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Thursday, 24 July 2008
Motivational Interviewing.
Motivational Interviewing (MI) is a term that is usually associated with drug counselling but it really applies to all forms of counselling. The therapist finds himself sitting in front of a 15 year old who’s mum found him smoking cannabis. So he has been brought to counselling so he will stop taking the drug.
Upon several enquires the therapist quickly establishes that the errant teenager sees nothing wrong with smoking pot, all his friends do it and he enjoys it. He is thus seen as having no motivation to stop the drug use. At that point the therapist is meant to apply the motivational interview. The goal of this is so the youngster will then become motivated to stop smoking pot and then commence gving up the drug.
I have always found the concept of MI a bit of a contradiction. The therapist applies the motivational interview with the client. So in this sense the client is a passive recipient of it. A passive person is kind of the opposite to a motivated person. The motivated person is self driven to get out and act in a certain way. The passive person waits for others to get them going.
So there is an inherent flaw in the whole idea of the MI in that it is encouraging the client to be passive in the relational with the therapist which is the opposite to being motivated. Its like the therapist who says to an inhibited client, “Be spontaneous”. As soon as the therapist says that, then the client can’t be.
MI basically involves highlighting the negatives of the particular behaviour and then it is assumed that the person will naturally want to stop doing it. Unfortunately that is a very big assumption and one which many psychological theroies make. For instance Maslow states that we all have a natural drive towards self actualization. Then we have people talk about things like the libido or creative energy in us or physis which is that innate drive in all humans to get better and grow and develop.
This is where we get to that thorny issue of hope. Humans hate the idea of there being no hope, they really don’t like it. So when psychological theories state that everyone has a natural tendency towrds growth and health they are alos saying that there is always hope for everyone. Are the theroies saying this because they are accurate or are they saying it because they want (or hope) it to be true when in fact it may not be. Just because something is distastful does not make it unture. Maybe sometimes there is no hope for some people? Perhaps these psychological theories are just feel good theroies in this way.
In counseling one really is confronted by this day in and day out. Why do some clients change and others do not? An often asked question and one with many different answers. Why do some clients grow towards health and others do not? One answer is that the theories are wrong and not all people do have an innate drive towards health and thus there is no hope for them. With such people doing MI of course is a waste of time. The therapeutic goal really is the for the client to accpet that this is their lot in life, this really is as good as it gets for them.
So in relation to the topic, I suppose I am identifying another flaw in the MI process. It assumes that all people are capable of becoming motivated to grow towards health. Maybe that assumption is incorrect?
Graffiti
20:31 Permalink | Comments (52) | Email this
Comments
No, I think all people can be internally motivated to grow towards health---that's probably one of the most basic evolutionary drives---to be healthy enough to propagate the species, right? But that is assuming all people have a picture of what "good health" is.
If your role models are all defective, I can see where you might have a pretty skewed vision of good health. And even what we see in the media skews our perception of good health. Smoke cigarettes and drink alcohol and take these prescriptions. If you just watched TV all day that might be the message you get. But if you're struggling for survival, say in remote Alaska or equatorial Africa you might be a bit more inclined to take your physical health seriously----but maybe your mental health would take a backseat in that case. It's so variable--then you throw in organic/chemical imbalances in people and that skews what someone might see as "good health" ....
I guess what I'm saying is that growing toward good health is probably something we all have at the most basic level, but it gets tainted by our interpretations of the people around us, the messages from the media, and our own brains telling us messed up things.
Posted by: April | Friday, 25 July 2008
This post doesnt sit comfortable with me.
I guess I do not agree that there is no hope for some.
That guy Ken blogged about some time ago. If he is still alive - then why? - he must still be hoping for something. Or if he killed himself, then he reached his hope to die.
And maybe the client who is not growing towards health is just with the wrong counsellor for them.
Posted by: kahless | Friday, 25 July 2008
This is an interesting post Tony. I remember going to my counsellor once and being very upset and saying there was no hope anymore. But gradually somewhere in me I pushed through that. I think we always have to have hope to get on with life.
But I can also see where you might get very negative clients who while they might have hope for better things, will still stay in the same situation or not want to be motivated for whatever reason. Maybe it is personality or scare about changing or wanting someone else to do it for them. I think sometimes while we hope for something different it is having the courage to push past the comfort zone and do something which scares the sh** out of us.
I have a friend at the moment who is unhappy about where she is in life right now. She has a job she doesn't like and is finding it hard to make a decision to change. I don't think she has any hope for the future of doing something that she'll really enjoy. I can see if she was a client that every suggestion that would be made, she'd have a counter arguement. She does it with most things - will always bring up the negative side of it. How do you motivate clients who are like that? It would be like batting your head against a brick wall.
But I still think the biggest thing against hope is the scare of change. It is frightening to change things.
Kazza
Posted by: KazzaB | Friday, 25 July 2008
Wrote a comment and it didn't post. Oh well, that's life. LOL Too early in the morning to think of it all again.
Kazza
Posted by: KazzaB | Friday, 25 July 2008
Kazza,
Your friend...
That is a game is it not?
Why dont you, yes but
or whatever is called?
And lol!
your comment posted
Posted by: kahless | Friday, 25 July 2008
Very delayed posting that was Kahless!! LOL It is a game but I can't think of it right now. Tony, Madeleine or Ken??? LOL Is it the game of Yes, But........... I don't know if that's what it is actually called though.
Kazza
Posted by: KazzaB | Friday, 25 July 2008
I've got a book by Eric Berne called Games People Play and I thought I would not be lazy and look up the game myself. LOL According to that the game is "Why Don't You - Yes But........ Whatever the person suggests to the other person is met with Yes But.......
Is it that the person making the suggestions is trying to be a rescuer and the person saying Yes but........a victim? I don't know if I've got that right?
Posted by: KazzaB | Friday, 25 July 2008
I got the same book; I definately cant be arsed to go fetch it though lol !!!
That is the game though.
One of the secretaries at work plays that one constantly. I cant help but just listen to it be enacted out! Never ceases to amaze me. I tried the antithesis once (though cant remember what it was right now lol!) and it worked. So cool.
Posted by: kahless | Friday, 25 July 2008
Oh and Tony, your latest pic makes me think that someone is tickling you and you are trying not to laugh.
Posted by: kahless | Friday, 25 July 2008
Just a brief comment as I have to go to work and will respond in more detail later.
Hope? Games People play?
Read the last sentence in the book (Chapter 18).
He maybe right and I hope he isn't.
Graffiti
Posted by: Tony | Friday, 25 July 2008
Damn; that is intriguing.
I might just have to get off my butt and look for the book. I think it may be under my bed (hopefully..)
Posted by: kahless | Friday, 25 July 2008
Well I am going to sleep now; maybe I will just get lucky and someone will type the quote here so I dont have to scrumage around in the morning...
:-)
Hope eternal...
Posted by: kahless | Friday, 25 July 2008
And I can't find my copy. Graffiti has me intrigued now.
Posted by: gezunda | Friday, 25 July 2008
It says "This may mean that there is no hope for the human race but there is hope for individual memberes of it"
He was refering to some who don't ever seem to change or rise above the programming of the past and to see something more rewarding than games. he says that perhaps thay are better off as they are seeking solutions elsewhere.
Good old Eric was also a "such is life man". God bless him.
I am still around Kahless if you were referring to me. I have been a little unwell and not able to express my usual passionate and thought provoking blogs. Does that mean my next one will be a doozy?
kenoath
Posted by: kenoath | Friday, 25 July 2008
Thanks Kenoath. Now I don't have to keep looking for my copy to satisfy my curiosity :-). Hope you are feeling betterer !!
Posted by: gezunda | Friday, 25 July 2008
ta Madeleine. I looked everywhere for my copy too. There are three copies in this house somewhere and I couldn't find one of them. But there it was next to the Astro Sex book.
kenoath
Posted by: kenoath | Friday, 25 July 2008
"Astro Sex", now that's an intriguing concept, Kenoath. Please explain !!
Posted by: gezunda | Friday, 25 July 2008
Yes please explain kenoath!
I am sorry that you have not been well Ken; I am hoping you a speedy and full recovery. What does doozy mean?
I think about that guy you talked about on your blog once from time to time. And wonder how he is. It was he whom I was referring to in my earlier comment.
Posted by: kahless | Friday, 25 July 2008
Google it Kahless and see what comes up :-).
Posted by: gezunda | Friday, 25 July 2008
I have now. I must say i was very disappointed with the results. I was hoping for something more, well, I dont know. More racey!!!
lol!
Posted by: kahless | Friday, 25 July 2008
LOL. thanks for the giggle Kahless. I'm not quite sure where your mind went on that one.
Posted by: gezunda | Friday, 25 July 2008
I guess I was thinking ....
astro ... to astral ... to flying ...to ...
Anyway; I am having a day of rest from the garden today. Off out to lunch so catch ya later.
Posted by: kahless | Friday, 25 July 2008
Maybe Kahless has developed a "racey" idea about me :)? I still don't know who you mean Kahless, because I am a ken oath or equally valid ken neth.
Hope you are having a doozy of a day Kahless.
kenoath
Posted by: kenoath | Friday, 25 July 2008
Have a great lunch Kahless. One day I will join you !!
Posted by: gezunda | Friday, 25 July 2008
Astro Sex is a book in my friends library its never been read I dont think. Its an Sun sign astrology book which has rather rather generalised statements about different sexual relations of the signs.
Funny enough they use statistics from a major world wide survey done about lovelife, sexlife and relationships of the twelve star signs. It says that Pisces men score 46% in the infidelity stakes which is just less than the norm. Where as Pisces women are the most likely of all the signs for infidelity. Their % is twice that of other women.
More pisces women than any other sign lay the blame for their infidelity on poor sex at home.
Believe it or not
kenoath
Posted by: kenoath | Friday, 25 July 2008
So what does it say about Leo women??
Posted by: gezunda | Friday, 25 July 2008
Leo women are turned on by sensual massage, she prefers in a luxury hotel or a warm deserted beach at sunset, the majority of Leo women dont fall by the wayside with regard to infidelity it seems. But those who do say it is because of physical attraction.
kenoath
Posted by: kenoath | Friday, 25 July 2008
Do you like me thinking of you as racey Ken?
;-)
Posted by: kahless | Saturday, 26 July 2008
Kenoath,
this is the guy who I was talking about earlier...
http://kabrahams.blogspot.com/2008/01/ending-despair.html
Gezunda,
you certainly dont want to eat with me at the place Mrs K and I went to at lunchtime. It was horrible.
Posted by: kahless | Saturday, 26 July 2008
Okay so we will knock that off our list of places to go to LOL.
Posted by: gezunda | Saturday, 26 July 2008
Just been reading a bit more about motivational interviewing and the idea of simply pointing out the problems with the behaviour to me in itself can cause problems. It seems to point out only the negatives i.e. this is what's wrong with your behaviour, these are the consequences etc. It doesn't seem to give the client anything to replace the old behaviour with. Therefore we end up with potentially a Parent contract.
I was working with a client yesterday and she kept telling me about all the things she had to stop doing - a Parent contract.
When I asked her what she could do differently, she had no idea. She only knew one way of doing things. The way she had learned as a child. We worked through this and she left with a place to start.
and I guess that's one of the problems I see with MI is that unless the client can work out a "start" contract rather than a "stop" contract, nothing will change. To me MI is a stop contract and therefore a Parent contract. If that makes any sense at all. It does in my mind.
Posted by: gezunda | Saturday, 26 July 2008
It seems that the new catch phrase amongst counsellors is now "unpack" To unpack an issue, to identify an area for the client and help to "unpack" that for them. Well, holly molly Grafitti, I never thought I was in the removal business or that I could unpack the shopping bags or perhaps the boot of someones car! So, when that is all unpacked what next? Perhaps MI is a little of that unpacking (a word I detest now) and Madeleine's very good client intervention to problem solve is something else.
gonna unpack me daks now
kenoath
Posted by: kenoath | Saturday, 26 July 2008
So when I get to the UK, Kenoath, you can unpack for me hehehehee
I hate to think what you are "unpacking" from your daks !!
Posted by: gezunda | Saturday, 26 July 2008
metaphorically speaking Madeleine,
I would very much like to unpack myself from your suit cases in London town.
kenoath
Posted by: kenoath | Saturday, 26 July 2008
You are welcome to come with me, Kenoath. Poor UK if we went together hehehehe
Posted by: gezunda | Saturday, 26 July 2008
Hi April,
I think I agree with what you are saying. I too would think that every person who was given a good physical and psychological start to life would have a strong tendency to grow and develop.
Obviously some don’t get that and get a much badder start to life. Some of that group from what I have seen of life in and outside my work just do not seem to have a spark that leads them to grow. It seems that it is just not there and it is that group where I would question that there really is any long term hope.
Certainly there is a group who live tragic life scripts and maybe some of them battle to find any hope
Graffiti
Posted by: Tony | Saturday, 26 July 2008
Kahless,
I, like you, do not like the idea that in some instances there maybe no hope. But again I am brought back to my statement:
Just because something is distasteful does not make it untrue.
If I was an oncologist and had a patient who had very little chance of survival then I would tell them the facts. I would not give them false hope by telling them there is always a chance and so forth even though in my heart I would certainly want to. That would just exacerbate their pain and suffering further.
Perhaps psychotherapists at times find them selves in the same boat. Telling some client that they can change and get better when looking at their treatment histories nothing has worked so far. And they have tried a lot of things. I must be careful not to give false hope as that will just increase their suffering.
Indeed sometimes it goes beyond that and the client can start to think that there is something wrong with them because I don’t change and take charge of my life.
Graffiti
Posted by: Tony | Saturday, 26 July 2008
KazzaB you say
Maybe it is personality or scare about changing or wanting someone else to do it for them
I think this is an accurate statement and what many therapists and the books would say about some of the reasons some people don’t change. I agree with you and ask if there is also another reason that is far less articulated. Perhaps some also don’t have that innate drive to health.
thanks for commenting and sorry for the delay in responding
Tony
Posted by: Tony | Saturday, 26 July 2008
I am not so sure that it is such a black and white situation Tony. I can understand those who choose not to go to therapy and stay stuck in their "ill health" however perhaps some therapists risk pathologizing some clients who do wish to have a better life even though that seems to take time.
I have noticed how some clients seem to pecieve me as persecuting them when I move toward some measure of awareness work, like they are "no good" in some way, and according to psychological theories. I have seen a therapist purposefully miss one member's turn to speak in the group - twice and the person severely regressed into her abandonment issues. There must be a point when the therapist and the client are ready to move forward with comfortability in my view.
kenoath
Posted by: kenoath | Saturday, 26 July 2008
Hello Kenoath,
Thanks for expressing your view. I hope you are right about
"There must be a point when the therapist and the client are ready to move forward"
But I have my concerns that sometimes that may not be the case
Graffiti
Posted by: Graffiti | Saturday, 26 July 2008
Perhaps I could have said "or not" after what I said in your quote. I am asuming that the relationship between client and therapist can give every opportunity for that to happen depending on the treatment goals. Hope sucks some times and such is life too Tony.
kenoath
Posted by: kenoath | Saturday, 26 July 2008
As you say Kenoath,
C'est La Vie and Such Is Life
Graffiti
Posted by: Graffiti | Saturday, 26 July 2008
Graffiti,
"Just because something is distasteful does not make it untrue."
I agree. But also just ecause something is distasteful does not make it true either.
Maybe my definition of hope is wider than yours, or different to yours. i am not saying that the dying cancer patient should be given false hope that they will survive. ut just because someone is dying does not mean they are without hope. Hope does not have to mean change. Or life. Maybe their hope is for a quick death? Or a painless death. or that they get to make peace with God. or their kids. Or they hope to make a memory book for their kids.
And as for clients. If someone has voluntarily gone to see a counsellor dont tell me they elieve they have no hope. Or they would not bother. the counsellor needs to understand what their hopes are. Maybe the hope is not to get better ut rather to have some functioning.
Hope can be small steps.
And ones hopes can evolve.
Posted by: kahless | Saturday, 26 July 2008
Or even just 'management' too Kahless.
k
Posted by: kenoath | Saturday, 26 July 2008
Yes K, hope for management.
I wont stop hoping there is always hope!!
Posted by: kahless | Saturday, 26 July 2008
Hi Kahless,
Personally I am a hopeful person and I think and optimistic person as well.
maybe we are , as you say having different definitions of what hope is.
Its wet, wet, wet here today
Cheers
Tony
Posted by: Tony | Sunday, 27 July 2008
Its wet wet wet here too; but only cos someone (not naming names) left the tap on full and then came outside to chat to me for an hour and flooded the house.
I know you are an optimistic person Tony. I am too. Its a good place to be eh.
Posted by: kahless | Sunday, 27 July 2008
That person you were wondering about Kahless; the last I heard from him was about two months ago and he was still "in care". He was taking his medication and severely depressed. He hasn't been online for some time as I can see he hasn't answered a message I sent him back then. He is allowed one hour internet access every week. I presume that he hadn't killed himself, however with his pancreatic cancer the prognosis has limited hope.
Hoping your house is drying out now, that naughty Mrs K
kenoath
Posted by: kenoath | Sunday, 27 July 2008
I'm kind of going off this one Tony,
"Kahless,
I, like you, do not like the idea that in some instances there maybe no hope. But again I am brought back to my statement:
Just because something is distasteful does not make it untrue."
Apart a game where the challenge is to block every move anyone ever makes - perhaps Psychotherapy is not the answer for some. It just may be that simple and if that's the case then it might do a therapist well to let them go. Let them search for their answer and because it could be a timing thing, if they come back around (perhaps to another therapist even) and they do find the answer then ... well done!
Just because someone may be colour blind that doesn't mean the colours they can't register or interperate don't exist. Just because some one (like my sister who must have something seriously array for her to be in this catagory) doesn't like mangos, doesn't mean they aren't the most delicious and sensualy arousing food on the planet! No! Because they are.
Well, because i said so.
I'm having a bit of a problem waiting for summer now. Bumma!
Posted by: roses | Sunday, 27 July 2008
Kahless,
Talk about turning on the waterworks!!!
Tony
Posted by: Tony | Sunday, 27 July 2008
Tony
hehehe...
I chuckled reading your comment.
Unfortunately at the time I didnt see the funny side; I was well grumpy!!
Mrs K has been on at me for months about us needing a new carpet. I guess this was one effective way to make the point!
Posted by: kahless | Sunday, 27 July 2008
Kenoath,
thanks for the update; I appreciate it.
And my house is drying our slowly.
Posted by: kahless | Sunday, 27 July 2008
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