Sunday, September 25, 2011

How could you help these people?

Are your clients stuck like these people in this video?

I am sure you have clients like this.  Positively Absolutely.

How do you respond?

What do you do?

Are you the repairman in the video or do you have another role not shown in the video?  Why or why not?

What would a person practiced in motivational interviewing do to help these people?

Please go to my blog and post your comments and thoughts!

Saturday, September 17, 2011

Bye Bye Resistance

If you are like most, you didn't relish the shift from toward "resistance" when the book Motivational Interviewing first was published.  Next year, when the 3rd edition of Motivational Interviewing (MI3) is published, the concept of "resistance" will be gone completely. 

And I for one am glad.

Counselors who slap clients as in "denial" are pathetic and should surrender their license. 
        (what, you don't like being labeled?!). 

Fortunately, labeling clients as in denial has become in many places "politically incorrect" meaning is has been replace with "resistant" (code word:  "denial") when blaming clients for our lack of clinical ability.  What will these people do when this concept is gone in MI3?

MI3 has many changes -- it is looking like it will be as different from the second edition of Motivational Interviewing as the second edition was from the first.  But this shift completely away from "resistance" is, IMHO, the biggest (and best) change.  

"Resistance" has been replaced with sustain talk plus discord between the client and the counselor.

For those unfamiliar with motivational interviewing these days, we are focused on two client verbal responses:  

  • sustain talk and 
  • change talk.

What we know works is change talk.  The more the better.  And, at the risk of over simplifying motivational interviewing, our techniques in counseling are focused on getting more change talk and less sustain talk.

Two other factors come into play here:  the client is either connected with the counselor (there is harmony in the relationship) or disconnected with the counselor (there is discord in the relationship).  Make sense -- are you with me?

Now, let's look at what happens when these factors interact around a particular target behavior:

  Harmony Discord
Sustain Talk High potential to move client toward change talk Low potential to move client toward change talk
Change Talk High probability of behavior change High probability of behavior change

To illustrate, consider this framework using the example of stopping cigarette smoking as a target behavior:

  Harmony Discord
Sustain Talk Client engages with counselor to discuss his smoking. Client argues with counselor, wants to leave treatment, etc.
Change Talk Client comes up with a plan to stop smoking. Client stops smoking despite counselor.

The great thing about this framework is that all areas are impacted by the counselor. So blaming the client for clinical shortcomings should be a thing of the past next year!

What do you think?  Share your comments.

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About Me

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Scott Graham

After receiving two undergraduate degrees from the University of South Florida (one in Psychology and one in Communication) I worked with at-risk kids then moved to New England to work as Counselor and Outward Bound Instructor.

(I had hiked the Appalachian Trail by myself a few years earlier so the opportunity to be in the wilderness and get paid was a dream-come-true).

Working with Outward Bound and other wilderness / adventure schools was great and it was here that I honed my abilities to help people tap into more then they thought they had.  It was here that I really learned to coach.

After a few years of working wilderness courses from Florida-to-Oregon I entered graduate school where I earned a degree in Management.  Along the way I achieved certification and faculty status with the William Glasser Institute.  Glasser's techniques grounded in Lead Management and Choice Theory help people identify what they really want and develop more effective ways to get it and is the primary model I use in coaching.  

I returned to Outward Bound for a short time as the Assistant Program Director of an Urban Center in Boston with the focus of developing therapeutic health services.  The pull of what had become my home was great however and I eventually returned to the country to work in Vermont.

I started working in a substance abuse treatment program through the Vermont Department of Corrections, called ISAP, and was eventually promoted to Program Director.  While working in the ISAP Program, I  was the architect of a consistent treatment design which I implemented statewide at nine sites.

Along the way I started 2 businesses:  ClinicalSupervision.biz, LLC and Willoughby Forest, LLC.

Currently I am active as a trainer, motivational speaker, business / personal coach, clinical supervisor and personal trainer (I am a Certified Personal Trainer by the National Federation of Personal Trainers).  My focus / approach to life coaching is as a Reality Coach™.  I am a member of the International Association of Certified Coaches (IAC).   

I am committed to common sense conservation [I am a former West Fairlee Conservation Commissioner].  My partner and I steward 110 acres of Vermont forestland (Tree Farm #1464) developing agri-forest products like ginseng, in addition to timber and are both Cooperators through Vermont Coverts.  I am active in Toastmasters, currently serving as District 45 Area 20 Governor.  I volunteer with the West Fairlee Fire Department, and serve my community as elected Town Lister and Constable.  In my spare time I teach at the Community College of Vermont.

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Scott is a member of the MINT

Scott is a member of the MINT
Motivational Interviewing Network of Trainers