WEBVTT
00:00:06.400 --> 00:00:11.279
Greetings everyone and welcome to another episode of Am I for Change?
00:00:12.960 --> 00:00:17.679
Have you ever watched a conversation between a professional and a client?
00:00:17.760 --> 00:00:27.120
And for those of you who are already well seasoned in motivational interviewing, you think, wait, this is motivational interviewing.
00:00:27.359 --> 00:00:38.719
Not because they said tell me more, and not because they use some perfectly scripted open-ended question, but because of something much more fundamental.
00:00:38.880 --> 00:00:42.479
They gave the person a voice in their decision.
00:00:43.039 --> 00:00:48.399
And I was thinking about this recently while watching the coverage of Lindsay Clansey.
00:00:48.640 --> 00:00:54.719
And by the time that you listen to this, maybe they would have deliberated already on the decision.
00:00:55.759 --> 00:00:57.520
Let's see, not a sharp.
00:00:57.759 --> 00:01:08.079
Anyways, um, before I go any further, this episode is not really about deciding whether Lindsay Clansey was responsible for what happened to her children.
00:01:08.319 --> 00:01:13.519
I know there's a lot of different theories out there of who did it, why they did it, and who was responsible.
00:01:13.840 --> 00:01:18.079
That is more of like a legal question that's being decided in court.
00:01:18.159 --> 00:01:21.680
And it's not about diagnosing her from a distance.
00:01:21.840 --> 00:01:29.200
What really caught my attention was something much smaller, the way we can think about treatment conversations.
00:01:29.599 --> 00:01:38.799
Because this case was brought a, it was brought about with a tremendous, tremendous amount of attention on that psychiatric treatment.
00:01:39.040 --> 00:01:46.239
I remember seeing maybe like three or two psychiatrists and perhaps a psychologist who spoke in her trial.
00:01:46.400 --> 00:01:53.519
And they spoke about medication, postpartum, mental health, and the relationship between the patient and the provider.
00:01:53.680 --> 00:01:55.680
Those were the things that really stuck out.
00:01:56.239 --> 00:02:01.280
And there was a moment discussed in the trial that really made me think about am I?
00:02:01.840 --> 00:02:08.479
The basic interactions was about medication history and what had or hadn't worked for Lindsay.
00:02:08.719 --> 00:02:14.479
And the part that stood out to me was the idea of asking, have you taken this before?
00:02:14.639 --> 00:02:18.159
This was one of the psychiatrists that I don't really remember her name.
00:02:18.240 --> 00:02:21.120
If you guys do, please put her there on the comment section.
00:02:21.280 --> 00:02:29.439
But I got a snippet of that interaction or was she reported in court from a Facebook post.
00:02:30.159 --> 00:02:38.159
And um, it's really different when you come from that perspective of have first asking, have you taken this medication before?
00:02:38.400 --> 00:02:42.879
instead of saying something like, I'm going to just prescribe you this medication.
00:02:43.120 --> 00:02:47.199
And then the psychiatrist asks, How did it work for you?
00:02:47.759 --> 00:02:55.039
And the person probably said some, well, she probably said something like, Honestly, I didn't really like it.
00:02:55.120 --> 00:02:58.879
And this was all alleged, this was all based on what the psychiatrist said.
00:02:59.120 --> 00:03:05.919
Instead of, well, you need to take it, the conversation becomes, okay, here are some other options.
00:03:06.159 --> 00:03:07.840
What do you think about these?
00:03:08.319 --> 00:03:12.560
And that last question is where things get really interesting.
00:03:12.800 --> 00:03:19.520
Because somebody listening might say, wait a minute, isn't the psychiatrist the one who decides what medication to prescribe?
00:03:19.759 --> 00:03:26.879
Well, yeah, the psychiatrist has the medical expertise and responsibility to determine what treatments are medically appropriate.
00:03:27.120 --> 00:03:35.039
But that's not the same thing as saying the psychiatrist, the psychiatrist makes every decision and the patient simply obeys.
00:03:35.439 --> 00:03:38.560
Those are two very different models of care.
00:03:38.800 --> 00:03:54.000
And this is where MI gives us something incredibly powerful because MI is not about giving the client control over things that aren't really in their control, it's about collaboration within professional boundaries.
00:03:54.240 --> 00:04:00.719
The clinician brings the expertise, the patient brings expertise to just a different kind.
00:04:00.879 --> 00:04:10.159
The clinician shows that they know about the medication, and the patient knows what it feels like to live inside their own body.
00:04:10.319 --> 00:04:15.599
The clinician knows the research, and the patient knows what they've experienced before.
00:04:15.759 --> 00:04:26.319
The clinician knows the treatment options, and the patient knows what they're willing to consider, what concerns them, what matters to them, and what has or hasn't worked in their life.
00:04:26.480 --> 00:04:30.480
And when you put those two types of expertise together, what do you get?
00:04:30.720 --> 00:04:32.480
Well, collaboration.
00:04:32.800 --> 00:04:38.079
And collaboration is really the heart of motivational interviewing.
00:04:39.839 --> 00:04:44.240
So think about what happens when we don't do this.
00:04:44.480 --> 00:04:48.639
A clinician says, here's what you're going to do.
00:04:48.800 --> 00:04:54.240
And the patient says, All right, okay, but okay doesn't necessarily mean I agree.
00:04:54.399 --> 00:04:56.240
It doesn't mean I understand.
00:04:56.399 --> 00:05:00.240
It doesn't mean I feel comfortable, and it definitely doesn't mean I'm going to do this.
00:05:00.399 --> 00:05:04.399
Sometimes okay just means I don't know how to disagree with you.
00:05:04.560 --> 00:05:07.040
And that is a very different conversation.
00:05:07.279 --> 00:05:21.439
This is something I see across so many helping professionals in psychology, with the work that I do with a lot of the clients, in parent coaching, behavior analysis, and I also see it in medicine, education.
00:05:21.680 --> 00:05:25.519
We have the expertise, so we naturally want to use it.
00:05:25.759 --> 00:05:33.439
And here's the trap: the more expertise we have, the easier it can become to overuse it.
00:05:33.680 --> 00:05:37.519
Because we know the answer, or at least we think we know the answer.
00:05:37.759 --> 00:05:41.759
And that's, I think, a very humbling experience there to not know the answers.
00:05:42.000 --> 00:05:47.600
So we start explaining, we start educating, we start correcting, we start recommending.
00:05:47.759 --> 00:05:50.079
We start saying you need to, you should.
00:05:50.319 --> 00:05:57.279
What you need to understand is, and suddenly the conversation is no longer a conversation.
00:05:57.439 --> 00:06:02.000
It's no longer a collaboration, it turns into a lecture.
00:06:02.720 --> 00:06:09.600
And the irony is that the person sitting across from us may already know exactly what we're telling them.
00:06:09.839 --> 00:06:13.279
They just haven't decided what they're going to do about it.
00:06:13.439 --> 00:06:16.160
And that's a very different problem to have.
00:06:16.399 --> 00:06:20.399
And this is why I love the difference between information and influence.
00:06:20.639 --> 00:06:24.160
In MI, our job isn't to withhold information.
00:06:24.399 --> 00:06:31.279
Actually, good MI allows us to provide information, but we don't assume that giving information automatically creates change.
00:06:31.360 --> 00:06:32.560
We know it doesn't.
00:06:32.800 --> 00:06:44.720
You can give somebody the best information in the world and they can still say, I'm not ready, or I don't want to, or that doesn't fit my life, or I've tried that before and it hasn't worked.
00:06:44.879 --> 00:06:51.839
And that's where our response really matters because a non-MI response is, but this time will be different.
00:06:52.079 --> 00:06:56.959
An MI response might be, tell me what happened when you tried it before.
00:06:57.199 --> 00:07:07.279
You see how one is more of this, I'm going to impose my will and this is going to work, instead of, hmm, let me become curious here.
00:07:07.600 --> 00:07:10.720
Were you able to hear the difference between those two statements?
00:07:11.600 --> 00:07:15.519
The first response was more of like, I want to win that argument.
00:07:15.600 --> 00:07:18.480
And then the second one, as I mentioned, is more about that curiosity.
00:07:18.639 --> 00:07:20.639
I want to understand their values.
00:07:20.800 --> 00:07:22.560
I want to understand where they're coming from.
00:07:22.720 --> 00:07:26.480
Which one do you think will receive more respect and more collaboration?
00:07:27.600 --> 00:07:35.600
And there's a really important MI concept hiding here that sometimes we forget, sometimes we ignore.
00:07:35.759 --> 00:07:37.120
And it's that autonomy.
00:07:37.360 --> 00:07:40.639
Autonomy doesn't mean whatever the client wants, we do it.
00:07:40.800 --> 00:07:42.720
That's not really ethical practice.
00:07:42.879 --> 00:07:48.639
Autonomy means recognizing that ultimately people have agency over their own choices.
00:07:48.800 --> 00:07:50.399
They're going to do whatever they want to do.
00:07:50.639 --> 00:07:55.759
And sometimes our job is to help them make a more informed choice.
00:07:55.920 --> 00:07:59.439
So imagine you're a psychiatrist talking about medication.
00:07:59.600 --> 00:08:05.199
You might say something like there are a couple of options that could make sense based on what we're seeing.
00:08:05.360 --> 00:08:08.319
Would it be okay if I walk you through them?
00:08:08.560 --> 00:08:16.240
And whoever is well seasoned or has been listening to these podcasts, you should be thinking that approach, right?
00:08:16.399 --> 00:08:18.639
That non-fixing approach.
00:08:18.879 --> 00:08:28.160
And instead, here we are offering with respect, but first we're checking in on what how they feel about it.
00:08:29.279 --> 00:08:38.480
So you've asked for permission, then you explain, and then of those options, what stands out to you, or what concerns do you have?
00:08:38.639 --> 00:08:42.159
So ending it up like that, or how do you feel about trying one of these?
00:08:42.240 --> 00:08:44.320
So checking in with the client again.
00:08:44.720 --> 00:08:47.039
That EP approach is so important.
00:08:47.360 --> 00:08:53.440
Now the patient isn't being asked to become the doctor, they're being asked to participate in their own treatment.
00:08:53.519 --> 00:08:54.480
Doesn't that make sense?
00:08:54.639 --> 00:09:00.240
That collaborative decision making and MI fits beautifully into those spaces.
00:09:00.480 --> 00:09:08.480
Now, let's bring this back to what I think is one of the most important lessons from the interaction that I saw on that Facebook post.
00:09:08.799 --> 00:09:12.960
The clinician didn't have to say, I'm not the expert, because they are.
00:09:13.200 --> 00:09:16.879
The clinician didn't have to say, you tell me what medication you want.
00:09:17.039 --> 00:09:18.240
That's really not the point.
00:09:18.320 --> 00:09:23.279
The clinician could still say, based on your symptoms, here's what I recommend.
00:09:23.440 --> 00:09:25.039
And then what do you think?
00:09:25.279 --> 00:09:31.039
That little question changes the relationship because now we're not saying here's your treatment.
00:09:31.200 --> 00:09:34.480
We're saying here's my professional recommendation.
00:09:34.639 --> 00:09:37.200
Let's talk about whether this makes sense for you.
00:09:37.279 --> 00:09:42.320
And that is MI, or at least that's very much in the spirit of motivational interviewing.
00:09:42.480 --> 00:09:52.480
And this is where I want to challenge therapists, BCBA psychologists, even the physicians or educators that may be listening to us, or anyone really in this helping profession.
00:09:52.720 --> 00:10:00.879
Ask yourself, how often do I ask for the person's perspective after I've already decided what I think they should do?
00:10:01.039 --> 00:10:06.320
Because sometimes we technically ask a question, but we've already made up our minds.
00:10:06.480 --> 00:10:07.919
We say, What do you think?
00:10:08.080 --> 00:10:12.159
But if they say something different, we immediately explain why they're wrong.
00:10:12.399 --> 00:10:14.159
That's not really collaboration.
00:10:14.320 --> 00:10:16.639
That's a disguise lecture.
00:10:16.879 --> 00:10:21.120
Real collaboration means being genuinely curious about their answer.
00:10:21.360 --> 00:10:23.279
If I ask, what do you think?
00:10:23.519 --> 00:10:26.399
I need to be prepared for, I don't agree.
00:10:26.559 --> 00:10:32.559
And instead of immediately responding with, here's why you should, I can say, well, tell me more.
00:10:32.639 --> 00:10:34.240
And that's a shift.
00:10:35.039 --> 00:10:39.919
And this applies beautifully into our wonderful field of behavior analysis.
00:10:40.080 --> 00:10:44.080
Imagine a parent that says, I don't think we should use that intervention.
00:10:44.159 --> 00:10:48.080
And the clinician says, but the data showed that it works.
00:10:48.399 --> 00:11:07.919
Okay, maybe the data do show that it works, but that's not the end of the conversation because a parent might be saying, I don't think we should use that intervention because my child is miserable when we do it, or I don't understand why we're doing it, or it doesn't fit what happened at home, or maybe I don't feel comfortable with it.
00:11:08.080 --> 00:11:09.919
And those are all different problems.
00:11:10.080 --> 00:11:16.159
And if we immediately respond with more data, we may completely miss the actual barrier.
00:11:16.480 --> 00:11:21.200
Instead, you can say something like, tell me more about what concerns you.
00:11:21.360 --> 00:11:24.720
Now we're listening about the function of that conversation.
00:11:24.879 --> 00:11:28.720
And yes, I'm going to say that again because I think it's so important.
00:11:29.360 --> 00:11:32.879
Listen for the function, not just the content.
00:11:33.120 --> 00:11:35.679
We have to get to the core of what's going on.
00:11:35.840 --> 00:11:40.399
And this is why MI is so much more than asking open-ended questions.
00:11:40.559 --> 00:11:45.360
You can ask open-ended questions all day long and still practice terribly.
00:11:45.519 --> 00:11:47.440
You can say, How do you feel about that?
00:11:47.600 --> 00:11:48.720
How do you feel about this?
00:11:48.960 --> 00:11:50.000
How is it going?
00:11:50.240 --> 00:11:57.759
And still be completely non-collaborative because MI isn't really a collection of magic questions.
00:11:58.000 --> 00:12:00.320
It's a way of being with people.
00:12:00.480 --> 00:12:03.360
And I want to overemphasize that.
00:12:03.519 --> 00:12:06.879
It is a way of being with others.
00:12:07.440 --> 00:12:12.960
It's, I have expertise, but I don't assume I know your experience better than you.
00:12:13.200 --> 00:12:16.639
It's, I can make a recommendation without demanding compliance.
00:12:16.799 --> 00:12:21.440
I can provide information without assuming information equals motivation.
00:12:21.600 --> 00:12:25.919
I can disagree with you without taking away your autonomy.
00:12:26.159 --> 00:12:28.320
And those statements are really powerful.
00:12:28.480 --> 00:12:29.360
Think about them.
00:12:29.600 --> 00:12:33.679
There's another thing I want you to notice about medication conversations.
00:12:33.840 --> 00:12:37.679
A person may have tried something before, it didn't work.
00:12:37.840 --> 00:12:39.600
Maybe they hated the side effects.
00:12:39.679 --> 00:12:41.759
Maybe they didn't notice any benefits.
00:12:41.919 --> 00:12:43.679
Maybe they stopped taking it.
00:12:43.840 --> 00:12:48.320
And the easiest thing for a professional to do is say, Well, let's try it again.
00:12:48.480 --> 00:12:51.679
But MI ask us to become curious.
00:12:52.000 --> 00:12:53.919
What was your experience like?
00:12:54.159 --> 00:12:56.720
What was your experience with that medication like?
00:12:57.039 --> 00:12:59.200
Because the answer contains information.
00:12:59.360 --> 00:13:00.559
It contains data.
00:13:00.720 --> 00:13:04.240
Maybe the person says, I hated how tired it made me.
00:13:04.480 --> 00:13:05.919
Now I know something.
00:13:06.240 --> 00:13:10.240
Maybe they say, I didn't think it helped.
00:13:10.480 --> 00:13:11.840
Now I know something.
00:13:12.080 --> 00:13:16.000
Maybe they say I stopped because I was worried about becoming dependent on it.
00:13:16.159 --> 00:13:17.679
Again, good information.
00:13:18.080 --> 00:13:22.799
And suddenly, instead of fighting resistance, we're learning from it.
00:13:22.960 --> 00:13:26.000
And that's one of the biggest shifts MI gives us.
00:13:26.240 --> 00:13:28.720
Resistance becomes information.
00:13:29.200 --> 00:13:30.960
So we don't have to hate resistance.
00:13:31.039 --> 00:13:32.799
We don't have to fight with resistance.
00:13:33.039 --> 00:13:37.279
We can actually embrace it and say, well, what is this resistance telling us?
00:13:37.440 --> 00:13:39.679
Let's befriend the resistance.
00:13:39.840 --> 00:13:49.840
In other words, I think this is a particularly important concept in mental health because people are often coming into treatment with a history.
00:13:50.080 --> 00:13:52.879
They've been told what to do by other therapists.
00:13:53.039 --> 00:13:55.120
They've been told what they should feel.
00:13:55.360 --> 00:13:58.159
They've been told what medication they should take.
00:13:58.399 --> 00:14:03.919
They've been told how they should parent if they're a parent or how they should behave.
00:14:04.159 --> 00:14:08.960
And sometimes the last thing they need is another person saying, here's what you need to do.
00:14:09.759 --> 00:14:14.399
They may need someone who says something like, Let's figure this out together.
00:14:14.559 --> 00:14:15.919
Think about how powerful that is.
00:14:16.080 --> 00:14:22.960
You go into a session with a therapist, and instead of them like prescribing you this or whatever it is, they say, Let's figure this out together.
00:14:23.120 --> 00:14:24.480
Or even a medical doctor.
00:14:24.639 --> 00:14:28.720
Think about the pediatrician to your child or just the medical doctor for yourself.
00:14:28.960 --> 00:14:31.279
Someone saying that, doesn't it feel warm?
00:14:31.440 --> 00:14:34.240
Doesn't it feel like you guys are working together?
00:14:34.639 --> 00:14:38.879
And that doesn't mean that that person abandoned their expertise.
00:14:39.120 --> 00:14:43.360
It means they're using their expertise, their expertise differently.
00:14:43.600 --> 00:14:49.039
We use we use it to expand someone's options rather than eliminate their voice.
00:14:49.200 --> 00:14:54.240
And that is really why we focus on using these MI skills.
00:14:55.600 --> 00:14:58.639
I'm gonna give you guys an MI challenge for this week.
00:14:59.360 --> 00:15:06.320
The next time that you find yourself thinking, I already know what this person needs to do, pause for a minute.
00:15:07.039 --> 00:15:11.039
And also ask yourself what do they think they need to do?
00:15:11.679 --> 00:15:15.919
Then ask yourself what matters to them about this decision.
00:15:16.399 --> 00:15:21.200
And maybe even what concerns you about my recommendations.
00:15:22.480 --> 00:15:26.159
And then this is the hard part for some of us.
00:15:26.480 --> 00:15:30.720
Listen, don't prepare your rebuttal while you're talking.
00:15:30.879 --> 00:15:33.840
Don't formulate the next five reasons you're right.
00:15:34.080 --> 00:15:35.679
Just simply listen.
00:15:35.919 --> 00:15:44.559
Because sometimes the information we need to help somebody isn't a textbook, it's sitting right in front of us in the person we're trying to help.
00:15:44.720 --> 00:15:50.720
And that's why that small interaction around medication really stuck with me when I heard it.
00:15:50.879 --> 00:15:58.159
Not because it gives us a lesson about medication or medicating someone or whether they should be medicated or not.
00:15:58.399 --> 00:15:59.600
It really doesn't.
00:15:59.840 --> 00:16:08.399
And certainly not because we should use a tragic case to make simplistic conclusions about psychiatric treatment.
00:16:08.639 --> 00:16:14.639
We really shouldn't, but it does give us an opportunity to think about something much bigger.
00:16:14.799 --> 00:16:21.519
What happens when the person receiving treatment becomes an active participant in the treatment conversation?
00:16:21.759 --> 00:16:23.120
And that's the question.
00:16:23.279 --> 00:16:27.919
Because the goal isn't how do I get this person to do what I think is best?
00:16:28.639 --> 00:16:35.279
The MI question is how do I help this person make an informed decision that they can own?
00:16:35.519 --> 00:16:37.279
And that's a very different goal.
00:16:37.519 --> 00:16:42.000
And when you change the goal, you change the entire conversation.
00:16:42.240 --> 00:16:55.200
So the next time that you're sitting in front or across from a client, a parent, a patient, a student, whoever, before you jump into here, this is what I what you need to do.
00:16:55.360 --> 00:16:56.879
Try what do you think?
00:16:57.039 --> 00:17:00.879
And then actually answer for listen to that answer.
00:17:01.039 --> 00:17:02.559
Not answer that answer.
00:17:02.799 --> 00:17:04.079
Listen to that answer.
00:17:04.240 --> 00:17:08.480
Because sometimes the most powerful intervention isn't another answer.
00:17:08.640 --> 00:17:11.759
It's giving someone enough space to find their own.
00:17:12.079 --> 00:17:15.039
I'll see you guys in the next episode of MI for Change.
00:17:15.119 --> 00:17:19.920
I hope that you found value in this and that you can share it with other colleagues.
00:17:20.160 --> 00:17:22.480
And I will see you guys next time.
00:17:23.599 --> 00:17:27.599
Thank you for joining me on today's episode of MI for Change.
00:17:28.079 --> 00:17:42.400
If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence.
00:17:42.640 --> 00:17:49.279
You can learn more at www.drmonicagilbert.com.
00:17:49.519 --> 00:17:53.839
Until next time, keep asking the questions that spark change.
00:00:06.400 --> 00:00:11.279
Greetings everyone and welcome to another episode of Am I for Change?
00:00:12.960 --> 00:00:17.679
Have you ever watched a conversation between a professional and a client?
00:00:17.760 --> 00:00:27.120
And for those of you who are already well seasoned in motivational interviewing, you think, wait, this is motivational interviewing.
00:00:27.359 --> 00:00:38.719
Not because they said tell me more, and not because they use some perfectly scripted open-ended question, but because of something much more fundamental.
00:00:38.880 --> 00:00:42.479
They gave the person a voice in their decision.
00:00:43.039 --> 00:00:48.399
And I was thinking about this recently while watching the coverage of Lindsay Clansey.
00:00:48.640 --> 00:00:54.719
And by the time that you listen to this, maybe they would have deliberated already on the decision.
00:00:55.759 --> 00:00:57.520
Let's see, not a sharp.
00:00:57.759 --> 00:01:08.079
Anyways, um, before I go any further, this episode is not really about deciding whether Lindsay Clansey was responsible for what happened to her children.
00:01:08.319 --> 00:01:13.519
I know there's a lot of different theories out there of who did it, why they did it, and who was responsible.
00:01:13.840 --> 00:01:18.079
That is more of like a legal question that's being decided in court.
00:01:18.159 --> 00:01:21.680
And it's not about diagnosing her from a distance.
00:01:21.840 --> 00:01:29.200
What really caught my attention was something much smaller, the way we can think about treatment conversations.
00:01:29.599 --> 00:01:38.799
Because this case was brought a, it was brought about with a tremendous, tremendous amount of attention on that psychiatric treatment.
00:01:39.040 --> 00:01:46.239
I remember seeing maybe like three or two psychiatrists and perhaps a psychologist who spoke in her trial.
00:01:46.400 --> 00:01:53.519
And they spoke about medication, postpartum, mental health, and the relationship between the patient and the provider.
00:01:53.680 --> 00:01:55.680
Those were the things that really stuck out.
00:01:56.239 --> 00:02:01.280
And there was a moment discussed in the trial that really made me think about am I?
00:02:01.840 --> 00:02:08.479
The basic interactions was about medication history and what had or hadn't worked for Lindsay.
00:02:08.719 --> 00:02:14.479
And the part that stood out to me was the idea of asking, have you taken this before?
00:02:14.639 --> 00:02:18.159
This was one of the psychiatrists that I don't really remember her name.
00:02:18.240 --> 00:02:21.120
If you guys do, please put her there on the comment section.
00:02:21.280 --> 00:02:29.439
But I got a snippet of that interaction or was she reported in court from a Facebook post.
00:02:30.159 --> 00:02:38.159
And um, it's really different when you come from that perspective of have first asking, have you taken this medication before?
00:02:38.400 --> 00:02:42.879
instead of saying something like, I'm going to just prescribe you this medication.
00:02:43.120 --> 00:02:47.199
And then the psychiatrist asks, How did it work for you?
00:02:47.759 --> 00:02:55.039
And the person probably said some, well, she probably said something like, Honestly, I didn't really like it.
00:02:55.120 --> 00:02:58.879
And this was all alleged, this was all based on what the psychiatrist said.
00:02:59.120 --> 00:03:05.919
Instead of, well, you need to take it, the conversation becomes, okay, here are some other options.
00:03:06.159 --> 00:03:07.840
What do you think about these?
00:03:08.319 --> 00:03:12.560
And that last question is where things get really interesting.
00:03:12.800 --> 00:03:19.520
Because somebody listening might say, wait a minute, isn't the psychiatrist the one who decides what medication to prescribe?
00:03:19.759 --> 00:03:26.879
Well, yeah, the psychiatrist has the medical expertise and responsibility to determine what treatments are medically appropriate.
00:03:27.120 --> 00:03:35.039
But that's not the same thing as saying the psychiatrist, the psychiatrist makes every decision and the patient simply obeys.
00:03:35.439 --> 00:03:38.560
Those are two very different models of care.
00:03:38.800 --> 00:03:54.000
And this is where MI gives us something incredibly powerful because MI is not about giving the client control over things that aren't really in their control, it's about collaboration within professional boundaries.
00:03:54.240 --> 00:04:00.719
The clinician brings the expertise, the patient brings expertise to just a different kind.
00:04:00.879 --> 00:04:10.159
The clinician shows that they know about the medication, and the patient knows what it feels like to live inside their own body.
00:04:10.319 --> 00:04:15.599
The clinician knows the research, and the patient knows what they've experienced before.
00:04:15.759 --> 00:04:26.319
The clinician knows the treatment options, and the patient knows what they're willing to consider, what concerns them, what matters to them, and what has or hasn't worked in their life.
00:04:26.480 --> 00:04:30.480
And when you put those two types of expertise together, what do you get?
00:04:30.720 --> 00:04:32.480
Well, collaboration.
00:04:32.800 --> 00:04:38.079
And collaboration is really the heart of motivational interviewing.
00:04:39.839 --> 00:04:44.240
So think about what happens when we don't do this.
00:04:44.480 --> 00:04:48.639
A clinician says, here's what you're going to do.
00:04:48.800 --> 00:04:54.240
And the patient says, All right, okay, but okay doesn't necessarily mean I agree.
00:04:54.399 --> 00:04:56.240
It doesn't mean I understand.
00:04:56.399 --> 00:05:00.240
It doesn't mean I feel comfortable, and it definitely doesn't mean I'm going to do this.
00:05:00.399 --> 00:05:04.399
Sometimes okay just means I don't know how to disagree with you.
00:05:04.560 --> 00:05:07.040
And that is a very different conversation.
00:05:07.279 --> 00:05:21.439
This is something I see across so many helping professionals in psychology, with the work that I do with a lot of the clients, in parent coaching, behavior analysis, and I also see it in medicine, education.
00:05:21.680 --> 00:05:25.519
We have the expertise, so we naturally want to use it.
00:05:25.759 --> 00:05:33.439
And here's the trap: the more expertise we have, the easier it can become to overuse it.
00:05:33.680 --> 00:05:37.519
Because we know the answer, or at least we think we know the answer.
00:05:37.759 --> 00:05:41.759
And that's, I think, a very humbling experience there to not know the answers.
00:05:42.000 --> 00:05:47.600
So we start explaining, we start educating, we start correcting, we start recommending.
00:05:47.759 --> 00:05:50.079
We start saying you need to, you should.
00:05:50.319 --> 00:05:57.279
What you need to understand is, and suddenly the conversation is no longer a conversation.
00:05:57.439 --> 00:06:02.000
It's no longer a collaboration, it turns into a lecture.
00:06:02.720 --> 00:06:09.600
And the irony is that the person sitting across from us may already know exactly what we're telling them.
00:06:09.839 --> 00:06:13.279
They just haven't decided what they're going to do about it.
00:06:13.439 --> 00:06:16.160
And that's a very different problem to have.
00:06:16.399 --> 00:06:20.399
And this is why I love the difference between information and influence.
00:06:20.639 --> 00:06:24.160
In MI, our job isn't to withhold information.
00:06:24.399 --> 00:06:31.279
Actually, good MI allows us to provide information, but we don't assume that giving information automatically creates change.
00:06:31.360 --> 00:06:32.560
We know it doesn't.
00:06:32.800 --> 00:06:44.720
You can give somebody the best information in the world and they can still say, I'm not ready, or I don't want to, or that doesn't fit my life, or I've tried that before and it hasn't worked.
00:06:44.879 --> 00:06:51.839
And that's where our response really matters because a non-MI response is, but this time will be different.
00:06:52.079 --> 00:06:56.959
An MI response might be, tell me what happened when you tried it before.
00:06:57.199 --> 00:07:07.279
You see how one is more of this, I'm going to impose my will and this is going to work, instead of, hmm, let me become curious here.
00:07:07.600 --> 00:07:10.720
Were you able to hear the difference between those two statements?
00:07:11.600 --> 00:07:15.519
The first response was more of like, I want to win that argument.
00:07:15.600 --> 00:07:18.480
And then the second one, as I mentioned, is more about that curiosity.
00:07:18.639 --> 00:07:20.639
I want to understand their values.
00:07:20.800 --> 00:07:22.560
I want to understand where they're coming from.
00:07:22.720 --> 00:07:26.480
Which one do you think will receive more respect and more collaboration?
00:07:27.600 --> 00:07:35.600
And there's a really important MI concept hiding here that sometimes we forget, sometimes we ignore.
00:07:35.759 --> 00:07:37.120
And it's that autonomy.
00:07:37.360 --> 00:07:40.639
Autonomy doesn't mean whatever the client wants, we do it.
00:07:40.800 --> 00:07:42.720
That's not really ethical practice.
00:07:42.879 --> 00:07:48.639
Autonomy means recognizing that ultimately people have agency over their own choices.
00:07:48.800 --> 00:07:50.399
They're going to do whatever they want to do.
00:07:50.639 --> 00:07:55.759
And sometimes our job is to help them make a more informed choice.
00:07:55.920 --> 00:07:59.439
So imagine you're a psychiatrist talking about medication.
00:07:59.600 --> 00:08:05.199
You might say something like there are a couple of options that could make sense based on what we're seeing.
00:08:05.360 --> 00:08:08.319
Would it be okay if I walk you through them?
00:08:08.560 --> 00:08:16.240
And whoever is well seasoned or has been listening to these podcasts, you should be thinking that approach, right?
00:08:16.399 --> 00:08:18.639
That non-fixing approach.
00:08:18.879 --> 00:08:28.160
And instead, here we are offering with respect, but first we're checking in on what how they feel about it.
00:08:29.279 --> 00:08:38.480
So you've asked for permission, then you explain, and then of those options, what stands out to you, or what concerns do you have?
00:08:38.639 --> 00:08:42.159
So ending it up like that, or how do you feel about trying one of these?
00:08:42.240 --> 00:08:44.320
So checking in with the client again.
00:08:44.720 --> 00:08:47.039
That EP approach is so important.
00:08:47.360 --> 00:08:53.440
Now the patient isn't being asked to become the doctor, they're being asked to participate in their own treatment.
00:08:53.519 --> 00:08:54.480
Doesn't that make sense?
00:08:54.639 --> 00:09:00.240
That collaborative decision making and MI fits beautifully into those spaces.
00:09:00.480 --> 00:09:08.480
Now, let's bring this back to what I think is one of the most important lessons from the interaction that I saw on that Facebook post.
00:09:08.799 --> 00:09:12.960
The clinician didn't have to say, I'm not the expert, because they are.
00:09:13.200 --> 00:09:16.879
The clinician didn't have to say, you tell me what medication you want.
00:09:17.039 --> 00:09:18.240
That's really not the point.
00:09:18.320 --> 00:09:23.279
The clinician could still say, based on your symptoms, here's what I recommend.
00:09:23.440 --> 00:09:25.039
And then what do you think?
00:09:25.279 --> 00:09:31.039
That little question changes the relationship because now we're not saying here's your treatment.
00:09:31.200 --> 00:09:34.480
We're saying here's my professional recommendation.
00:09:34.639 --> 00:09:37.200
Let's talk about whether this makes sense for you.
00:09:37.279 --> 00:09:42.320
And that is MI, or at least that's very much in the spirit of motivational interviewing.
00:09:42.480 --> 00:09:52.480
And this is where I want to challenge therapists, BCBA psychologists, even the physicians or educators that may be listening to us, or anyone really in this helping profession.
00:09:52.720 --> 00:10:00.879
Ask yourself, how often do I ask for the person's perspective after I've already decided what I think they should do?
00:10:01.039 --> 00:10:06.320
Because sometimes we technically ask a question, but we've already made up our minds.
00:10:06.480 --> 00:10:07.919
We say, What do you think?
00:10:08.080 --> 00:10:12.159
But if they say something different, we immediately explain why they're wrong.
00:10:12.399 --> 00:10:14.159
That's not really collaboration.
00:10:14.320 --> 00:10:16.639
That's a disguise lecture.
00:10:16.879 --> 00:10:21.120
Real collaboration means being genuinely curious about their answer.
00:10:21.360 --> 00:10:23.279
If I ask, what do you think?
00:10:23.519 --> 00:10:26.399
I need to be prepared for, I don't agree.
00:10:26.559 --> 00:10:32.559
And instead of immediately responding with, here's why you should, I can say, well, tell me more.
00:10:32.639 --> 00:10:34.240
And that's a shift.
00:10:35.039 --> 00:10:39.919
And this applies beautifully into our wonderful field of behavior analysis.
00:10:40.080 --> 00:10:44.080
Imagine a parent that says, I don't think we should use that intervention.
00:10:44.159 --> 00:10:48.080
And the clinician says, but the data showed that it works.
00:10:48.399 --> 00:11:07.919
Okay, maybe the data do show that it works, but that's not the end of the conversation because a parent might be saying, I don't think we should use that intervention because my child is miserable when we do it, or I don't understand why we're doing it, or it doesn't fit what happened at home, or maybe I don't feel comfortable with it.
00:11:08.080 --> 00:11:09.919
And those are all different problems.
00:11:10.080 --> 00:11:16.159
And if we immediately respond with more data, we may completely miss the actual barrier.
00:11:16.480 --> 00:11:21.200
Instead, you can say something like, tell me more about what concerns you.
00:11:21.360 --> 00:11:24.720
Now we're listening about the function of that conversation.
00:11:24.879 --> 00:11:28.720
And yes, I'm going to say that again because I think it's so important.
00:11:29.360 --> 00:11:32.879
Listen for the function, not just the content.
00:11:33.120 --> 00:11:35.679
We have to get to the core of what's going on.
00:11:35.840 --> 00:11:40.399
And this is why MI is so much more than asking open-ended questions.
00:11:40.559 --> 00:11:45.360
You can ask open-ended questions all day long and still practice terribly.
00:11:45.519 --> 00:11:47.440
You can say, How do you feel about that?
00:11:47.600 --> 00:11:48.720
How do you feel about this?
00:11:48.960 --> 00:11:50.000
How is it going?
00:11:50.240 --> 00:11:57.759
And still be completely non-collaborative because MI isn't really a collection of magic questions.
00:11:58.000 --> 00:12:00.320
It's a way of being with people.
00:12:00.480 --> 00:12:03.360
And I want to overemphasize that.
00:12:03.519 --> 00:12:06.879
It is a way of being with others.
00:12:07.440 --> 00:12:12.960
It's, I have expertise, but I don't assume I know your experience better than you.
00:12:13.200 --> 00:12:16.639
It's, I can make a recommendation without demanding compliance.
00:12:16.799 --> 00:12:21.440
I can provide information without assuming information equals motivation.
00:12:21.600 --> 00:12:25.919
I can disagree with you without taking away your autonomy.
00:12:26.159 --> 00:12:28.320
And those statements are really powerful.
00:12:28.480 --> 00:12:29.360
Think about them.
00:12:29.600 --> 00:12:33.679
There's another thing I want you to notice about medication conversations.
00:12:33.840 --> 00:12:37.679
A person may have tried something before, it didn't work.
00:12:37.840 --> 00:12:39.600
Maybe they hated the side effects.
00:12:39.679 --> 00:12:41.759
Maybe they didn't notice any benefits.
00:12:41.919 --> 00:12:43.679
Maybe they stopped taking it.
00:12:43.840 --> 00:12:48.320
And the easiest thing for a professional to do is say, Well, let's try it again.
00:12:48.480 --> 00:12:51.679
But MI ask us to become curious.
00:12:52.000 --> 00:12:53.919
What was your experience like?
00:12:54.159 --> 00:12:56.720
What was your experience with that medication like?
00:12:57.039 --> 00:12:59.200
Because the answer contains information.
00:12:59.360 --> 00:13:00.559
It contains data.
00:13:00.720 --> 00:13:04.240
Maybe the person says, I hated how tired it made me.
00:13:04.480 --> 00:13:05.919
Now I know something.
00:13:06.240 --> 00:13:10.240
Maybe they say, I didn't think it helped.
00:13:10.480 --> 00:13:11.840
Now I know something.
00:13:12.080 --> 00:13:16.000
Maybe they say I stopped because I was worried about becoming dependent on it.
00:13:16.159 --> 00:13:17.679
Again, good information.
00:13:18.080 --> 00:13:22.799
And suddenly, instead of fighting resistance, we're learning from it.
00:13:22.960 --> 00:13:26.000
And that's one of the biggest shifts MI gives us.
00:13:26.240 --> 00:13:28.720
Resistance becomes information.
00:13:29.200 --> 00:13:30.960
So we don't have to hate resistance.
00:13:31.039 --> 00:13:32.799
We don't have to fight with resistance.
00:13:33.039 --> 00:13:37.279
We can actually embrace it and say, well, what is this resistance telling us?
00:13:37.440 --> 00:13:39.679
Let's befriend the resistance.
00:13:39.840 --> 00:13:49.840
In other words, I think this is a particularly important concept in mental health because people are often coming into treatment with a history.
00:13:50.080 --> 00:13:52.879
They've been told what to do by other therapists.
00:13:53.039 --> 00:13:55.120
They've been told what they should feel.
00:13:55.360 --> 00:13:58.159
They've been told what medication they should take.
00:13:58.399 --> 00:14:03.919
They've been told how they should parent if they're a parent or how they should behave.
00:14:04.159 --> 00:14:08.960
And sometimes the last thing they need is another person saying, here's what you need to do.
00:14:09.759 --> 00:14:14.399
They may need someone who says something like, Let's figure this out together.
00:14:14.559 --> 00:14:15.919
Think about how powerful that is.
00:14:16.080 --> 00:14:22.960
You go into a session with a therapist, and instead of them like prescribing you this or whatever it is, they say, Let's figure this out together.
00:14:23.120 --> 00:14:24.480
Or even a medical doctor.
00:14:24.639 --> 00:14:28.720
Think about the pediatrician to your child or just the medical doctor for yourself.
00:14:28.960 --> 00:14:31.279
Someone saying that, doesn't it feel warm?
00:14:31.440 --> 00:14:34.240
Doesn't it feel like you guys are working together?
00:14:34.639 --> 00:14:38.879
And that doesn't mean that that person abandoned their expertise.
00:14:39.120 --> 00:14:43.360
It means they're using their expertise, their expertise differently.
00:14:43.600 --> 00:14:49.039
We use we use it to expand someone's options rather than eliminate their voice.
00:14:49.200 --> 00:14:54.240
And that is really why we focus on using these MI skills.
00:14:55.600 --> 00:14:58.639
I'm gonna give you guys an MI challenge for this week.
00:14:59.360 --> 00:15:06.320
The next time that you find yourself thinking, I already know what this person needs to do, pause for a minute.
00:15:07.039 --> 00:15:11.039
And also ask yourself what do they think they need to do?
00:15:11.679 --> 00:15:15.919
Then ask yourself what matters to them about this decision.
00:15:16.399 --> 00:15:21.200
And maybe even what concerns you about my recommendations.
00:15:22.480 --> 00:15:26.159
And then this is the hard part for some of us.
00:15:26.480 --> 00:15:30.720
Listen, don't prepare your rebuttal while you're talking.
00:15:30.879 --> 00:15:33.840
Don't formulate the next five reasons you're right.
00:15:34.080 --> 00:15:35.679
Just simply listen.
00:15:35.919 --> 00:15:44.559
Because sometimes the information we need to help somebody isn't a textbook, it's sitting right in front of us in the person we're trying to help.
00:15:44.720 --> 00:15:50.720
And that's why that small interaction around medication really stuck with me when I heard it.
00:15:50.879 --> 00:15:58.159
Not because it gives us a lesson about medication or medicating someone or whether they should be medicated or not.
00:15:58.399 --> 00:15:59.600
It really doesn't.
00:15:59.840 --> 00:16:08.399
And certainly not because we should use a tragic case to make simplistic conclusions about psychiatric treatment.
00:16:08.639 --> 00:16:14.639
We really shouldn't, but it does give us an opportunity to think about something much bigger.
00:16:14.799 --> 00:16:21.519
What happens when the person receiving treatment becomes an active participant in the treatment conversation?
00:16:21.759 --> 00:16:23.120
And that's the question.
00:16:23.279 --> 00:16:27.919
Because the goal isn't how do I get this person to do what I think is best?
00:16:28.639 --> 00:16:35.279
The MI question is how do I help this person make an informed decision that they can own?
00:16:35.519 --> 00:16:37.279
And that's a very different goal.
00:16:37.519 --> 00:16:42.000
And when you change the goal, you change the entire conversation.
00:16:42.240 --> 00:16:55.200
So the next time that you're sitting in front or across from a client, a parent, a patient, a student, whoever, before you jump into here, this is what I what you need to do.
00:16:55.360 --> 00:16:56.879
Try what do you think?
00:16:57.039 --> 00:17:00.879
And then actually answer for listen to that answer.
00:17:01.039 --> 00:17:02.559
Not answer that answer.
00:17:02.799 --> 00:17:04.079
Listen to that answer.
00:17:04.240 --> 00:17:08.480
Because sometimes the most powerful intervention isn't another answer.
00:17:08.640 --> 00:17:11.759
It's giving someone enough space to find their own.
00:17:12.079 --> 00:17:15.039
I'll see you guys in the next episode of MI for Change.
00:17:15.119 --> 00:17:19.920
I hope that you found value in this and that you can share it with other colleagues.
00:17:20.160 --> 00:17:22.480
And I will see you guys next time.
00:17:23.599 --> 00:17:27.599
Thank you for joining me on today's episode of MI for Change.
00:17:28.079 --> 00:17:42.400
If you're ready to keep growing your motivational interviewing skills, I'd love to invite you to explore my MI Academy, where you'll find a full library of on demand courses designed to help you put MI into practice with confidence.
00:17:42.640 --> 00:17:49.279
You can learn more at www.drmonicagilbert.com.
00:17:49.519 --> 00:17:53.839
Until next time, keep asking the questions that spark change.
