by Jamie Blum, LCSW-C
Anyone who has ever made and broken a New Year’s Resolution can appreciate the difficulty of behavior change. Making a lasting change in behavior is rarely a simple process, and usually involves a substantial commitment of time, effort and emotion. For some people, support from others helps them stay motivated and committed to their goals.
Motivation varies by individual and their circumstances. Therapy can support change by helping to identify, evoke, and strengthen an individual’s motivation and resolution. Psychologist Dr. William R. Miller, pioneered the concept of motivational therapy in the 1980s as he researched the fundamentals of the psychology of change with a focus on addictions, but the research shows it is also important in other areas where people desire long term changes in behavior.
What is Motivational Interviewing?
Motivational Interviewing (MI) is a collaborative discussion between a client and therapist with the goal of strengthening a person’s own motivation for changing a specific behavior. The two core values in MI consist of collaboration rather than confrontation and autonomy. The therapist’s role shifts from authority to support. This allows the client to start focusing on changes and to have a “safe space” to make these changes.
Jane’s story will illustrate motivational interviewing (MI) and will outline the different stages of change.
Jane is an addict. Jane has a family and a full time job. However, her addiction became a second full time job; and she started therapy because she was tired of what she called the race. At our first appointment she said that she had tried all avenues to beat her addition but was unsuccessful. She was frustrated and angry but stated that she was motivated to come to treatment and work toward her recovery.
Jane’s story and Stages of Change:
The first step in motivational interviewing is to examine and understand how motivated the individual is to start making changes in behavior and what drives that motivation. It is important for them to understand their own motivation as well. When the client is ready, they will identify that they are ready to start making changes and then will focus on taking steps to make those changes. When a client is not prepared to start making changes, this is referred to as the pre-contemplative stage. The goal of therapy in this stage is to discuss the ambivalence of making changes.
At the first session Jane stated that she was motivated to start making changes around her addiction because she was seeing its impact on her family and her life. While she stated that she was motivated for treatment, beyond coming for therapy there was no evidence that she was considering making any specific changes at that time. She would say things such as “At work they say that I do a great job…”and “ It’s really not that bad.”
For Jane it was several months of encouragement and active listening before she was ready to discuss past struggles with her addiction. She slowly began to discuss both the advantages and disadvantages of continuing her behavior, started to explore her triggers and began to set short-term goals around making changes in her drug use. Slowly her language began to shift from “I can’t” to “maybe” and “ possibly”. As she began to acknowledge her ambivalence she was moving into a new stage referred to as the contemplation stage.
There is no clock for an individual to remain at any given stage. For Jane, while she was in the pre-contemplative stage for months, she transitioned from contemplation to the preparation stage rapidly. Instead of saying that she ‘might try’ to behave differently sometime in the future, now she began to create a plan around making small, positive, changes and within the month and she established realistic goals if she were to relapse.
Similar to many others struggling with addiction, Jane cycled through these stages multiple times before she was able to reach the action stage in which she was able to commit to change. Throughout that time she and I would continue to address the fear of relapse; however, in the action stage, she was also able to focus on positive changes that started to come with abstinence. She talked about making new friends at work as well as positive changes in her relationship with her husband that had been rocky in the past. Jane found a group of people who could relate to her struggles and fears.
Jane was able to maintain abstinence for a year before stopping therapy. Her family had become sources of support where previously they had been sources of reprimand and conflict. She had new friends and found support in new places. She was able to develop a plan if relapse were to occur again; relapse being the final stage.
How can you use motivational interviewing techniques at home?
While the use of Motivational Interviewing is a successful tool to examine behavior change in a medical or therapeutic setting, some key element can be applied to more everyday situations.
1. Understand where your loved one is at in making changes to their behaviors. If they are not ready to acknowledge the problems associated with the behavior, all the yelling and arguing in the world won’t change them.
2. If your loved one is ready to start discussing the issues then listen and ask clarifying questions rather than sharing your opinion. Help them to make one small change rather than big promises that are hard to deliver. Provide support by asking open-ended questions and validating their successes.
3. Understand that they may relapse into old behaviors since improvement is not a straight line. Rather, change tends to follow the saying “Two steps forward, one step back”. Focus on positive changes that were made and reinforce the capacity to change. Be aware that the process of change is challenging and can be discouraging for your loved one not just for you.
4. Lastly, when your loved one is ready, provide support in their seeking treatment; however, let them make the phone calls necessary to start treatment. Don’t do it for them.
Jamie Blum, LCSW practices in Baltimore and Annapolis. She is experienced in cognitive behavioral therapy and motivational interviewing with both adults and adolescents. Please visit www.cpeclinic.com website to read more about her practice. She can be reached via email at Jamie.Blum@cpeclinic.com.