It is not the stuff of whimpy kid making that brings someone to our service. The courage to first realise, admit and then reach out for the help you so desperately need can be draining and often overwhelming. To finally understand there are no resources in the toolkit of life that are working for you in truly rock bottom. To know that all the default behaviours have let you down and you are (truly) running on empty is a scary place from which to seek help.
To really engage with another person involves active listening. This means 100% focus on what is being said, what is being implied (the sub-story) and being able to empathise without patronising or diminishing the person’s level of anxiety about their situation. The effort taken to listen actively is great; leaving one’s personal values – from which we make judgements – and core beliefs – from where our world view emanates – at the front door is a practised skill involving self-awareness, self-effacing discipline.
Some years ago I heard about taking one’s emotional pulse, a new concept yet one with which I am now familiar. Knowing my frame of mind, where my emotions are running and what preconceived ideas I may already be holding about the outcome of this time of engagement with the client are valuable indicators that tell me how effective I am likely to be in the visit. I am paid for my time my client is not, they are there voluntarily and attending from a position of vulnerability. The least I can do is set aside my ‘stuff’ and afford them the courtesy of hearing their story which I can only do if _ _am free from judgement and expectation.
Motivational Interviewing (MI), or Motivational Enhancement Therapy, as it is now called is about providing the foundation for change rather than being the agent that forces change. Just look around, everyone is motivated by something. Promoting change comes by uncovering that motivator and then building a case for change. Being stuck in a set of behaviours is one of the greatest barriers to change as it shows we have lost motivation. Uncovering that motivation helps us find the things that matter to us. For example if we value relationships and find meaning and purpose in connecting with others, when we become isolated and depressed we loose that connection, purpose and left unattended for a time will become very difficult to find our way back. On the one hand we value connection, yet on the other we have isolated ourselves. What has happened to cause that pulling away from the things from which from which we draw energy and purpose? For my clients it is isolation caused by shame and guilt of drug-taking activities. Helping them reconnect with those values helps uncover the motivation to change.
Not everyone who reaches out is change-ready and within the Motivational Interviewing framework we enter the journey at their stage of change with the goal of slowly moving them from one stage of the cycle to the next. Always at their pace and in their way.
Not ready to change: we provide information about their drug of choice, effects of their drug on behaviours and the impact on parenting capacities
Thinking about change: looking at the pros and cons of using; and the pros and cons of not using; where will I be in five years if I continue and if I stop using now
Getting ready to make a change, planning and commitment: identifying goals, strategies to help achieve these and the barriers that could prevent a good outcome
Making the change, implementing the plan, taking the action: looking at possible high risk situations, people and places, forming a plan if found in any of those situations and starting to live each day differently from the past.
Sustaining behaviour change until integrated into lifestyle, maintaining, integrating: tweaking new skills as well as learning how to navigate life now that they are drug free yet others maintain an unhelpful perspective of the person as a drug user.
Slipping back to previous behaviour and re-entering the cycle of change: look at why the lapse/relapse happened, what triggers were ignored or embraced, the next step, getting back on track
Leaving the cycle of change: I am not sure that addictive personalities ever leave the cycle just as the rest of humanity have ups and down so too will the once substance dependent person.
The client-focussed and driven approach at the core of this therapy is non-threatening both to the client as well as the clinician. Motivational Interviewing has proven its efficacy time and time again. I have tried many other therapeutic interventions and return to home base every time. MI was introduced in 1991 targeting substance dependent clients and many of its techniques have been integrated into other therapies. Across the board they take from each other and when scrutinaneously pondered they all claim to be client focussed, strengths-based etc … forms of interventions. Finding the therapeutic model that works best for our personal style is a matter of trial and error. I am grateful that I did not have to find MI rather it found me … in the classroom at college at the start of a new direction in career.
I am totally convinced of its worth and efficacy in promoting change and well done it empowers the vulnerable to once again take responsibility (control if you like) of their lives.