Motivational Interviewing (MI)

When a person suffers from substance abuse and addiction, they come to us with histories and circumstances that are as wide ranging as their personalities. Good rehabilitation understands this and uses it as a strength and guide within the development and implementation of treatment.

Here, at The Treehouse, we understand that the diversity of needs that people carry with them, set against this unique and varied background, demand from us a certain caliber of care that is both versatile and structured. This allows for a person to be supported within a fully-integrated treatment environment that can aid them in each and every concern that may impact the cause and rehabilitation of their substance abuse and addiction.

Our staff employs a variety of methods to help us deliver this attentive and compassionate care, one of includes a therapeutic method called Motivational Interviewing (MI), so that we can, together, build an alliance towards your recovery.

Understanding That It Can Be Hard To Change

When a person is addicted to drugs or alcohol, they are engaging in a life that threatens their health and wellbeing. Sometimes a person may continue to use and abuse substances even when they know this, which is one of the hallmarks of an addiction.

Even if a person wants to change, they face a measure of irresolution towards it; despite the fact that part of them realizes the detriment of their actions, another part may want to hold on to these behaviors because of what they represent to them (fun, social outlet, coping mechanism, etc.). On the other hand, at certain points, they may—due to the negative effects (legal, educational, vocational health or relationship troubles)—want nothing more than to change. It is this uncertainty and ambivalence that can make them unreceptive or overwhelmed by the notion of changing.

Our staff realizes that this is a normal reaction. We realize that changing is a journey, one that takes time and direction. We want to meet you where you’re at and help direct you towards finding a personal action plan that can move you in an individualized way towards change and wellness. This is why we believe in utilizing the power of motivational interviewing.

The Substance Abuse and Mental Health Service Administration’s “Enhancing Motivation for Change in Substance Abuse Treatment” is a treatment protocol that gives us powerful words on this motivation for change, asserting that “motivation is redefined as purposeful, intentional, and positive–directed toward the best interests of the self.”

Change doesn’t happen over night. Motivational interviewing is based on the concept that change is incremental. According to information on MI found through SAMHSA, there are stage-specific motivational conflicts, or essentially, steps that a person must work through as they find resolution and momentum towards change. They are:

Motivational Interviewing Precontemplation

  • Precontemplation – During this stage a person may be in denial, they may not see how their substance use warrants concern, or how it is a problem. If they do consider seeking help at all, it is not because they feel that they need it, but because it appeases someone else that is concerned (a boss or a spouse).

Motivational Interviewing Contemplation

  • Contemplation – A person begins to see and understand how quitting drugs or alcohol would improve their life in some manner, but they don’t yet see themselves actually quitting or committing to changing, this stage is when a person is overcome by ambivalence.

Motivational Interviewing Preparation

  • Preparation – A person is gaining momentum and feeling more positive about quitting, they begin to formulate steps that they can take towards change. Some people may still feel uncertain as to if they have what it takes to follow through and exact the change.

Motivational Interviewing Action

  • Action – At this point, a person is in the beginnings of change, and has likely seen the positive results of their action, having begun to take some positive steps (i.e. they’ve been sober for a month or have stopped hanging out with friends that encourage behaviors that revolve around drugs or alcohol), however, part of them may still feel the urge to use or question why they should continue.

Motivational Interviewing Maintenance

  • Maintenance – A person has gained momentum and established patterns and good behaviors that they have maintained for some time. Relapse prevention needs to be on the forefront of their concerns.

When a person comes to us for treatment, they may have experienced any number of these steps—some people may have progressed through the first four only to have relapsed, while others may have cycled through these steps several times throughout the course of their struggles with their addiction, whereas others might just be starting out. MI helps us to give you a space where you can find the freedom to share with us where you are, so that we may help you.

Motivational Interviewing, Building Receptiveness To Change

Research illustrates that motivational interviewing holds great impact and success within the realm of addiction medicine. Why is this? One study, titled “Eight Stage of Learning Motivational Interviewing,” sums it up best, characterizing it as “a clinical approach that is collaborative, evocative, and respectful of client autonomy.”

At The Treehouse, we believe that each person holds the ability to change and overcome the ambivalence that may leave them detached from their treatment and without the success that they need and deserve.

The standout dynamic of MI is that it lets addiction staff administer an assessment and evaluation that touches on the same information that a traditional intake session does, but with a greater dynamic of connection and client-centered mindfulness that we rely so heavily on here at The Treehouse. Motivational interviewing is a comprehensive and collaborative partnership between you, the client, and those at The Treehouse who stand so steadfastly behind you.

What this means is that we are gathering the same information from a person as an administer of the more traditional approach does. This includes information that pertains to a client’s current and past substance abuse (including the pertinent methods, mindsets, and behaviors that it was rooted in, as well as the quantitative aspects such as quantity and frequency of use), a history of treatment, if any, experience with relapse and any elements of psychosocial functioning that may influence their drug or alcohol use.

We do this in a way that allows our clients the sense of being seen, understood, and appreciated for who they are and where they are within their journey. MI relies heavily on empathy and removes the oftentimes sterile sense of detached observation and assessment that other means may portray.

Oftentimes within treatment you hear about how substance abuse and addiction affects a person’s physical, mental, emotional and even spiritual states. This is true, and MI allows us a venue for ascertaining how a person’s abuse or addiction impacted these things, and how it elicited reactions within them that may have changed the scope of their abuse in a manner that was detrimental. In doing so, we use this information to better adapt our treatment to increase your chances for success.

How does MI impact your chances of success?

  • By increasing retention within the program
  • Increasing the rate of participation within the program
  • Higher chances of a successful treatment outcome
  • Increased likelihood of continued sobriety after leaving the program

The Principles Of Motivational Interviewing

Motivational interviewing relies on five principles that are foundational to its success, our staff centers our approach on these as a way to ensure that a) their assessment and recommendation for treatment is solid and grounded in a client-centered approach and b) our clients receive an assessment that is non-confrontational that encourages them to listen to their inner voice as a catalyst for change.

The following principles are taken from SAMHSA’s treatment protocol, here we explain how we utilize them in our program.

1. Express empathy through reflective listening

This protocol urges that empathy “is a specifiable and learnable skill for understanding another’s meaning through the use of reflective listening. It requires sharp attention to each new client statement, and the continual generation of hypotheses as to the underlying meaning.”

This protocol explains that a therapist’s “attitude should be one of acceptance, but not necessarily approval or agreement, recognizing that ambivalence about change is to be expected.” Instead of telling a person what to do, this acceptance and listening provides our clients with an opportunity to glean understanding and confidence on their own, in a way that will help them to exert positive changes on their life.

2. Develop discrepancy between goals/values and current behavior

This step is one that helps a person to see the impact of their current substance use or addiction on their life, specifically in terms of their future, in a manner that can precipitate concern or a willingness for change.

Through listening, the therapist becomes able to ascertain a person’s goals and desires towards their future plans, and utilizes their responses and questions in a way that supports the person in seeing the discrepancy between the current path their life is taking, and the circumstances they hope to find themselves in down the road.

The awareness of this discrepancy should urge a person to develop motivations towards change, by asking open-ended questions, and reiterating what a person is saying, the therapist helps to lead a person to this conclusion, allowing them to find it on their own, which in turn, creates a more lasting impact.

3. Avoid argument and direct confrontation

When a person uses substances in a manner that is considered to be abuse or addiction, their mind and emotions may become off-balanced. A person’s cognitive abilities and sense of reasoning may be impaired, and for this reason, some of their perspectives and opinions may not exist in the most fluid manner. In addition, a person’s emotional state may be compromised, leading them to think emotionally, rather than rationally or logically, especially during difficult situations or the conversations that surround them.

Changing behaviors and the thought patterns that surround them can be hard for anyone, changing these things when they are linked to an addiction, can be even more difficult. During this assessment, the therapist will not overexert their opinions, or observations, instead, they will patiently assist the client in finding these truths on their own.

4. Adjust to client resistance rather than opposing it directly

Motivational interviewing is about adaptation. If a client resists, our staff reminds themselves that this resistance may not in every case be borne out of contention, rather it may be a person’s way of illustrating to us that they feel off-balanced and that the conversation isn’t accurately reflecting what they feel or need.

Mindfulness is essential here for both client and staff, as each need to work in partnership with the other to foster the respect and patience that this methodology hinges on. Our staff remains attuned to your needs, and will help you to channel this energy that is based in opposition, to a supposition for healthful change.

5. Support self-efficacy and optimism

At this point, our staff should have intuited a sense of who you are, where your struggles lie, and the trepidation that surrounds them, what your hopes are and the beginning of ways that you’ve conceived that you can change.

Drug and alcohol addiction creates imbalance in a person and fosters negative emotions that may devolve into untruths, thus our clients may be experiencing low self-esteem, set against a backdrop of guilt or shame. Even though our staff has already helped you to make progress through the former steps, these feeling may still linger in a manner that causes some hesitation or pessimism about the client’s capability toward change.

Our staff will use the information that they’ve already obtained from the assessment to remind a client of what his strengths are and how they empower him towards finding the will, skill and courage to change. The protocol elaborates on this, reminding us that “Improving self-efficacy requires eliciting and supporting hope, optimism, and the feasibility of accomplishing change.”

In order to foster realistic optimism, our staff will paint an accurate picture of the journey before each client, and the dynamics that influence it. The protocol continues to say that “Making the biology of addiction and the medical effects of substance use relevant to the clients’ experience may alleviate shame and guilt and instill hope that recovery can be achieved by using appropriate methods and tools.”

Let Us Help You Look Within To Find The Power For Change

Don’t lose sight of yourself any further. Maladaptive thoughts and behaviors can pollute a person’s body and mind when they’re struggling with drugs or alcohol. Our expert staff can help to initialize and implement compassionate care that is tailored to meet you in the ways that will best support your journey away from your substance abuse or addiction and towards sobriety. Not only this, but we will help you to look within and find the strength and perseverance that is inherent in your desire for wellness.

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