Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression
Have you ever wanted to change something, but wondered whether it’s worth the effort? Been stuck in an area of your life where you knew something needed to change, but you couldn’t get yourself to do it?
Let’s say, for instance, you want to quit smoking. Despite the fact that it’s a healthy choice, most people can also find reasons not to do it. So, a part of you might think, “This is healthy. I am afraid of cardiovascular disease and cancer. I should do it.“ Another part of you might think, “This is going to be hard. I need the cigarettes to relax. I enjoy my cigarettes too much.”
It’s very common to have some mixed feelings about change. There’s a therapeutic technique called Motivational Interviewing (MI), through which a therapist can help you sort out your dilemma. The technique helps you become more connected to the part of you that wants to make a positive change. You get to think through the consequences of your decisions. Having someone ask you really good questions can make you feel more inspired to pursue your healthy goal, even if it is difficult.
Initially, MI was developed to treat people with substance abuse problems. The goal was to motive people to get help for their addiction. Nowadays, MI goals can include anything from quitting smoking to joining a gym, to leaving an unhealthy relationship, or going to the doctor and getting a checkup
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“Research shows that MI is very effective in moving people toward change” says Dr. Barbara Kistenmacher, an expert on MI. “There are certain techniques in MI that intentionally focus on making people committed to changing their behaviors and helping them recognize motivation that has always been there but maybe needs to be brought to the surface and strengthened. Another advantage of MI is that therapists feel less burnout when using MI, probably because they are likely to see results when using this method. My own experience has been that MI has helped me develop a more sincere connection with clients, while at the same time, providing me with a lens through which to hear statements of hope and motivation.”
What’s less known, according to Dr. Kistenmacher, MI can also be used for people who have personality disorders. Of course, it was not originally created to treat personality disorders, but there are particular strategies and techniques that end up being helpful, and, even though they are not the same, there is some overlap between MI techniques and DBT techniques.
For instance, people with BPD tend to feel emotions very intensely and can vacillate between extreme points of views and extreme emotional experiences. An example of that might be a relationship in which one minute they feel extremely passionately for another person and the next minute they feel like they don’t want anything to do with them. The MI therapist provides an empathetic ear to both sides of this experience, and validates both ends of the extreme. This helps the person feel comfortable expressing both sides of these contradictory and conflicting points of view, making them feel validated for their experience, no matter what it is, and therefore more safe to consider a healthy way of behaving. The MI therapist does not give advice, albeit sometimes with permission, but rather invites the person make their own arguments for change. While MI does not provide the skills to change things, it does help the client make a decision and increase their level of motivation and commitment.
Another example would be someone with Avoidant Personality Disorder who has an avoidant coping style. Let’s say the person wants a promotion, but feels too afraid of being embarrassed, and therefore, they don’t ask. Here, the two sides of the conflict are: On the one hand, the person wants a promotion, and on the other, they dread experiencing the feelings that may go along with asking for it, such as anxiety or shame. The MI therapist would help the person acknowledge both sides of the conflict, and eventually the person would connect to the side of themselves that is able to ask for a promotion. The therapist might ask, “Was there ever a time when you felt similarly and still decided to go for what you want?” In so doing, the therapist strengthens the part of the patient that feels capable. If the person has never had a success in the past, MI invites the person to think about what they would need in order to be successful. Some therapists might even be using some of these techniques without knowing it. The difference, though, is that the MI therapist uses very specific and defined techniques in order to intentionally bolster confidence.
If you’re interested in finding an MI therapist, you can go motivationalinterview.org. Therapists can learn MI by attending a 2-3 day workshop that includes things like didactic presentations, role-plays, video demonstrations, and group discussion. In addition, therapists should participate in ongoing supervision.
Interested in reading up on MI? Try the book “Motivational Interviewing: Preparing People for Change” by William R. Miller and Stephen Rollnik.
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