Over the past two decades, huge strides have been made working with clients previously thought to be untreatable. Motivational interviewing has been used with significant success for clients with addiction issues, when compared to other clients receiving the same addiction treatment with no motivational interview.
Motivational interviewing assumes the person with the problem addiction is truly the only one that can change his behavior. The role of the therapist is to uncover and release the person's intrinsic motivation through connecting with his already-formed values and belief system.
Open-Ended Questions
It is really common for people to feel disgusted with or superior to a person whose life is clearly out of control. This is especially true when that person's behavior has harmed his family, friends, workplace or community. A therapist's internal attitudes, even when unspoken, can sabotage the atmosphere of the interview. To help a person find the power to change from her own values, the therapist needs to be open and curious about what is being hidden or even protected by the client's addiction. A useful stance is curiosity and openness to what remarkable values and qualities she has inside her to bring to bear on her ability to change.
Open-ended questions follow. What is it that brings you here now? What is working or not working in your life right now? What would you like to be different? If in a year, you were living in a way that felt good to you, what would feel different? What's the smallest step you could take to start moving in that direction?
These questions cannot be answered with a yes or no and invite further conversation on the part of the client and further listening on the part of the therapist.
Reflective Listening
As the client begins to share what's out of balance and what dreams he has, the therapist mirrors back to him what she is hearing. This is a skill that takes different amounts of time to develop. Some people, when they are first learning reflective listening, may parrot back what the client said, and find the client exasperated with them.
What you are doing is listening for the deep, and likely archaic, conflict or need that was not addressed or attended to at an earlier time in the person's life. For some people, the addiction may be a way to avoid a feared situation or a sense of hopelessness. When you hear that unstated fear or discouragement, respond with a statement like, "Sounds like you had lots of times when your mother/father (fill in the blank) ignored (fill in the blank) you. So is that why you feel . . . ?" The client can then clarify what is accurate and inaccurate in your understanding and when you finally fully share the perspective with the client, he can finally release the unexpressed emotion and begin to learn he can be heard.
This work is as skilled as being a good comedian or a good lover; timing and attunement is everything. A correct but out-of-sync response will feel wooden, and the client is likely to just chalk it up as one more time he wasn't worth hearing. Your helpfulness as a therapist is over.
Affirmations
At this point the therapist knows enough about the client and her situation to truly appreciate the strengths she has used in her life, and recognize all the effort she has made to get to today. A child who grew up in foster care after being taken from a chaotic abusive home may as a parent herself use drugs. She also grew up in spite of difficulties many people didn't have. Maybe she kept alive in herself a love of music, or takes care of her dying mother. Maybe she's the one in her trailer park other people turn to for comfort when they're having a bad day.
Identify the strengths she is willing to bring in service of her own healing. Acknowledging that she has suffered long enough and maybe there's one small step she can take toward health.
Summarizing
Here's where ambivalence and resistance may show up. Who likes to change? The job of the therapist at this point is to help the client notice his ambivalence and to affirm it, and yet to encourage him to focus on what's most important to him, on his core values. It is essential that the values are the client's own values and not those of the pastor, or therapist, or faith community. Someone else's paddle can never power the client's boat. Change talk helps the client speak what inside him he is bringing to bear on the current situation that will make things better for him.
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