Motivational Interviewing 8 · 4 MOTIVATIONAL INTERVIEWING Tips for Making the Best Use of the DVD 1. USE THE TRANSCRIPTS, COMMENTARIES AND SKILL CODES Transcripts: Make notes in

Instructor’s Manual for

MOTIVATIONAL INTERVIEWING

from the series

BRIEF THERAPY FOR ADDICTIONS

with

WILLIAM R. MILLER, PHDand hosts Jon Carlson, PsyD, EdD and Judy Lewis, PhD

by

Randall C. Wyatt, PhD&

Erika L. Seid, MA

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The Instructor’s Manual accompanies the DVD Motivational Interviewing (Institutional/Instructor’s Version). Video available at www.psychotherapy.net.

Instructor’s Manual Copyright © 2008, Psychotherapy.net, LLC. All rights reserved. DVD version of Motivational Interviewing released by Psychotherapy.net, 2007; VHS version by Allyn and Bacon, 2000.

Published by Psychotherapy.net

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Teaching and Training: : Instructors, training directors and facilitators using the Instructor’s Manual for the DVD Motivational Interviewing may reproduce parts of this manual in paper form for teaching and training purposes only. Otherwise, the text of this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher, Psychotherapy.net. The DVD Motivational Interviewing (Institutional/Instructor’s Version) is licensed for group training and teaching purposes. Broadcasting or transmission of this video via satellite, Internet, video conferencing, streaming, distance learning courses or other means is prohibited without the prior written permission of the publisher.

Wyatt, Randall C., PhD & Seid, Erika L., MA Instructor’s Manual for Motivational Interviewing with William R. Miller, PhD

Cover design by Sabine Grand

Order Information and Continuing Education Credits: For information on ordering and obtaining continuing education credits for this and other psychotherapy training videos, please visit us at www.psychotherapy.net or call 800-577-4762.

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Instructor’s Manual for

MOTIVATIONAL INTERVIEWINGwith William R. Miller, PhD

Table of ContentsTips for Making the Best Use of the DVD 4

Group Discussion Questions 8

Reaction Paper Guide for Classrooms and Training 11

Motivational Interviewing Skill Codes 12

Session Transcript with Commentary 14

Suggestions for Further Readings, Websites and Videos 59

Video Credits 62

Earn Continuing Education Credits for Watching Videos 63

About the Contributors 64

More Psychotherapy.net Videos 66

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Tips for Making the Best Use of the DVD

1. USE THE TRANSCRIPTS, COMMENTARIES AND SKILL CODES Transcripts: Make notes in the video Transcript for future reference; the next time you show the video you will have them available. Highlight or notate key moments in the video to better facilitate discussion during the video and post-viewing.

Commentaries: Take a look at the dialogue commentaries Miller inserted throughout the transcript and post-session comments. These reflect his thoughts, feelings and ideas about the session at different points along the way. Pass out a copy of the transcript to viewers so they can benefit from Miller’s insights and observations.

Coding the Session: Miller has coded the session using the Motivational Interviewing Skill Codes.

2. GROUP DISCUSSION QUESTIONSPause the video at different points to elicit viewers’ observations and reactions to the concepts presented. The Discussion Questions provide ideas about key points that can stimulate rich discussions and learning

3. LET IT FLOWAllow the session to play out some so viewers can appreciate the work over time instead of stopping the video too often. It is best to watch the video in its entirety since issues untouched in earlier parts often play out later. Encourage viewers to voice their opinions; no therapy is perfect! What do viewers think works and does not work in the session? We learn as much from our mistakes as our successes and it is crucial for students and therapists to develop the ability to effectively critique this work as well as their own.

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4. SUGGEST READINGS TO ENRICH VIDEO MATERIALAssign readings from Suggestions for Further Readings and Websites prior to viewing. You can also time the video to coincide with other course or training materials on related topics.

5. ASSIGN A REACTION PAPERSee suggestions in Reaction Paper section.

6. ROLE-PLAY IDEASAfter watching the video, organize participants into pairs. Assign each pair to role-play a therapy session with a client struggling with addiction, with a focus on applying the principles of Motivational Interviewing (see item seven, below). Each role-play shall consist of one therapist and one client. You can have the pair switch roles and play out another stage if time permits. Let each client develop their own addiction and play it out or assign them different types and levels of addictions. After the role-plays, have the pairs come together to discuss their experiences. First ask the clients to share their experiences. Then have the therapists talk about their experiences in the session. Finally, open up a general discussion on what participants learned about Motivational Interviewing.

An alternative is to do this role-play in front of the group with one therapist and one client; the entire group can observe, acting as the advising team to the therapist. Before the end of the session, have the therapist take a break, get feedback from the observation team, and bring it back into the session with the client. Other observers might jump in if the therapist gets stuck. Follow up with a discussion that explores what does and does not work in using Motivational Interviewing with this population.

7. WATCH THE SERIESThis video is one in a series portraying effective approaches to therapy for addictions. Each video in the series presents a master therapist working with a real client, just as you see here. By showing several

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of the videos in the series, you can expose viewers to a variety of approaches, allowing them an opportunity to see what fits best for their own style and beliefs.

Key Aspects of Motivational Interviewing: Motivational Interviewing is a process that helps people resolve their ambivalence and move toward healthy change. The therapist creates an atmosphere that is conducive to change by following five general principles.

First, the therapist expresses empathy, demonstrating nonjudgmental understanding of the client’s perspective. Second, the therapist works to develop discrepancy by helping clients explore the gaps between their current behavior and the lives they would like to lead. Once this discrepancy is perceived, clients can begin to make the case for change. The fact that it is the client—not the therapist—who presents the reasons for change helps with the third principle: avoiding argument. The therapist avoids falling into the trap of being the one whose arguments for change awaken resistance in the client. The fourth principle, rolling with resistance, involves accepting the reality of ambivalence and inviting the client to enter into the process of problem solving. Finally, the therapist supports self-efficacy, encouraging the client’s sense of the possibility of change

Addiction Treatment Models: Other videos in the series use different therapeutic models. We can reflect upon the differences among these models by exploring the following questions:

• How does the model explain the addictive process?

• What assumptions does the model imply about the process of change?

• How is theory translated into practice in real-life situations?

• What is the role of the therapist?

• What outcomes are associated with successful therapy?

• How does the therapist work with people who have mental health problems along with addictions?

• What kinds of research support the approach?

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8. PERSPECTIVE ON VIDEOS AND THE PERSONALITY OF THE THERAPISTPsychotherapy portrayed in videos is less off-the-cuff than therapy in practice. Therapists or clients in videos may be nervous, putting their best foot forward, or trying to show mistakes and how to deal with them. Therapists may also move more quickly than is typical in everyday practice to demonstrate a technique. The personal style of a therapist is often as important as their techniques and theories. Thus, while we can certainly pick up ideas from master therapists, participants must make the best use of relevant theory, technique and research that fits their own personal style and the needs of their clients.

*A NOTE ON CONFIDENTIALITYBecause this video contains an actual therapy session, please take care to protect the privacy and confidentiality of the client who has courageously shared his personal life with us.

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Group Discussion QuestionsProfessors, training directors and facilitators may use a few or all of these discussion questions keyed to certain elements of the video or those issues most relevant to the growth, development and interests of the viewers.

INTRODUCTION

1. Client Centered and Directive: What do you think about Miller’s portrayal of the therapist’s role in Motivational Interviewing as including following the client and having a specific idea about where the therapist wants the client to go? As a therapist, how would you work with the dynamic tension between these two approaches?

2. Ambivalence: Miller states that people with addictions are fundamentally ambivalent: doing something that is pleasurable, in spite of adverse consequences, or continuing to engage in a behavior that is both pleasurable and destructive. What do you think about Miller’s assertion that therapists may inadvertently stimulate or reinforce clients’ resistance to treatment by taking a position on the side of change and stopping the addiction? How does that work?

3. Confrontation: In your thinking about working with addicts, do you find yourself in the “confront denial” camp, or more in Miller’s “role with resistance” camp? What appeals to you about one or the other of these two orientations? What about the other one doesn’t sit as well with you? Why?

4. Five Steps: Miller outlines five components of Motivational Interviewing: 1) Empathy and reflective listening, 2) Develop discrepancy, 3) Avoid argument, 4) Role with resistance, 5) Support self-efficacy. How do these five components fit with the way you currently think about psychotherapy and addiction treatment? Do they conflict or coincide with your ideas? Does Miller’s description of this process call any of your current assumptions into question? Which ones?

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PSYCHOTHERAPY SESSION5. Ambivalence: How did Miller work with Mike around his

ambivalence? Was his approach effective? What reactions do you have when you think about sitting with clients who are ambivalent about their addiction? How much do you feel pulled to advocate for the client to stop using?

6. Two Approaches in One: In what ways do you see Miller meeting Mike where he’s at and following him? In what ways do you see Miller being more directive and helping Mike move toward change? Do you think Miller balanced the two approaches in a way that was helpful to Mike? What would you have done differently?

7. Drawing Out: How do you see Miller drawing out Mike’s motivation for change? Give examples. In working with a client like Mike, what potential pitfalls would you see for yourself in drawing out the client’s motivation for change?

8. The Client’s Perspective: What do you think may have been difficult about this session for Mike? Which specific moments or interactions in this session seemed particularly powerful or growth enhancing for him? As you think about using Motivational Interviewing with your own clients, how do you think it might feel for them? How does that impact your thinking about the work?

DISCUSSION9. The Therapeutic Relationship: How would you characterise

the therapeutic relationship in this video? Did Miller form a good alliance with Mike? How significant do you think the relationship was in this particular course of therapy?

10. Miller’s Style: What about Miller allowed Mike to feel comfortable enough to engage in the therapy? How did he join with Mike?

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11. The Model: What do you think about this model for working with clients who are addicted to substances? Does it make sense to you? Do you see yourself using it in your work with this population? What would be most challenging for you about itl?

12. Personal Reaction: How would you feel about being Miller’s client? Do you feel an alliance could be made? Would Miller be effective with you or not? How so?

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Reaction Paper for Classrooms and Training• Assignment: Complete this reaction paper and

return it by the date noted by the facilitator.

• SuggestionsforViewers: Take notes on these questions while viewing the video and complete the reaction paper afterwards, or use the questions as a way to approach the discussion. Respond to each question below.

• LengthandStyle: 2-4 pages double-spaced. Be brief and concise. Do NOT provide a full synopsis of the video. This is meant to be a brief reaction paper that you write soon after watching the video—we want your ideas and reactions.

What to Write: Respond to the following questions in your reaction paper:

1. Key points: What important points did you learn about psychotherapy and Motivational Interviewing with clients who are addicted to drugs and/or alcohol? What stands out in how Miller works?

2. What I am resistant to: What issues/principles/strategies did you find yourself having resistance to, or what approaches made you feel uncomfortable? Did any techniques or interactions push your buttons? What interventions would you be least likely to apply in your work? Explore these questions.

3. What I found most helpful: What was most beneficial to you as a therapist about the model presented? What tools or perspectives did you find helpful and might you use in your own work?

4. How I would do it differently: What might you have done differently than Miller did in the video? Be specific in what different approaches, strategies and techniques you might have applied.

5. Other Questions/Reactions: What questions or reactions did you have as you viewed the therapy in the video? Other comments, thoughts or feelings?

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Motivational Interviewing Skill Codes

The following code key is adapted from the Manual for the Motivational Interviewing Skill Codes, Version 2.0, pp. 14-15 and 49. Use it to understand the codes Miller has inserted throughout the session transcript below. Viewers interested in honing their Motivational Interviewing skills can download the complete manual at http://casaa.unm.edu/download/misc.pdf.

COUNSELOR BEHAVIOR CATEGORIES AD Advise Subcategories: with (ADP) or without permission (ADW)

AF Affirm

CO Confront

DI Direct

EC Emphasize Control

FA Facilitate

FI Filler

GI Giving Information

QU Question Subcategories: Closed (QUC) or Open Question (QUO) RC Raise Concern Subcategories: with (RCP) or without permission (RCW)

RE Reflect Subcategories: Simple (RES) or Complex (REC)

RF Reframe

SU Support

ST Structure WA Warn

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SIX KINDS OF CHANGE TALK Every time an example of one of these occurs in client speech, it is recorded with a positive (+) or negative (-) valence, depending on whether it reflects inclination toward (+) or away from (-) the Target Change Behavior (TBC)

A Ability (A+) or inability to change (A-)

C Commitment to change (C+) or not to change (C-)

D Desire to change (D+) or not to change (D-)

FN Follow/Neutral

N Need to change (N+) versus lack of need for change, or a need not to change (N-)

O Other

R Reasons to change (R+) or reasons not to change (R-), (subcodes: d: Desire, a: Ability, n: Need)

T or TS Taking steps toward (T+) or away from change (T-)

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Complete Transcript of a Demonstration ofMotivational Interviewingwith William R. Miller, PhD

SESSION INTRODUCTION BY DR. MILLER

This session was recorded in the year 2000 in Chicago, Illinois. The client was referred to discuss alcohol problems and knew that the purpose of this videotaped interview was to demonstrate a specific method in addiction counseling. I chose to be told nothing at all about him ahead of time, so that the interview would closely parallel a first clinical session. We met, sat down, and without further preparation the filming began.

Motivational Interviewing Skill Codes: The left-hand boxes below contain transcription of the 229 exchanges that constituted this 41-minute session. For those interested in psychotherapy process research, these boxes also show expert codes for interviewer and client responses, based on the Motivational Interviewing Skill Code, Version 2.0 (http://casaa.unm.edu/download/misc.pdf).

Session Commentaries: In the right-hand boxes I offer comments on what was happening from my perspective during the session, particularly my own thoughts and feelings as the session progressed, and Motivational Interviewing (MI) strategies behind some of my responses.

Before reading the transcript and my comments below, I suggest that you just watch the whole interview once and form your own impressions of what is happening along the way. Then go back if you

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wish and take a more micro-level look at the conversation, and what was going on in my head as we talked

Note to facilitators: We have marked indicators at five-minute intervals throughout the transcript, which coordinate with chapter markers on the DVD, so that you may easily skip to desired points within the session.

TRANSCRIPT COMMENTS

Miller - 1: So, fill me in a little bit. What is it that brings you here today? (QUO)

Knowing nothing about his situation, I begin with an open question.

Mike - 1: Well, actually I’m doing a favor for a friend of mine.

His first response bespeaks low personal investment in being here. He is doing a favor for a “friend” who referred him.

Miller - 2: Uh huh.

Mike - 2: And he told me about a study you guys were doing, and so I figured I’d participate in it, and they told me you were basically an addiction counselor, and he thought I might be an interesting subject. (FN)

He’s not too sure what to expect, but he has an idea. I don’t know yet just what “addiction counselor” means to him, but it turns out to be a loaded term, as we soon discover.

Miller - 3: Uh huh.

Mike - 3: Okay?

Miller - 4: Okay. Well, tell me about where you are now with the addictions that you’ve been… (QUO)

I knew only that he was referred to discuss some form of addiction.

Mike - 4: Well, what do you want to know in particular? (FN)

He seems to expect specific, closed questions.

Miller - 5: Well, are you in recovery now, or... (GI)

Mike - 5: No, I’m not. (FN)

Miller - 6: Okay. Alright. So what are the drugs or what it is you struggle with? (QUC)

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Mike - 6: Well, honestly cigarettes.

Miller - 7: Okay.

Mike - 7: That’s the biggest.

Miller - 8: Okay. (O+)

Mike - 8: Alcohol to a degree, (O+) but I think I’ve had more of a problem with that two or three years ago, you know, it seems to have gone down to a degree (O+) and probably simply because of the environment. (R+)

He minimizes problems with alcohol. I notice his understatement.

Miller - 9: So that’s kind of settled down. (RES)

I simply reflect it instead of challenging it. In MI one does not push back against resistance or defensiveness.

Mike - 9: Well, not all that much. (O+) Okay, but enough, it’s gone down simply because I’m getting too old to do this stuff anymore if that make any sense to you. (R+)

To my reflection of his minimizing, he immediately responds with the other side of his ambivalence about alcohol. In MI this is noted as “change talk.”

Miller - 10: It does. You can’t keep up with it anymore. (REC)

A complex reflection, making a guess about what he means.

Mike - 9: I don’t think I can. I really don’t think I can. (R+)

More change talk

Miller - 11: And then the cigarettes are still a real addiction for you? (RES)

I reflect his original statement.

Mike - 11: Yeah, I really do. I think they are worse. (O+) In the past I’ve done cocaine. I’ve even done crack cocaine. I’ve heard that’s one of the most addictive drugs around. Quite frankly, from my own personal experience, I don’t find it addictive at all. (FN)

He reveals a little more, but in an interesting way. His statement that cocaine is not addictive at all seems provocative for an “addiction counselor.” He seems to be trying to pick a fight. I already like this guy, and enjoy talking with him.

Miller - 12: Yeah, it’s interesting how it is different for different people. (GI)

I don’t push back, but just comment that people have different experiences.

Mike - 12: Yeah.

Miller - 13: Yeah, but for you it’s tobacco and alcohol. (RES)

Returning to what he has said is problematic for him.

Mike - 13: Yeah. Yeah, and coffee.

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Miller - 14: Yeah.

Mike - 14: I mean if we want to get that specific. (FN)

Miller - 15: How far do you want to go there? (RES)

Mike - 15: How do you want to go? I got a lady that’s supposedly addicted to Chapstick. (FN)

He belittles the concept of addiction. He seems to be looking for an argument around some classic themes of “addiction counseling.”

Miller - 16: It gets used for almost anything these days. (REC)

Instead of arguing, I reflect his dismissal of the term.

Mike - 16: Right. (FN)

Miller - 17: Yeah. Well, how might you like things to be different? I guess that’s a good place to start. (QUO)

I focus back on where he perceives a need for change. It would have been very easy here to be caught up in defending concepts. I sense he expects me to do that.

Mike - 17: Well, basically, you know, I don’t, see that’s my problem. I don’t think I’m really all that committed to making things all that different (C-) because I’m not seeing that much harmful benefit (R-). I was told that you are not able to slow down. It’s progressive. You get worse and worse and worse and worse, and that just doesn’t seem to be the case with me. Okay? I think that there are certain things in my lifestyle that just preclude me not using, okay? (R-)

He states that he is not committed to change. In MI, this is an example of “sustain talk,” an argument against change. It is simply stating the other side of his ambivalence.

He explains a little more about what bothers him about the concept of “addiction,” and is specifically questioning the idea of a progressive disease as has commonly been taught in U.S. addiction treatment programs. What treatment experiences has he had?

He argues that he can’t abstain because of his lifestyle – more sustain talk.

Miller - 18: Right. (FN)

Mike - 18: And that, and smoking has become a problem because I’m starting to play soccer, okay? (R+)

This is change talk with regard to smoking, but not alcohol.

Miller - 19: So you can’t breathe. (RES)

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Mike - 19: So I can’t breathe (R+). The kinds are younger and younger. They are half my age, twice my size. I’m having a problem with it. (R+)

Miller - 20: You are noticing it. (RES)

Mike - 20: Okay. Yeah. (R+)

Miller - 21: So, I mean the message that you shouldn’t use at all is like somebody out there telling you that, but that doesn’t fit your experience. (REC)

I try to reflect his rejection of what others have told him.

Mike - 21: I don’t know. Use at all. What does that mean? What do you mean by that? (FN)

He responds abruptly, sounding annoyed or defensive, signaling some dissonance in the counseling relationship.

Miller - 22: Well, I guess maybe I misunderstood you. I thought you were saying people tell you that you can’t use or shouldn’t use or whatever. (GI)

I respond by taking responsibility for a possible misunderstanding, and restate the reflection.

Mike - 22: Oh yeah. Yeah, they’ve told me that before, you know. I’ve been through (FN), I guess you know nothing about me do you? (FN)

He realizes that I don’t know anything about him. Did he think that I had a lot of background on him and was lying in wait to trap him?

Miller - 23: Nothing at all. (GI)

Mike - 23: Okay, I’m sorry about that (FN). I though at least they filled you in on some... (FN)

Miller - 24: No, I asked not to be. (GI)

Mike - 24: Okay. Well, no. Alright, here’s what happened. I got a DUI a while back. I think it was back in ‘93, and I had one prior to that in ‘85 and went though some counseling. It was mandatory, state-driven. Basically you go through the counseling, and after you successfully complete it, you are rehabbed. Actually rehabbed.

Here is an interesting moment in this session. He leans forward, relaxes, and basically says, “Well OK then, let me tell you my story.” There is a qualitative shift right here. Often in a first MI session I perceive a moment of “join-up,” to borrow a concept from the original horse whisperer, Monty Roberts, in which the client relaxes a bit on fight/flight, and joins in more of a conversation with the interviewer.

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Miller - 25: Right.

Mike - 25: Then you get your driving privileges back. And I guess what I’m trying to say is that I’ve had some bad experiences. Not bad experiences with the counselors, but I found them to be not less than professional but just very rigid in their approach. (FN)

Remember that a few minutes ago I was an “addiction counselor.” Now his language changes and he talks about addiction counselors in third-person as “them.” He distances me from his prior experiences.

Miller - 26: Okay. And that didn’t work for you, that didn’t fit. (REC)

Mike - 26: It didn’t fit at the time, and at the time I don’t think I was really all that committed to quitting, and then I was, but at another time, but the other time was because I was earning $40 an hour, and I was working ten hours a day five days a week, so guess what? You’re not supposed to be able to quit, you see? That’s what those counselors told me. That was strange that I was, wasn’t it? So I mean, I guess what I’m saying is that I do probably have a rather negative attitude about some of the things I’ve been through as far as the state program is concerned. I don’t know how I could explain that more, or if you have any… (FN)

Now he talks about a time in the past when he was committed to changing his drinking. This is not coded as change talk because it is stated in past tense, but it does say that there are conditions under which he could be motivated to change. I wonder what they are. He gives a clue: it’s when he has something that is too good to lose. Now a question that I have in mind is, “What would be good enough for him to want to make a change in his drinking?”

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Miller - 27: Well, I think I’ve got it. It sounds like your experience doesn’t match what you were being told. (REC)

Mike - 27: No. (FN)

Miller - 28: They are telling you this is how you are, and you look at yourself and say, no. (RES)

I join with his use of third-person language.

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Mike - 28: Yeah, that’s not necessarily true. And then there too you are supposed to say well I’m an alcoholic and I’ve always had problems and I have to quit and I can never drink again and this, that, and everything else. And you had to really say that, see. Or else you weren’t fitting in the role they wanted you to play. Without fitting in the role they wanted you to play you could not get your license back. So, you know, I played the game basically, and I went to AA, and I also found that just to be a little bit on the, you know, it didn’t work for me. It’s bumper sticker therapy. Fake it till you make it. Wow, how profound. Man, you guys are deep, you know. (FN)

With cynical wit, he tests another spot where he might arouse an argument from me.

Miller - 29; Alright.

Mike - 29: And you know, yes seriously, I’ve been there and these guys didn’t do anything all day, but they didn’t drink that day. You know, I would rather, let’s say, lift weights, maybe build a patio, maybe program R base, and then drink instead of just not drink and do nothing else. I just, I found that you know, certain aspects of it I like, but I think you have to have a deep seated religious belief for it to work for you. (FN)

He begins to tell me things that he enjoys. He tests again whether I’ll argue with him.

Miller - 30: Well, and it sounds like you want to have an active life. Not drinking is not doing something, it’s doing nothing. (REC)

I could have asked what it was that he liked about AA. Instead I pick up on the theme of activity that competes with drinking, offering a complex reflection that prepares the way to explore what might displace drinking.

Mike - 30; Yeah, it’s doing nothing. (FN)

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Miller - 31: So, for you the question is what am I going to be doing? How do I spend my time? Playing soccer, and... (REC)

I ask an open question in the form of a reflection. I notice that I shifted here to first person “I” in my reflection. This more directly gives voice to what he may be experiencing. It can be a little risky to do this, to be the “I” voice for a client. I was feeling fairly confident that I understood him accurately.

Mike - 31: Yeah, that’s good. (FN) Actually I was thinking myself the way I can best quit smoking is not by quitting smoking but playing soccer three times a week. Okay? Now, I’m going for something, okay? (C+)

“That’s good.” It should be, because it’s his own material. He affirms that my reflection is on the mark, and also shifts the focus back to smoking.

Miller - 32: That’s right. (RES)

Mike - 32: And then all of a sudden I’m having a problem breathing, okay? (R+) So guess what? You’re gonna quit smoking (O+). You’re not going to say I gotta quit smoking, you know. But to me that doesn’t work for me. (FN)

Miller - 33: It might even less than not work. It might make it less likely. (REC)

I reflect that he reacts negatively to coercive messages, even if they are his own.

Mike - 33: I think it’s less likely (FN). I quit smoking before for about four months (C+). Then I blew out my knee, and you know, I went down to see my brother, and boom (FN), right back to it (C+). And you know, it’s the same thing with drinking. I think I was actually more, how shall I say, I seem to have more of a craving when I was going through counseling.

Where is this going? Why is he telling me about a return to smoking?

He comes back around to drinking on his own.

Miller - 34: Right?

Mike - 34: Then when I wasn’t, okay? So, it’s like okay, reverse effect. Guys you really helped me a lot, you know. (FN)

He echoes his backlash reaction to being told what to do.

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Miller - 35: Well, I wonder if it isn’t being told you can’t or like being in prison in a way. (REC)

Mike - 35: Yeah, it could be just immaturity on my part. You know, if you tell me I can’t do something, I’m going to do something.

He takes partial responsibility for reacting negatively in the past to well-intentioned advice. It seems to signal a willingness to negotiate.

Miller – 36: Right.

Mike - 36: You know, maybe what they should say is you better drink every day goddammit. I want you to drink a fifth before noontime. Then maybe I’d say “Screw you guys,” you know. I don’t know. Maybe there is something about my personality that is like that. So, you know, what shall I say? One size doesn’t fit all. (FN)

Miller – 37: Yeah, exactly. (RES)

Mike - 37; One size doesn’t fit all. (FN)

Miller - 38: And for you what matters is having something that you are going toward, not something you run away from. (REC)

I bring the focus back to what he does want in life. If we were working together longer than this one session, I might do more to explore with him what he wants and values in life.

Mike - 38: Right, right. (FN)

Miller - 39: And one of those things is soccer. (REC)

Mike - 39: Yeah. (R+)

Miller - 40: What else? (QUO) An open “what else” question to invite what he values.

Mike - 40: Well, tennis (R+). How ‘bout backpacking (R+). You know, how ‘bout just waking up clear-headed. (R+)

Wow! Suddenly he is arguing for sobriety.

Miller - 41: Yes, that’s right. (RES)

Mike - 41: I mean, don’t you think that’s kind of...

He continues to persuade me.

Miller - 42: That’s great. (RES)

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Mike - 42: ...pleasurable, sometimes, you know? (R+)

Miller - 43: So just getting up in the morning and being able to think clearly. (RES)

Mike - 43: Yeah but I’m telling you one thing right now. You know, sometimes I won’t drink four, five, six days. If I smoke two packs of cigarettes, I wake up with a hangover. I thought it was the booze, but it isn’t. (R+)

And now, as usually happens with someone who is ambivalent about change, he comes back to express his doubts. “It’s not really alcohol that is the problem, but smoking.” In classic American addiction counseling this could be seen as “denial,” but it is a perfectly natural expression of ambivalence. He thinks that his drinking is problematic, and also at the same time he thinks that it is not really a problem. If I take up the “good” side of the argument here (or anywhere) that his drinking really is a problem, I can expect to elicit more of the counterargument, which is precisely what I do not want to do in MI.

Miller - 44: Even without the booze. (RES)

Mike - 44: Oh, yeah. It’s carbon monoxide, man. You got no oxygen in your system. (FN) So. I guess that’s my real problem right now is the cigarettes. (O+)

I certainly hear the smoker’s wheeze in his voice as he laughs.

Miller - 45: Uh huh.

Mike - 45: So.

Miller - 46: It sounds like you are not that worried about alcohol really. (REC)

Instead I offer a complex reflection of his sustain talk.

Mike - 46: No, it’s bad (O+), but it’s not as bad (O+).

He acknowledges that “it’s bad,” then takes it back a bit. Ambivalence.

Miller - 47: Not causing you problems... (REC)

I again reflect the sustain, status-quo side of his ambivalence.

24


Mike - 47: Well, it is. It will cause anyone problems (R+).

He responds with change talk.

Miller - 28: Hm, how so? (QUO) Asking for elaboration.

Mike - 48: Have a six-pack of beer, wake up, try to program a computer. (R+)

And there follows a string of change talk.

Miller - 49: Okay.

Mike - 49: And so, have a six-pack of beer, wake up, find out how alert you are for the first two hours of the day. (R+)

Miller - 50: Right.

Mike - 50: It’s going to cause anyone problems. (FN) You know, have a six-pack, have a twelve-pack, try to play soccer the next day. (R+)

Miller - 51: Right.

Mike - 51: Okay. It’s...

Miller - 52: It’s amount and the after-effects of that. (REC)

2-10

Mike - 52: Right. Right. And I think my tolerance is up so high that it takes me too much to get the same buzz, (R+) and unfortunately, the recovery, it’s getting to the point where it is just not worth it. (R+) If I could get like a 12-pack high on three beers, then I only have three ounces I’ve got to process. If it’s taking me 12 to get the same which I got three on, now I got 12 to process you see. (FN)

I don’t have to give him a lecture about the risks of tolerance to alcohol. He already knows.

Miller - 53: Yep. (RES)

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Mike - 53: So we are at a balance point where we are getting diminishing returns on ever expanding, how shall I say, quantities. (R+)

A nice personal expression of his ambivalence, indicating that he is at a kind of tipping point. He certainly didn’t seem to be at this point ten minutes ago. This conversation is a good example of how motivation for change emerges in an interpersonal context.

Miller - 54: Like the slot machine doesn’t pay off so much anymore. (REC)

Mike - 54: Well, you know, it’s addictions, so you’re stupid, so you keep on playing it, you know. (O+)

Now he is making the kind of argument that “addiction counselors” made before.

Miller - 55; It is amazing. How long you keep going. (REC)

Mike - 55: Yeah. (O+)

Miller - 56: But you’re, with alcohol, you are kind of hitting a point where this isn’t worth it anymore. (RES)

I reflect his statement of being at a tipping point in the motivational balance.

Mike - 56: Yeah, yeah. (R+) But it is not because anybody is telling me from the outside, because I’m being forced to do that. (FN) It’s just because I gotta wake up in the morning, and I know how I feel. Period, Okay? (R+) And I think what has happened is before I used to drink all the time, and I was always drinking. And then I stopped and found out how good I felt, okay? Now I have a compare and contrast whereas before I never had a compare and contrast. (R+)

He affirms that the motivation that matters is his own, again rejecting external persuasion. He is persuading himself, and the stream of change talk continues.

Miller – 57: Now you know. (RES)

26


Mike - 57: Now you know. Now you know, hey wait, wasn’t it a lot better when I was clear headed then when I was, so, (R+) and to me then it does become a problem because now at least you have something you can you know, you can relate to. You can say this is how I am without it. This is how I am with it. This is my performance without it. This is my performance with it, you know. (R+)

Miller - 58: It’s only when it’s a problem for you, really, that it matters. (REC)


Miller - 59: If somebody else is telling you... (REC)

Mike - 59: Yeah, it doesn’t work. (FN)

Miller - 60: Or worse. More likely you back away from it. (REC)

Mike - 60: Well, then why is the approach the opposite? That’s what I, I don’t mean to be belligerent toward addiction counseling, but I can’t help but be. Why, sometimes I wonder if these people didn’t do more bad than good... (FN)

Miller - 61: It doesn’t make any sense to me. It’s human nature to push against something when they push against you. (GI)

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Mike - 61: Well, I always heard in AA too, is the dumbest things I ever heard. Some of the comments I heard that were just god awful stupid. And these people were just complete idiots. We alcoholics don’t like to be told what to do. I’m thinking wait. We alcoholics. What are you some special breed of people? No one likes to be told what to do. You know what, I really got tired of that kind of… The kind of like we’re special because we have this disease or come feel sorry for us because we have a disease. And quite frankly, the more I read about alcoholism, no one knows what the hell it is. So I’m not going to say I am cause until there is a definitive area that we can agree on, you know, I could say alcohol dependent. Now that makes sense. It’s a bit more clinical... (FN)

Trying to persuade him to accept a label like “alcoholic” would be a losing cause.

But he does recognize dependence.

Miller - 62: That you can understand. (RES)

Mike - 62: Yeah, that’s understandable, but that’s one of the things I didn’t like about AA is they wore it like a badge. It’s nothing to be proud of, but it’s nothing to be ashamed of. But you certainly don’t do some reverse pride on it, and you know, we’re special because we’re this. We’re different. I didn’t see any difference between those people and normal people. (FN)

Miller - 63: It seems to work for some people, but that’s not going to help you. (REC)

28


Mike - 63: Well, who do you think it works for? Apparently highly religious people who believe in higher powers and miracles and some deity is going to come down and save them anytime they have problems. I’m not that type of person. (FN)

Sarcasm.

Miller - 64: That’s not you. And for you it has to be some reason that you see that persuades you, okay, it’s time. (RES)

Emphasizing his own intrinsic reasons for change

Mike - 64: Yeah, a little bit. (FN)

Miller - 65: A little bit. (RES) I wasn’t sure what “a little bit” meant, and rather than asking, I simply reflected it.

Mike - 65: A little bit more realistic, okay. No nonsense, no bumper sticker stuff. (FN)

Miller - 66: And not being able to breathe on the soccer field is no nonsense. (REC)

Mike - 66: I think that’s kind of, I don’t know if you can get too much more guttural than that you know, and so that’s where it is. (FN)

Miller - 67: So, it’s having something to pursue, having something to live for really. (REC)

Coming back to the theme of what displaces drinking for him.

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Mike - 67: Yeah, yeah. That’s it in a nutshell. I’ve read a couple of books, and the one thing I really enjoyed was the book Positive Addiction. You know, having been a runner before, being cross-country, I can see exactly how that worked. Basically, this guy was saying what had happened is he was under the suspicions that a lot of people running were actually, had drinking problem and ran themselves out of those. Now I think that is actually true because after I run, I have about this much desire to drink, and I have about that much desire to smoke. (FN)

He refers to William Glasser’s book, which makes exactly this point, that addiction is displaced when we find something better.

He comes back to smoking but begins to tie it to drinking.

Miller - 68: Yeah. (RES)

Mike - 68: You got endomorphins, you feel good, you are alert. (FN)

Miller - 69: Yep, yep. (RES)

Mike - 69: Why would you want to pollute yourself, you know? (R+)

Miller - 70: Makes sense to me. (SU)

Mike - 70: So, that’s my deal on that. My read on who I am. (FN) But am I committed? (C-) No. Total abstinence? No. Not at all. (C-)

Not committed? This surprises me. What does he mean?

Miller - 71: Oh, to total abstinence. Okay. Because I am hearing a lot of commitment in what you are saying, that it’s worth it to me to, in order to be able to breathe on the soccer field... (REC)

2-15

Mike - 71: Right. (C+)

Miller - 72: ...to do something about cigarettes. (RES)

I am suppressing my “righting reflex” here to say, “But what about drinking?”

Mike - 72: Yeah. (C-)

30


Miller - 73: To quit smoking even. (REC)

Mike - 73: Yeah. (C+)

Miller - 74: So there I was hearing some commitment. (REC)

Mike - 74: Yeah, I think there is. You see when I quit smoking, I quit drinking, too, you know. (O+)

He comes back around to drinking on his own.

Miller - 75: Is that right? (QUC)

Mike - 75: Well, you have to. Well, I mean at least I have to. (C+)

He is persuading me, making the argument for change.


Mike - 76: Cause I can’t like drink. If I drink I’ll have a cigarette. (C+)

A minute ago he was not committed to abstinence. Now he says “I can’t drink.” This is his strongest statement thus far about drinking.

Miller - 77: Okay, they are that tied together. (REC)

Mike - 77: Yeah. (FN)

Miller - 78: You do them together so many...

Mike - 79: Well you...

Miller - 80: tens of thousands of times. (REC)

Mike - 80: Yeah. Well, even coffee. You know coffee, cigarette, just association. Yeah, I think like when you drink, you lose your judgment and your willpower just goes down. I don’t know if you call it willpower. I think its just judgment. (O+)

He adds another down side of drinking.

Miller - 81: Whatever it is. (RES)

Mike - 81: You are going, “Oh a cigarette sure would taste good now.” Oh, yeah, okay. (O+)

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Miller - 82: That happens with cocaine too. I mean people, drinking is the most common reason why people go back to using cocaine when they really wanted to stay away from it. (GI)

I wanted him to know that I had not missed his earlier statement about using cocaine.

Mike - 82: Oh, really? (FN)

Miller - 83: Yeah. So that’s exactly what you are talking about. (GI)

Mike - 83: There is such an association between the two? (FN)

Miller - 84: Well, whatever it is. Or it just kind of dulls down your judgment.

Mike - 84: Yeah.

Miller - 85: Enough that you say, “Oh that would feel nice.” (RES)

Mike - 85: Should I ask if you drink? (FN)

This is always an interesting question. Sometimes, particularly with teens, I tell them I will answer the question, but want to know first what it will mean to them if I say yes, and what it will mean if I say no. Either way the client may use it to disqualify me. I’m not really concerned about that here.

Miller - 85: I do. Yes, I do. (GI)

Mike - 86: Well, you know how the judgment goes. And let’s face it, it goes. It goes on everyone, you know. They always say oh we alcoholics are different. No, no, no, no. You feed someone six beers and their judgment is going to go down. (FN)

He seems to use my answer to enhance my credibility.

Miller - 87: It’s going to have that effect. (RES)

Mike - 87: It’s a physiological reaction to a toxic drug. You know, let’s face it. (FN)


32


Mike - 88: So, it is. (FN)

Miller - 89: So, you really would be talking about stopping cigarettes and alcohol then. (REC)

Mike - 89: Well, yeah. (C+)

Miller - 90: In order to breathe. (R+)

Mike - 90: But I don’t want to think about it.

Huh? What’s this?

Miller - 91: Oh.

Mike - 91: I don’t want to think about that. (FN)

Aha – he differentiates thinking about doing something from actually doing it.

Miller - 92: Meaning you just want to do it and not think about it, or you don’t want to get serious? (QUC)

Mike - 92: Well, I would rather do it and not think about it. (O+)

Miller - 93: Yep. Not much point in thinking about it. (RES)

Mike - 93: Well, I mean, is there? (FN)

Miller - 94: No, no. (SU)

Mike - 94: Do I think about working out every day? Do I think about brushing my teeth? If I did I wouldn’t want to brush my teeth. I gotta brush my teeth tomorrow. That’s going to be pretty bad, you know that. I gotta brush my teeth. You know what I’m saying? (FN)

Again his wit comes through.

Miller - 95: I do. (RES)

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Mike - 95: I think that’s what happens when people do that, and I see more procrastination because it is worse to think about having to go to the gym and work out. My god it’s going to hurt and oh I’m going to do those curls and my biceps are going to kill me and then I have to wake up and brush my teeth. I think that when you think about stuff like that, I think it actually is more counterproductive than just saying, oh screw it. Just do it. (FN)

How much better than if I had told him, “Just do it!”

Miller - 96: Thinking about going to sleep. (RES)


Miller - 97: As long as you are doing that you are not going to be going to sleep. (RES)

Mike - 97: You’re not going to sleep, no. I hope that makes sense to you. (FN)

Miller - 98: Oh, it does. No, it wasn’t what I had meant by think about it, but I see exactly what you mean, that if you are thinking about something or like trying. In other words if you are trying to do it, you are not doing it. You either do it or you don’t do it. But you don’t try to do it. You don’t try to go to sleep. You just go to sleep. (RES)

Mike - 98: You just go to sleep. (FN)

Miller - 99: So what would be great is if that was just natural. You’re not thinking about it. It’s just natural to do it. (REC)

Instead of telling him how he can change, I invite him, in a complex reflection, to consider it himself.

34


Mike - 99: I mean, what do you think? I’m thinking basically the thing I could best do it just start running again and just start really substituting habits. (C+) I don’t think, I think substitution of habit and making habits so counterproductive or contradictory I should say maybe which you just replace one habit with another habit rather than just try to get rid of one habit. I think it kind of comes up to a vacuum state. Now what do I do? I got rid of this habit. Now what do I replace it with? You know, so... (FN)

And he does.

Miller - 100: Well, you are clearly telling me that’s what works for you. That’s what is going to do it. (REC)

Mike - 100: Well, that’s what has done it in the past. (R+a) That’s what’s done it in the past. Actually I got to join another soccer team. I can play with even better people and that way I will really get pissed off at myself, you know. So. (C+)

He ties this back to the prior time when he “was committed” by having a life too good to lose.

Miller - 101: And that’s what worked for you before? (QUC)

Mike - 101: Mm hm. (FN)

Miller - 102: Good indication. (EC)

Mike - 102: Yeah. Well, what hasn’t worked for me is drug addiction counselors, sorry to say. (FN)

Miller - 103: Yeah, yeah. No your reaction to that was... (RES)

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Mike - 103: Well, you have to realize first off, most of the people there, and I’m not trying to be apologist for them, but in a way I am. They were good people. Most of the people there were forced to be there. They weren’t there on their own free will. So, of course, they are going to be resistant. And most of the people there, I mean you are basically, you have to talk a certain way, behave a certain way, do certain things so they think you are, quote, whatever, rehabbed. So you learn real quickly how to play the game. What are you looking for? Okay, what’s this counselor looking for, or what’s this person want me to say? Okay. I’m supposed to feel this way about something because that’s the way she’s been told that we define this addiction. So what I’ll do is I’ll just play in her bullshit even though it isn’t true, and as long as I can do it in a convincing way and fool her, boom, whappo, I got it, and I got my license back. And you know that’s a game that I was playing the whole time, and actually, I kind of lost respect for people because they were so easy to fool. All I did was I read the addiction counseling books. I found out what they are looking for, what the traits were... (FN)

He takes another shot at addiction counselors, venting his reactive anger that had him stuck.

2-20

Miller - 104: Played the game. (RES)

Mike - 104: Played the game. Found out, you know, what they wanted to hear. And to me that’s really counterproductive. It, if anything, it’s a waste of time, and it might even be more harmful than it is helpful. (FN)

Miller - 106: It sounds like it was for you. (REC)

36


Mike - 106: Yeah. Does anyone quit anything if they are not committed to it? (FN)

He reemphasizes the importance of his own personal commitment.

Miller - 107: My own sense is it’s that internal reason that really makes the difference. When instead of there being somebody out there... (GI)

Mike - 107: External. (FN)

Miller - 108: ...telling you, what’s telling you is something inside of you. Your lungs or whatever it is. (GI)

Mike - 108: I think this time it’s my body. (R+)

Some committing language – “It’s time.”

Miller - 109: Hey, yeah right. (RES)

Mike - 109: My brain is saying hey, “I’m stupid (O+), but your liver doesn’t like you too much. (R+) Your lungs are a little pissed, you know.” (R+)

Miller - 110: Yeah.

Mike – 110: So.

Miller - 111: So, what gets in the way of your sticking with that? What gets in the way of running? (QUO)

Technically this is a backward question in MI because the answer to it is sustain talk – why he doesn’t change. Such questions can be useful, however, particularly when hearing clear motivation for change. What stands in the way?

Mike - 111: You know, I don’t know. I think it may be a fear of failure. I really do. Could be that. (R+) Could be just the amount of effort. (R-) Like I say it’s been going down, going down, going down, but I seem to really have a problem totally committing to just okay this is the year man. Let’s do it. (C-)

He’s already been moving toward change, but hasn’t wanted to take the plunge.

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Miller - 112: Yeah, well because it is pretty total. I mean, that was what I was picking up earlier. At least the way you are thinking about it. It means stopping cigarettes and stopping drinking. (REC)

Mike - 112: Well, you know, it used to be a fear of withdrawal with drinking, and when I quit I found out... (R-)

Miller - 113: It’s not a big deal. (REC) I am “continuing the paragraph,” anticipating what he means to say. Sometimes counselors worry about “putting words in their mouth,” but when you can do it accurately it moves things along.

Mike - 113: It’s not. And that’s another thing. Don’t tell people about DT’s because quite frankly that doesn’t happen all that often. (FN)

Miller - 114: It’s pretty rare. (RES)

Mike - 114: I mean, what do you get? You get maybe higher energy level and that’s it. (R+) And you feel better, okay? (R+) I mean, whoa, you are going to get DT’s, you are going to go through withdrawal. Oh, you are going to have to have doctor’s supervision. By telling someone that you are just scaring the fuck out of them. You know? Excuse my French, but that’s what you do. (FN)

More change talk.

Miller - 115: That is something that happens to some people but not very many. (RES)

38


Mike - 115: Yeah. Yeah. But I’m really worried about the smoking because I remember last time I got just violent. I mean I was bad to be around for five days. I mean really bad. I mean I was just blowing up on everything. Every little thing I was just, everything was just ticking me off. (R-) And then after five days I was pretty cool, and after two weeks I was real cool. (FN) And I was kind of, yeah, but I’m thinking my god, what if a client calls me up. What am I going to do? (R-)

This is called “envisioning” in MI. He is looking ahead to having made the change (in this case, quitting) and anticipating the problems that may come up. This can sound like resistance or counter-argument, but it is actually a signal of increasing readiness to change.

Miller - 116: Like five days in a mountain hut somewhere. (REC)

Mike - 116: Oh well, you think a kayak trip? Just throw me for five days out in a kayak. (C+)

He responds energetically to this idea. It’s doing something besides just quitting.

Miller - 117: That’s a nice idea. AF

Mike - 117: No cigarettes, (O+) no booze. (O+)

Miller - 118: Yeah, the Grand Canyon or something. (RES)

Mike - 118: Well, you see, that would be very good. (O+)

Miller - 119: It would. (RES)

Mike - 119: I mean that’s what I was thinking of doing. (C+)

Committing language – still lower level (“thinking of”), but coming along.

Miller - 120: Something physical. (REC)

Mike - 120: Yeah. Do something like that. (C+)

Miller - 121: You’re committed. (REC) By which I mean, when you’re out there with no alcohol or cigarettes, you are committed.

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Mike - 121: Backpacking. 100 miles from nowhere. (C+) And maybe I could reward myself with a cigarette by the time I get there. By the time I get there it will be ten days and I won’t want one. (C+)

He picks up the image.

Miller - 122: Well, and the trip itself for you sounds like it would be a reward. (REC)

Mike - 122: Oh yeah. (R+)

Miller - 123: Doing it would be fun. (RES)

Mike - 123: Yeah. (R+)

Miller - 124: So it might be a way to get through those five days. (REC)

Mike - 124: Yeah. Yeah, like I say, I’m, how shall I say? I’m teetering on the edge where you know I’ve cut down, (TS+) I’ve cut down, I know how it feels to at least not drink that much, (R+) but now I’m finding out, hey, it’s not the drinking that’s giving me the hangover. It’s the cigarettes. (R+)

Here is some “taking steps” language, which also signals readiness for change, and more change talk.

Miller - 125: Mm hm.

Mike - 125: And the drinking only compounds it because when I drink I smoke like a son of a bitch. (R+) And one of the things is I think I’m cutting down on my drinking, not because I’m trying to cut down on my drinking, but because I don’t want to smoke that many cigarettes (R+d) which is weird, and you’re not supposed to be that way. Not by the definition of drug addiction. (FN)

Miller - 126: Well, you are breaking all the rules. (REC)

This is a guy who likes to break the rules.

40


Mike - 126: Yeah, I know. But I mean, I wish they wouldn’t tell me rules there. If they are not sure, I don’t want to hear them.


Mike - 127: You know, I mean it’s like I think a lot of this crap is self-fulfilling prophecy. You have given people false information and they are taking this false information to heart because these experts in the field, so called experts, and it’s really funny how many different variations of the definition of alcoholism we have. All of them almost contradictory. You get some poor slob that’s going to say well so- and- so says this, and they’ve been a leader in their field for the last 20 years. So, therefore, because they say this, I have to be this way. And instead of defining themselves as individuals, they go into the stupid pattern or whatever type of behavior that is supposed to be attached to them, and they assume that behavior is theirs. And that’s why I don’t like, it’s not, it doesn’t work. And I don’t think it ever will. I mean, do you agree with me, or am I... (FN)

Yet another rant against the form of addiction counseling that he experienced.

Miller - 128: Well, you know more about you than I do, obviously. (EC)

Affirming his personal control and wisdom

Mike – 128: Well, that’s the whole thing. (FN)

Miller - 129: I believe you. (SU)

Mike - 129: Yeah, but I mean how many people have you counseled in your lifetime? (FN) I mean you’ve had to see certain things works for certain people and certain things work for other people, and it’s not going to be one size fits all. (FN)

He asks but doesn’t need an answer.

2-25

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Miller - 130: No it isn’t. (SU)

Mike - 130; It just, it’s not there. (FN)

Miller - 131: I’ve worked with people who have done really well in AA. And I’ve worked with a lot of people who have said, “Ah, it’s not for me. That’s not my cup of tea.” (GI)

Mike - 131: And I’m not trashing them. I mean if it works for you, fine. (FN)

Miller - 132: There you go. (SU) In Albuquerque this phrase is an affirmation, an agreement.

Mike - 132: If it works for you that’s fine. And I’ve seen it help a lot of people, and I know the type of person it is going to work for. It is not going to work for me. (FN)

Miller - 133: Now, tell me about this teetering on the edge business. (QUO)

Querying where he is in the balance. Is it time for Phase 2 of MI – negotiating a change plan and committing to it?

Mike - 133: Don’t know. I think it’s, like I said, I think it’s fear of failure. (R-) I think on my part it’s a fear of failure, and it’s also the fear of withdrawal, especially from nicotine. Because I know how I get. (R-)


Mike - 134: And I’m committed (C+) and then I’m not. It’s this ambivalent feeling. (FN)

Not quite ready for Phase 2 yet.

Miller - 135: Yeah.

Mike - 135: And I can’t seem to, you know, and that’s where I’m stuck. That’s where I’m stuck. I’m stuck in that ambivalence (C-) which I guess is a good thing in a way. I mean, it’s better than just being not committed at all. (O+)

He sees ambivalence as progress.

42


Miller - 136: Well, that’s exactly right. It’s a step forward. (REC)

Mike - 136: Yeah, it’s a step forward, but it’s still… (FN)

Miller - 137: Becoming ambivalent is the first step toward change. (GI)

Mike - 137: Yeah, but let’s face it, that’s cognitive dissonance. The ambivalence I really want to get over it, (O+) but I can’t seem to, I can’t seem to just say okay, today’s the day. This is it. (C-)

This fellow reads psychology.

Miller - 138: Right.

Mike - 138; So maybe, I don’t know. See I don’t know even what to do, quite frankly... (FN)

Miller - 139: Well, you mentioned a couple of things. (REC)

I point him back to his own ideas on how to succeed.

Mike - 139: Yeah, see I’m thinking I could cut down slowly. (C+) See, look it, if I quit cigarettes, drink is going to go. It’s going to have to go.

Miller - 140: Mmm hmm.

Mike - 140: Okay, so then that’s it. That’s out. Now that I know isn’t that hard. (R+a)

Back to committing language. Drinking is done, he says.

Miller - 141: Right. You’ve done that. (REC)

Mike - 141: Yes, but the nicotine, ooooh, that’s a scary thing for me, man. (R-)

He is less confident of his ability to quit smoking.

Miller - 142: And you’ve done that before also. Yes? (QUC)

Mike - 142: Playing. Yeah, I was playing around. I was playing two games a week. (FN)

Miller - 143: Okay.

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Mike - 143: Now I would have to start running every day, an hour a day five days a week. (C+) I would have to gradually cut down, okay? (C+) And then I would have to set a date, (C+) and I guess go on the patch, (C+) and I would have to stay away from anyone that wants to have a beer with me, because if I have one beer, boom. Right back to smoking. (C+) Now I’m telling you what happened with smoking. What was it, four months? Whatever it was, blow out the knee. As soon as I started again, now this is, as soon as I started again, I was back up to two packs within a day. (FN)

He has a change plan for smoking. He doesn’t seem to need one for drinking. It’s as if he’s already crossed that bridge.

Miller - 144: That’s scary isn’t it? (REC)

Mike - 144: Within a day. It wasn’t like this gradual, “Oh I’ll just have one.” It was just like boom, and I was just right back in there, (FN) and then I feel the lungs quit on me, (R+) yeah I guess a fear of failure. I don’t know. Maybe it was fear. I don’t know what it is. Maybe it’s fear of failure. I don’t know. (R-)

Miller - 145: How confident are you that you can do it? (QUO)

Mike - 145: That’s the problem. I don’t know. (FN)

Miller - 146: You’re not sure. (RES) It would have been good here to ask him to rate his confidence on a 0-10 scale, and then explore why he is as whatever number he offers, rather than zero. In what ways is he confident?

Mike - 146: I’m not too sure. I’m really not too sure. (R-a)

Miller - 147: It’s not so much the wanting to do it as, “I don’t know if I could if I make the decision.” (REC)

Mike - 147: Right, right, right.

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Miller - 148: Mm, okay.

Mike - 148: It’s confidence probably. (R-a)

Miller - 149: Well, and that’s what would help. Something that you could really be confident in. Like the way you lit up when we talked about the Grand Canyon or something. Like I could get through five days that way. I could do that. (REC)

Instead I invite him to wrestle with how he could do it.

I wasn’t conscious of using the phrase “lit up” here, but it plays on the smoking theme.

Mike - 149: Am I supposed to spend maybe a year out there? (FN)

Miller - 150: No, I’m just using that example. (GI)

Mike - 150: Wait a second, if I made a lot of money, that would be a good... (FN)

Miller - 151: How long would it be? Well, the first five days you said are the tough ones. (REC)

Mike - 151: Yeah, the first five are tough. (R-a) But really what it is, what basically what it really is just not hanging around Chris because Chris will come over and he’ll want a beer. (C+) I don’t care if he has a beer, but if I have a beer, boom. I’m going to light up. (O+)I’m going to have to stay away from Bogden. (C+) That’s another guy on my soccer team. (FN) It would have to be like really staying away from a lot of people I know. (C+) You know, maybe I’m just making excuses for myself. I don’t know. I don’t know. But I would have to do that, and then I would really, I would have to watch myself and not let myself talk to any clients for five days. Because I know how I get. (C+)

He does come up with part of a change plan – to avoid the immediate triggers. Again he is envisioning what it will be like to quit drinking, and thinking seriously about how to do it.

Miller - 152: Oh that five day period. Yeah. (RES)

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Mike - 152: Yeah, I don’t know. I don’t know. I’m still ambivalent. (FN)

Miller - 153: Well, that clearly is where you are. (REC) And you are right that that’s a normal place people pass through. (SU) You are saying, “Well let’s get through,” you know. (REC)

Mike – 153: I still want to... (FN) Hear the ambivalence – I want to, but am not sure if I can. This often resolves into “I’ll try,” which bespeaks higher desire, lower confidence.

Miller - 154: It’s an unpleasant place to be. (REC)


Miller - 155: You either want to go back to not being able to... (RES)

Mike - 155: Which is more comfortable. Let’s face it. Which is more comfortable. And I’ll tell you that right now. That’s a hell of a lot more comfortable saying, “Ah, I’m not going to quit smoking.” That’s more comfortable. (R-)

He sees that saying “I can’t” is an out – a way of decreasing the tension involved in ambivalence.

Miller - 156: Either side is more comfortable. (REC)

Mike - 156: Either side is more comfortable than the ambivalence. The ambivalence is the hell. (FN)

Miller - 157: It is. (SU)

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Mike - 157: That’s the hell. Okay, cause well I know I shouldn’t (R+) but I will (C+) and I don’t know if I should. (R+) Here’s what it is. It’s knowing that you are taking a carcinogen, a known carcinogen, and you are putting it in your lungs. (R+) You know that it’s upping your blood pressure. (R+) You know it is increasing your chance of lung cancer. (R+) You know it’s really screwing up your soccer. (R+) It’s that, it’s doing that is pissing me off. (O+) It’s knowing that you are taking a poison, a poison called alcohol. (R+) You know the second drink your judgment is going to go to hell. (R+) And why am I doing this? Let’s just bang that head against that brick wall some more too please. And that’s what pisses me off. (O+) I mean if I was stupid, I could forgive myself for it. If I define myself as an addict, you know, and I think a lot of people do, then they can forgive themselves for it. (O+) But that’s, no. (O+)

He reminds himself of the reasons to quit smoking

and comes back to drinking as well.

2-30

Miller - 158: That is not a way out of you. (REC)

Mike - 158: No. That out doesn’t work. That’s a cop-out. I mean, and see I wish I was stupid and I could just say, didn’t know any better. (R+)

Miller - 159: And you could sit back here and...

Mike - 159: Yeah.

Miller - 160: ...be comfortable. (REC)

Mike - 160: Yeah, right. (R-)

Miller - 161: Now the place where you are is real uncomfortable. (REC)


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Miller - 162: And moving either way from it is more comfortable. (REC)

Mike - 162: Of course. Of course. Moving up or back. (FN)

Miller - 163: But staying in the ambivalence, because you are conscious of it, you are conscious of taking in the poison or the carcinogen or whatever it is... (REC)

Developing discrepancy – he is already experiencing plenty of it

Mike - 163: That’s the problem. (R+)

Miller - 164: Boy. (SU)

Mike - 164: That is, what are you doing this for? You know, what are you doing this for? And... (R+)

Miller - 615: And that’s the teetering then. “Which way am I going to move off of this… (REC)

Again I am using “I” language in reflections to amplify awareness of his dilemma


Miller - 166: …beecause I don’t want to stay here.” (RES)

Mike - 166: And not only that. You know the guys at soccer they always kill me. “Hey, you smoking again” Oh yeah. You’re stupid, man? So I got a little peer pressure going there. (R+)

Miller - 167: So they are not all pulling you into drinking and smoking? (REC)

Mike - 167: Oh, no, no. They wouldn’t, well it all depends. This is the Polish soccer team. Most of these guys are right off the boat, okay? And they do drink a lot, so... (FN)

Miller - 168: They just give you a hard time about smoking? (RES)

Mike - 168: Right, and they don’t smoke. (FN)

Miller - 168: Oh, okay. (RES)

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Mike - 169: And I say, “Well listen, you know, hey, if you want me to quit smoking, I’m going to have to quit drinking.” “Oh no you could.” “No,” I says, “I can’t.” It doesn’t work that way for me. And then having never done it they don’t know. So I’m going to have to like, if I do this, I’m going to have to stay away from them at least long enough to establish some type of... (C+)

More envisioning

and change planning

Miller - 170: There you go. People who make it through change usually do it, I mean you’ve got it. Usually do what you are saying which is for a while avoid the valley of the shadow of death, you know. I mean avoid the difficult place. And then it gets more okay. You’ve got to not rush too quick back in there, but it gets to be okay. You don’t then have to stay away... (GI)

One of my longer speeches. I am doing a little educating while also affirming that he is right in his perception.

Mike - 170: Forever. (FN)

Miller - 171: Right. So it’s not forever and ever. But for a while you are probably right. (GI)


Miller - 172: Or, somehow, get them to, say, “Help me out guys.” I mean, if they won’t do it, then you are right. (AD)

Mike - 172: No, it’s not like they are bad guys. They just don’t know. See, they’re not... (FN)

Miller - 173: Haven’t done it. (RES)

Mike - 173: You know, they don’t know. I mean I think if you don’t smoke, you don’t smoke cigarettes, you don’t know. You’re not going to know. And how could they possibly help it? (FN)

Miller - 174: Well, I only meant that if they could get it in their heads that what you are saying is right... (GI)

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Mike – 174: Yeah, right. (FN)

Miller - 175: That if they want to help you stop smoking, they’ve gotta also not encourage you to drink. (REC)

Mike - 175: Don’t come over with the 12-pack and want something. (FN)


Mike - 176: You know, come on. (FN)

Miller - 177: So if you could ask them to do that, help you out that much, then... (REC)

I’m doing a little too much suggesting here

Mike - 177: They’re guys. They’re guys. (R-)

And he negates it.

Miller - 178: They won’t... (RES)

Mike - 178: These are guys, okay? They’re guys. I’m single you see. If I was married I could blame it on my wife. In fact, I’m thinking of getting married, well I’m just kidding. But I’m thinking of a rent-a-wife situation. See you rent a wife and you tell all your guy friends, “Hey, I’m a married man. My wife will kill me if you guys come over.” Then you get to get then the hell out of your place. If you are a bachelor, they’re trying to get away from their wives, guess who they come over and hang around with? You.


Mike - 179: And guess what. That excuse doesn’t work. The only thing they understand is some bitchy lady with a skirt, okay? (FN)

Miller - 180: That would work. (RES)

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Mike - 180: And then you could clear them out of the place. Otherwise, you can’t clear them out, man. See, then you have no excuse but to do what they want to do. (R-)


Mike - 181: That’s the way guys are. At least the guys I know are that way. (R-)

Miller - 182: So, you are right. You would have to stay away from them for a while. (REC)

I reaffirm his earlier commitment in a reframe.

Mike - 182: Right. Right. I hope I’m not babbling here. (C+)

He agrees.

Miller - 183: No, no. (SU)

Mike - 183: I seem to be all over the place here. (FN)

Miller - 184: I mean you are giving me a real good sense of who you are. (GI)


Miller - 185: I mean I love to read a book to the end, and I’d love to know which way you are going to go from this place. (GI)

Mike - 185: I would like to know myself. I don’t even know. You know, I don’t even know. Like I say, I’m still at the ambivalent stage, and it’s getting to the point where I’m going to have to make... (FN)

Miller - 186: It’s too uncomfortable. (RES)

Mike - 186: Well, yeah. But what do you want to go back? I mean, where’s back? Where’s back going to take you” (RES)

He reaffirms his commitment to move forward toward change.

Miller - 187: Yeah. You know. (RES)

Mike - 187: Yeah. Yeah. (FN)

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Miller - 188: But it’s that “Can I do it?” obstacle. (REC)

Mike - 188: Well, that’s, it’s a confidence problems. (R-a)

Miller - 189: So something that would help you be more confident. (RES)

Inviting him to think more about how he could succeed. I am aware that the time allowed for our interview is coming to a close.

Mike - 189: Yeah, well, yeah, yeah. (FN)

Miller - 190: To be able to look at it and say, “I could do that. I can see myself doing that.”

(REC)

Mike - 190: Well, yeah, but what’s that going to do? (O-)

Miller - 191: I’m not sure. (GI)

Mike - 191: It’s going to have to be internal if it’s going to work for me.


Mike - 192: It can’t be anything external. I can’t deal with cheerleaders. I can’t deal with, “Oh you can do it you can do it.” Hey, come on. I’m a little too old for that. (O-)

Miller - 192: There is certainly nobody pushing you. (REC)

Mike - 193: Well, you know, I’m going to have to figure out that I can do it myself or just not going to be able to get done. And that’s just, the long and the short of it is that’s what it’s really going to take.(RES)

2-35

Miller - 194: That’s the bottom line. (RES)

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Mike - 194: Yeah. I mean for a person like me, that is the bottom line. And it has to be important enough. But I think it is important enough now or else I wouldn’t be thinking about this in the first place. (FN)

Miller - 195: That’s how it sounds. (REC)

Mike - 195: You know, as far as I’m concerned, I don’t care if I die tomorrow. This is not about my health. (FN)

It’s not fleeing from something that motivates him,


Mike - 196: Boy I can’t stand, if I’m not the fastest guy out there, I have an identity crisis, okay? (R+) It’s my arrogance, okay? (R+) It’s my conceit. (R+) It’s my pride, okay? (R+) So I am using all the negative stuff you’re never supposed to have in AA to help me... (TS+)

But chasing something.

Miller - 107: Challenge. That’s what will get you through. Sheer cussedness. (REC)

Mike - 197: Yeah just sheer, you know, if anything, arrogance. If anything, probably that’s all it is. And it really has nothing to do with health. It really doesn’t. I mean I hate to admit it, but as far as longevity and life, I don’t really care about it. High quality of life? Well, everyone dies. Everyone makes such a big goddam deal out of it. I’m so goddam tired of these people who, “Oh I eat these healthy food, and I do this, and I know go out in the sun,” and yeah, yeah, you’re 400 pounds overweight, you don’t work out. You know, don’t give me this live forever, but live what? (FN)

For him, emphasizing bad things that will happen to him if he doesn’t change will fall on deaf ears.

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Miller - 198: We’re all going to die anyhow. (RES)

Mike - 198: We’re all going to die anyhow. What are you going to do? Just never go out in the sun? (FN)

Miller - 199: But while you are here, you want to be the best. (REC)

Mike - 199: Well, you know, it would kind of be nice to wake up, you know, and feel healthy and be able to do what you like to do. (R+)

He reaffirms positive motivation.

Miller - 200: It is. (SU)

Mike - 200: Uh, well, yeah, if you could do what you like to do forever, hey. I would like to do that. But I know that’s not going to happen, and I accept that, and to me it’s not so much a longevity issue (FN) as it is a quality of life issue. And so that’s the deal. (R+)

Miller - 201: You know the funny thing is it sounds to me like you have made up your mind. (REC)

Probing commitment

Mike - 201: Possibly. (C+) He gives me a mid-range signal.

Miller - 202: Maybe. (RES)

Mike - 202: Yeah. I think I’m swaying. (O+)

Miller - 203: Leaning just a little. (RES)

Mike - 203: Swaying (O+). I hope it’s not a pendulum, you know. (R+d)

Miller - 204: I don’t know though. It’s kind of back there. (RES)

Reflecting his status-quo voice.

Mike - 204: Yeah, back there is more comfortable. At least it’s known. It’s known. See that’s... (R-)

Miller - 205: It’s predictable. (RES)

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Mike - 205: That’s all it is. It’s known. (R-)

Miller - 206: It is predictable. (RES)

Mike - 206: That’s all it is. It’s known. Yeah, someone told me and it made a lot of sense. Bang your head against a brick wall, you start to miss that brick wall when you quit banging your head against it. You know, I think that’s what everything is. Not just smoking, not just drinking, not just doing whatever, cocaine or anything else, but everything else. I think bad relationships are like that.

Miller - 207: Mmm, hmm.

Mike - 207: I think bad jobs are like that. I think living in bad areas of town are like that. I think, it’s familiar. Because it is familiar it is predictable. (FN)

Miller - 208: Right. (RES)

Mike - 208: You are comfortable with it. It’s not that terrible change (R-), you know, that’s a scary thing. And you know, maybe that’s what it is. So. (R-)

Miller - 209: What if you stopped smoking and drinking and you still couldn’t keep up with the young guys? (QUO)

Mike - 209: Oh, I don’t think that is going to be a problem. (O+)

Miller - 210: That’s alright. (RES)

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Mike - 210: I already can. That’s the thing. It’s just that you know I’m getting older, and this is not going to last forever. I put a lot in a bank account. I had a scholarship, marathon scholarship, when I went to college which I didn’t take. Ran a 4:32 mile, always been fast. (FN)

He comes up with another metaphor for his motivation for change.

Miller - 211: Really. (RES)

Mike - 211: But I always had, the way I’m looking at it, I always had a bank account, and I put a lot in that bank account, that cardiovascular bank account. (FN) Well, I’ve been drawing off that bank account for a long time. Now it’s just about... (R+)

Miller - 212: Balance is getting low. (RES)

Mike - 212: Balance is getting low (R+). So I have to kind of start filling it up again. And... (R+n)

Miller - 213: That’s a nice image. AF

Mike - 213: Well, I think that’s exactly what’s going on. (R+n)

Miller - 214: That works. (RES)

Mike - 214: You can only do this stuff so long before you are going to start feeling the effects. I’m starting to feel the effects. Maybe I always was but I was too stupid to realize it. I’m not too sure. (R+)

Miller - 215: You don’t want to go into debt. (RES)

Complex reflection - continuing the paragraph within the metaphor.

Mike - 215: No. I don’t want to go into debt. (R+)

Miller - 216: Makes sense to me (SU). Well, I’d love to know how the story comes out. (GI)

I see that we are running out of the allotted time for this filming session.

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Mike - 216; Well, should we do a follow up? (FN)

Miller - 217: I’d like to know. (GI)

Mike - 217: You know, I tell you. If I do this, it’s not going to be for two to three weeks, you know. Everyone says, “Oh do it tomorrow.” You know what? No. (FN)

He envisions quitting two to three weeks from now.

Miller - 218: You are going to set a date out there somewhere. (REC)

Mike - 218: Well, yeah. (C+)

Miller - 219: Not tomorrow. (REC)

Mike - 219: Not tomorrow. Not tomorrow. Not today, not right now. I mean, you know, I’m just not going to do that you know. (FN) It’s going to be, here’s what happens to me. When I start doing shit that’s contradictory to bad habits, the bad habits start disappearing almost naturally. And I start getting a roll. (C+)

He returns to his primary change theme.

Miller - 220: Beautiful. (REC)

Mike - 220: And then I start getting to the point where I want to continue this good habit. Bad habits, I’m not really thinking about. They are starting to go away. So I want to kind of like steamroll this turkey, and then as soon as I got that steamroll thing going and I got this thing on the run, it’s okay baby, and now we’re going to get you. Now you are vulnerable. Now you’re going to die. That’s... (C+)

He is speaking here to his addiction.

2-40

Miller - 221: That’s the plan that works for you. (RES)


Miller - 222: Good. (SU)

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Mike - 222: Does that work for other people or am I strange? (FN)

Miller - 223: No, people are real different in terms of the way they find, and it’s kind of your personality and what grabs you and what’s the thing that finally tips the seesaw for you. (GI)

Mike - 223: I was told, “That doesn’t work.” I was told, “Well no, no. One size fits all. This is how we have to do this. This is the only way we do it.” You know, that’s what I was always told. It made no sense to me, and I just really lost respect for, you know, anyone in the industry because, do you have any intuition? Do you ever listen to your clients? Have you ever thought that there could be something called individuals out there” “Hey, bell shaped curve, guys. Hey, you know what it is.” Guess what different IQ levels, different personality traits. Guess what. (FN)

Miller - 224: People know something about themselves. (REC)


Miller - 225: Mmm hmm. Yeah. (RES)

Mike - 225: So, but I never got that far. Of course, like I said, it was state run. It was a little bit different, so. (FN)

Miller - 226: Well, I wish you well. I’d like to know how the story comes out. (GI)

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POST-SESSION COMMENTARY BY DR. MILLER

I felt a bit rushed because session length was prescribed by the filming. It would have been good to offer him a recapitulation summary, pulling together his change talk from the session, followed by a key question. Had I done so, it might have been something like this.

“You’ve been thinking quite a lot about your drinking and smoking, and you’ve reached a kind of tipping point. You don’t like labels and the games you had to play in addiction counseling before, but in a real sense you’d like to be done with alcohol and tobacco. You’d feel better in the morning, have more energy and be able to think more clearly and do the things you love to do. In fact, doing those things is an important part of quitting, because it replaces them like a positive addiction. You’re sure that you need to quit drinking in order to stop smoking. Quitting drinking seems pretty easy to you – no big deal, but you think smoking is likely to be tougher to kick. You liked the idea of getting away for long enough to get through the five to ten days it will take, and you also think that you’ll need to avoid your soccer buddies for a while after that. It’s uncomfortable to stay on this seesaw, and you’re also pretty clear that you don’t want to go back to status quo just for the comfort of predictability. You also don’t want to think about it much, but just do it. So how are you going to do it?”

I did follow up a year later to find out what happened. Mike had quit drinking, but was still smoking.

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Suggestions for Further Readings, Websites and Videos

BOOKSMiller, W. R., & Carroll, K. M. (Eds.) (2006). Rethinking substance

abuse: What the science shows and what we should do about it. New York: Guilford Press.

Miller, W. R., & Delaney, H. D. (Eds.) (2005). Judeo-Christian perspectives on psychology: Human nature, motivation, and change. Washington, DC: American Psychological Association.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.

Miller, W. R., & C’de Baca, J. (2001). Quantum change: When epiphanies and sudden insights transform ordinary lives. New York: Guilford Press.

Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.

WEB RESOURCESIn-depth Interview with Stephanie Brown, PhD on Psychotherapy and

Addictions

http://www.psychotherapy.net

William Miller’s faculty page at the University of New Mexico’s Center on Alcoholism, Substance Abuse and Addictions http://casaa.unm.edu/miller.html

Manual for Motivational Interviewing Skill Codes http://casaa.unm.edu/download/misc.pdf

Website for Stephen Rollnick, co-developer of Motivational Interviewing http://www.stephenrollnick.com

A resource for clinicians, researchers and trainers sponsored by the

60


Mid-Atlantic Addiction Technology Transfer Center http://www.motivationalinterview.org

NAADAC: The Association for Addiction Professionals http://naadac.org

The Center for Substance Abuse Treatment, US Department of Health and Human Services http://csat.samhsa.gov

National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov

RELATED VIDEOS AVAILABLE AT WWW.PSYCHOTHERAPY.NETCognitive Therapy for Addictions

–Bruce S. Liese, PhD

Couples Therapy for Addictions: A Cognitive-Behavioral Approach

–Barbara S. McCrady, PhD

Harm Reduction Therapy for Addictions

–Alan Marlatt, PhD

Integrating Therapy with 12-Step Programs

– Joan Ellen Zweben, PhD

Reality Therapy for Addictions

–Robert E. Wubbolding, EdD

Solutions Step By Step: A Solution-Focused Approach to Treating Substance Abuse Problems

– Insoo Kim Berg & Norman Reuss

Stages of Change for Addictions

–John C. Norcross, PhD

Treating Alcoholism in Psychotherapy, Volumes I & II

– Stephanie Brown, PhD

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Notes …

62


Video Credits

HOSTS:Dr. Judy Lewis, Governors State University Professor

Dr. John Carlson, Governors State University Professor

FEATURED THERAPIST:William Miller, PhD

SPECIAL THANKS TO:Christine Nolan

John Cebuhar

Addison Woodward

Diane Alexander

Arthur Durant

Virginia Lanigan

Stephen G. Smith

David Sachetti

PRODUCED BY:Governors State University

Copyright © 2007, Allyn and Bacon

DVD version released by Psychotherapy.net, 2007

VHS version by Allyn and Bacon, 2000.

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About the Contributors

VIDEO PARTICIPANTSWilliam R. Miller, PhD, Featured Therapist, is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. He served as Director of Clinical Training for UNM’s doctoral program in clinical psychology and as Co-Director of UNM’s Center on Alcoholism, Substance Abuse and Addictions. He served as principal investigator for numerous research grants and contracts, founded a private practice group, and served as a consultant to many organizations including the United States Senate, the World Health Organization, the National Academy of Sciences, and the National Institutes of Health.

Dr. Miller’s publications include 40 books and over 400 articles and chapters. Fundamentally interested in the psychology of change, he has focused in particular on the development, testing, and dissemination of behavioral treatments for addictions. In recognition of his research contributions, Dr. Miller is a recipient of the international Jellinek Memorial Award, two career achievement awards from the American Psychological Association, and an Innovators in Combating Substance Abuse award from the Robert Wood Johnson Foundation. He maintains an active interest in pastoral counseling and the integration of spirituality and psychology. The Institute for Scientific Information lists him as one of the world’s most cited scientists.

Jon Carlson, PsyD, EdD, Host, is Professor of Psychology and Counseling at Governors State University and a practicing clinical psychologist. He has authored 40 books, 150 journal articles, and developed over 200 videos featuring leading experts in psychotherapy, substance abuse treatment, and parenting and couples education.

JudithA.Lewis,PhD, Host, is Chairperson of the Department of Addictions and Behavioral Health at Governors State University. She is past President of both the American Counseling Association and the International Association of Marriage and Family Counselors.

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Dr. Lewis has written several books, including Substance Abuse Counseling, and over 60 articles and book chapters.

MANUAL AUTHORSRandall C. Wyatt, PhD, is Editor-in-Chief of Psychotherapy.net. He is the Director of Professional Training at the California School of Professional Psychology, San Francisco at Alliant International University and a practicing psychologist in Oakland, California.

ErikaL.Seid,MA,LMFT, Educational Programs Manager at Psychotherapy.net, is a practicing psychotherapist in the San Francisco area, specializing in cultural issues and sexual offender treatment.

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GeorgeDeLeon The Therapeutic Community (3–DVD set)Pamela Dunne Exploring NarradramaGeorge J. DuPaul & Assessing ADHD in the Schools Gary Stoner Classroom Interventions for ADHDBruce Ecker Down Every YearJohn Edwards Tools and Techniques for Family TherapyStephen Feldman Legal and Ethical Issues for Mental Health

ProfessionalsArthur Freeman Depression: A Cognitive Therapy ApproachLindaGask Suicide and Self-HarmGlendon Association Sex, Love and Intimate Relationships

Invisible Child AbuseVoices About RelationshipsVoices of Suicide

KennethV.Hardy The Psychological Residuals of SlaverySusan Heitler The Angry CoupleKarin Heller Coming Out

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Psychotherapy.net

Harville Hendrix Harville Hendrix on the Healing RelationshipEvan Imber-Black Family SecretsArnoldLazarus Arnold Lazarus: Live Case ConsultationSteveLerner She’s Leaving MeRonaldLevant Effective Psychotherapy with MenHannaLevenson Time-Limited Dynamic PsychotherapyMarco J. D. Maida Jacob Levy Moreno: His Life and His MusesRollo May Rollo May on Existential PsychotherapyMonica McGoldrick The Legacy of Unresolved LossDonald Meichenbaum Mixed Anxiety and DepressionScott Miller What Works in PsychotherapyJacob Moreno Moreno Movies (4–DVD series)Zerka T. Moreno The Zerka T. Moreno Series (3–DVD series)Rod Mullen Encounter Groups for Addictions (3–DVD

set)Frank Ochberg Explaining PTSD

PTSD and VeteransThe Counting Method

George Papageorge Connecting with Our KidsErving Polster Psychotherapy with the Unmotivated PatientRon Scott (Producer) Psychotherapy with Gay, Lesbian and

Bisexual Clients (7–DVD series)Martin Seligman Positive Psychology and PsychotherapyLenoreWalker The Abused WomanIrvin Yalom The Gift of Therapy

Irvin Yalom: Live Case ConsultationUnderstanding Group Psychotherapy (3–DVD series)

Harry Wexler Therapeutic Communities in Prisons

COUPLES THERAPY WITH THE EXPERTS SERIESJon Carlson & Mary Arnold

Culture-Sensitive Therapy

PatLove Imago TherapyGus Napier Experiential TherapyRichardC.Schwartz Couples Therapy

Internal Family Systems Therapy

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BRIEF THERAPY FOR ADDICTIONS SERIESBruceS.Liese Cognitive Therapy for AddictionsG. Alan Marlatt Harm Reduction Therapy for AddictionsBarbara S. McCrady Couples Therapy for AddictionsJohn C. Norcross Stages of Change for AddictionsRobert E. Wubbolding Reality Therapy for AddictionsJoan Ellen Zweben Integrating Therapy with 12-Step Programs

CHILD THERAPY WITH THE EXPERTS SERIESJon Carlson Adlerian Parent ConsultationJanet Sasson Edgette Adolescent Family TherapyGerald Koocher Psychotherapy with Medically Ill ChildrenTerry Kottman Adlerian Play TherapyStephen Madigan Narrative Therapy with ChildrenBruce Masek Cognitive-Behavioral Child TherapyJohn J. Murphy Solution-Focused Child TherapyVioletOaklander Gestalt Therapy with ChildrenDavid Scharff Object Relations Child TherapyAnin Utigaard Person-Centered Child TherapyRobert E. Wubbolding Reality Therapy with Children

PSYCHOTHERAPY WITH THE EXPERTS SERIESInsoo Kim Berg Solution-Focused TherapyJames Bugental Existential-Humanistic PsychotherapyJon Carlson Adlerian TherapyMary Goulding Transactional AnalysisKennethV.Hardy Family Systems TherapyAllen Ivey Integrative TherapyJeffrey Kottler Integrative CounselingJohnKrumboltz Cognitive-Behavioral TherapyArnoldLazarus Multimodal TherapyDonald Meichenbaum Cognitive-Behavioral TherapyNatalie Rogers Person-Centered Expressive Arts TherapyErnest Rossi Mind-Body TherapyJill Savege Scharff Object Relations TherapyLenoreWalker Feminist TherapyRobert E. Wubbolding Reality Therapy

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Motivational Interviewing 8 · 4 MOTIVATIONAL INTERVIEWING Tips for Making the Best Use of the DVD 1. USE THE TRANSCRIPTS, COMMENTARIES AND SKILL CODES Transcripts: Make notes in