliveJewel

MyPTSD Pro
MI was first described in 1983. CBT developed out of
My bad. I think something said that MI sets up the will to change, CBT goes about the action of change.

Interesting reading about the leading questions. Makes me very much think about the prototypical used car salesman. And advertising in general. Motivation is a pretty important concept for people who make their money designing ads and for people who want to sell their crap. (Am I jaded? No! 😇)

I sometimes wonder if I could train myself to work in finance. It seems to me like a secret club that purposefully obscures the door. Also there is something in me deeply opposed to chasing money, yet I spent a bunch of time chasing after state benefits to be rewarded with $30 a month. My brain feels all jumbled about economic issues. I wonder if I could motivationally interview myself about my need to be able to have money but also vilifying those who are wildly successful at it.

Did not mean to veer into a digression about my money fears. But just going to leave it.

@CoolBreezeonahotday I will try to respond to your thoughts
shouldn't one strive for positive unconditional regard in relationships and friendships?
Friendships and relationships… by relationships I think you mean partner relationships? (As opposed to professional relationships). I will answer based on my assumption. And the answer is a resounding NO. I would like to (kindly 😊) shout this to all the codependents and enablers in the world.

Who should have unconditional positive regard? One’s own children, clients of T’s, minors in a school setting, customers. Mostly children because clients of T’s can cross boundaries and lose that unconditional positive regard. Customers can be kicked out. (Unfortunately children are increasingly seen as tiny adults (again❕, since this was the case historically) despite the evidence that their brains are wildly different.)

Carl Rogers taught about unconditional positive regard for a therapeutic setting. I don’t know his views on reparenting but basically (from my perspective) unconditional positive regard mimics what the parents should have provided to the child so that the individual can complete their psychological development which was frozen at some point.

The reason adults don’t provide unconditional positive regard for their partners and friends is that it opens them up to maltreatment and violence. Children act like little drunk bastards and it is the parents’ responsibility to stay present and correct the behavior (how to do this is a huge argument among self-proclaimed parenting experts.). Adults act like drunk bastards and it is no one’s responsibility but their own to stay present and correct their own behavior—unfortunately countless adults are trained (by society?) to parent other adults in their friendships and partners.

I blame the church for infecting my mind and those in my family (mostly women) with the idea that we could be the Jesus and Mary of our families, turning the other cheek, bringing the metaphorical dead back to life, and forgiving everyone with a blank look of sorrow on our faces.

he says no, don't motivate the person 'towards' what you would deem recovery
Carl Rogers also advocated for non-directive approach. I don’t think the issue is binary, as in either direct the questions or don’t. I think the issue is when to use each approach. Non-directed on topics where the person displays a firm position, directed when the person displays an ambivalent position, particularly with respect to a behavior that is harming them or others.
 
I understand your perspective I think @OliveJewel , thank you. I'm sorry I am pressed for time for a response that does your's more justice, which it deserves. I kind of meant all relationships, but of course partners and friends. More the attitude and thoughts rather than codependency or abuse. I'm basing it on John Gottman's work. I guess more like noticing what's right, or the person does, or strengths, appreciation and gratitude. But individuated selves (although there can be relationship strengths together (i.e. a good team/ compatibility).

ETA , By way of explanation, so if your friend ignored you, positive regard would say maybe there is a reason that is not negative, not a reflection on you, provided she was aware it was hurtful to you and she showed she was not a hurtful person. Then, in dialogue, if in the future she could reduce that, perhaps not perfectly (who is?), and you would do the same for her pain points. Hope that makes sense.

I think it's a bit like a pendulum (not a metronome) for me, sometimes I go further one way but with time and choice (based on reason to) to trust and with practice I deviate to less extremes, if that (also) makes sense? (Well, I am a work in progress and it takes a lot of work! 🙄 )
 
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"Leading questions" isn't an MI technique, at least not the way I learned it. If I was going to use MI on you, I would not be steering you towards any outcome. I would be working with your ambivalence toward finding ways to improve your life, and for people with addictions, this often ends up doing some kind of work towards ameliorating the addiction (but not always).

It's an incredibly reasonable technique and it meets people exactly where they are - not where they would like to be, and definitely not at a place we think they should be.
 

OliveJewel

MyPTSD Pro
@CoolBreezeonahotday I see your point. If my friend is ignoring me I might try giving her the benefit of the doubt, checking in with her, etc. I would need evidence that she is *actually* ignoring me. I think the pendulum is an accurate metaphor for developing awareness of how as a survivor I may have discounted myself and my needs way too much in the past in order to offer what I thought was continuous unconditional positive regard, but was actually a wall of resentment and disorganized attachment in many ways.

toward finding ways to improve your life
Had to laugh because this is steering toward an outcome. It’s funny because who wouldn’t want to improve their life? But in some ways when I was deep in my drinking I saw my life as pretty great and the drinking “helped” me feel that way. I think addiction counselors automatically see that as denial and self-delusion, and I agree but it’s interesting (to me) how I could see it that way.

Reminds me of Hegel’s dialectic. Whichever position one takes, causes the opposite position to spring forth. Until (hopefully) a third position arises which encompasses the two oppositional ones. Sounds like MI is kind of a dance with resistance, keeping in mind that staking a position leads to the opposite one, so avoiding that?

Interesting how you distinguish that in your learning MI does not advocate taking a position (other than bettering one’s life, which in my mind is still a position but one that is fairly universally accepted?) , but rather is maintaining an openness to hear the position of the other and move in that direction, is that an accurate rephrasing?
 
Well, if you're in a position that you're seeing someone who's using Motivational Interviewing on you, you're almost certainly aware that something in your life isn't going the way it should be.

I could help you explore what that is and what you can do about it through talking and questioning using MI. I would just want what's best for you, and I'm usually going to assume that you do too. I'm not pushing for any particular outcome except for you to be able to do something for yourself that will improve your life. But I'm going to help you get there through cheerleading and asking questions, not advising or telling you what to do.

Now, some folks with trauma don't actually want what's best for themselves and don't really want to improve their lives, but even if that's the case we can usually discover that there are still small ways they can do better things for themselves. Often it helps.
 
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