#63- What’s Wrong with Motivational Interviewing?

This is Part 2 of comparing Relapse Prevention and Relapse Promotion. While Relapse Prevention is logical and straightforward, Relapse Promotion highlights the counter-intuitive nature of change. Rather than directing the client toward a specific outcome, Relapse Promotion is an open ended process that gives the client the opportunity to discover his own path to recovery. Surprisingly, we do not directly focus on changing behavior. Rather the idea is to influence an internal shift that alters the client’s experience of connectedness, empathy & genuineness, self-esteem, and trust. When this shift occurs disruptive behavior automatically release to a more calm and relaxed state.In Relapse Prevention the client is often told ‘what they need to do’ to change. However in Relapse Promotion, we seek to raise self-awareness as a way to increase self-responsibility and the ability make ‘free-will choices’. The advantage of this approach is that when the client takes responsibility in choosing his recovery path, he is more likely to remain invested in maintaining and continuing positive growth, rather than complying with directives imposed by an outside authority. Relapse Promotion therefore offers an alive sense of discovery that allows the client to move forward in a manner that he can fully own and appreciate his progress and success.In addition, we will also discuss how the Relapse Prevention model provokes a power struggle within treatment. Many therapists end up struggling with clients because they find it hard ‘to let go of the control’ based on working toward a predetermined and planned outcome. In their mind, they have trouble trusting Relapse Promotion which honors a deeper wisdom for clients to make choices that naturally bring about growth and healing.

Now some of you may be wondering… I heard of a Relapse Prevention Model, but what in the world is a Relapse PROMOTION Model?Now let’s be logical here. A Relapse PREVENTION Plan makes perfect sense.But a Relapse PROMOTION Plan makes no sense at all. It would be totally antithetical to the direction and goals of treatment. So, there’s nothing to talk about here! Without even giving it a 2nd thought, a ‘Relapse Promotion Plan’ is off the wall and obviously a crazy idea!!                                 Or is it??!!In fact - a Relapse PROMOTION Plan may be so crazy that it may actually work!The question is – Is it just ‘reverse psychology’ or is there more to it? In this podcast we will explore the hidden potential of addressing the client in this way. We will learn the method behind the madness. In addition, we will discuss how and why the confusion this model instigates actually gives the client the opportunity to take self-responsibility and grow in an authentic manner.    

Therapy has various techniques to help clients address trauma and disowned aspects of the self. Among the most popular are the ‘Empty Chair’ technique and ‘Parts Integration Work’. In the 1960’s, Gestalt Therapy, developed by Fritz Perls promoted the Empty Chair technique. Here the client projects a person (or parent) on the ‘empty chair’ and enters a dialogue to resolve conflict. More recently Internal Family Systems (IFS) developed by Richard Schwartz further expanded this type of dialogue to include ‘disowned parts’ that keep the client stuck and limited. The logic of conventional wisdom is that growth depends on the client’s ability to ‘integrate’ these projected or disowned parts.While this is true to a certain degree, there is a whole aspect to this healing process that is taken for granted and overlooked. Sometimes clinicians accidently touch on this ‘secret ingredient’ which dramatically increases therapy  success. However – because it happens accidentally - the clinicians are often unaware of how and why certain clients benefit more from ‘empty chair / parts work’ than others do. While the technique is often the vehicle that brings an issue to the surface, it is actually the presence of the ‘secret ingredient’ that allows change and growth to happen. Today’s podcast will address both the technique and secret ingredient that bring life and success to the therapy

hat’s the secret that makes narcissists so loveable? Some might say it’s having an unreasonable degree of self-importance; the feeling of being superior, so that one can ‘look down’ at others. Maybe it’s their lack of personal awareness and difficulty adapting to change? Or is it the need to be admired – with or without any real achievements? Or how about being arrogant and coming across as conceited? Or could it be their difficulty with managing their emotions, behavior, and easily feeling slighted. Maybe it’s their desire to always be ‘right’ and never admit when they might be wrong or made a mistake? Or lack of flexibility, and being impatient with others who disagree with them? Or maybe it’s that they have trouble handling anything that seems like criticism, and have contempt for those who do not see things their way?In this podcast, we will discuss all these aspects, as well as the core underlying issue that makes them so ‘loveable’. And what ultimately has to happen if treatment is ever going to have a chance to work….?

‘Guilt and shame’ are common feelings that are part of the human experience and are regularly addressed in the process of therapy. Animals who live by their limiting and rigid instincts do not suffer from the internal struggle of these emotions. It is the struggle around these emotions that is often tied to addictions and mental health issues. In this podcast we will discuss the difference between guilt and shame as well as the difference between ‘healthy shame’ and ‘toxic shame’. While toxic shame can overwhelm and paralyze a person, healthy shame is value-based and can motivate a person to align with one’s integrity and toward healthy social interaction. Join us for a discussion of the paradoxical aspects that encompass guilt and shame and our struggle to stay balanced as part of the human condition.     Healthy shame is a temporary, value-based signal that you've done something wrong (e.g., "I did something bad"), prompting you to correct behavior, make amends, and learn, unlike toxic shame, which is a global, paralyzing belief that "I am a bad person," leading to self-disgust and stagnation. It's an adaptive emotion for social connection, helping you align with your integrity, understand social rules, and foster humility, while toxic shame stems from feeling inherently flawed and unworthy. 

For the most part therapists view the process of change as occurring in a linear step-by-step manner. We envision change as happening when we help the client ‘put one foot in front of the other’ until he finally reaches his stated goal. And from within a logical framework, this seems to make a lot of sense. However, in following this line of thinking, the obvious conclusion is that therapy is inevitably a long process that will likely take months or even years. And of course, for him to be successful, he must understand that he will have to put in a lot of time and effort to reach his goal. The problem with this view is that the therapist assumes that the client is ‘trapped’ by his physical reality and history. From this finite reality it would seem that he can only ‘escape’ by taking limited and small steps forward. However the ‘true reality’ of man’s existence, is that he has unlimited and ‘infinite potential’. When the therapist is able to help the client access this innate unlimited potential, the client’s natural tendency is to take ‘quantum leaps’ forward in his growth and recovery. This means that it is possible for the therapist to work on ‘secondary problems’ that are seemingly unrelated to the primary issue, but have an impact on the primary issue. For example, if we help the angry client improve self-esteem, his primary issue of anger will automatically diminish. This podcast will explore the nature and conditions that perpetuate ‘horse & buggy’ type therapies, and how a slight change in the therapist’s perspective can influence the client to spontaneously take exponential or quantum leaps forward toward positive change. 

Of all the years, I’ve been doing therapy I have not once ever heard anyone say a bad word about Motivational Interviewing! Call me cynical… but if you can’t find at least one thing wrong with a therapy modality, - then that’s a major ‘red flag’! Fortunately, this podcast will finally bring MI back to Earth and put it in its rightful place. Sure there’s a lot that is ‘right’ with MI, but often it is those very things that end up bogging down the process. On the positive side – it’s accepting with no power struggles; logical; and direction oriented. But on the negative side – it can be too accepting without challenging the client; logical enough for the client to see through it; and the therapist can easily get caught in his own direction and agenda. For the most part MI considers therapy to be a long term process in that we have to be patient until the client finally ‘comes around’. But a big problem is that sometimes we can’t wait forever until the client finally wakes up and ‘comes around’.

This is a follow-up to last week’s podcast (61) Bullying: For or Against?In this week’s episode we will analyze and review a successful 3 session paradoxical intervention conducted by Dr. Kaplan with a group of teenage boys who were involved in escalating sexualized behavior, living in a residential treatment facility. Of the 11 residents in the cottage, 4 - 5 boys had banded together, and had started to sexually target and bully younger and smaller residents in the unit. Although the staff had advised the boys that such behavior was inappropriate and needed to stop, aggressive sexualized behavior continued to escalate. When the staff contacted Dr. Kaplan, who then working at the facility as a PSB (Problem Sexual Behavior) psychologist, they informed him that the boy’s ‘sexual play’ was rapidly becoming an internal threat to the residence unit’s safety. With the permission of the Director of Psychology, Dr. Kaplan was able to video the intervention.After the 3 group sessions, the intervention was completed. At that time the staff reported that sexual play and acting-out had reduced to the point that it was no longer an internal threat to safety within the unit. Even 4 months following the intervention, staff continued to report that sexualized behavior was no longer considered a danger within the residential unit. In this video, we will analyze the key aspects of the paradoxical approach and how it contributed to treatment success.

Bullying ain’t what it used to be!In the old days the bully used to be one of the big kids in class.He could intimidate and push other kids around, and nobody messed with him.During recess he could target the smaller kids, who were no match for him, and could easily take away their lunch boxes. Of course he had a sad life.Everyone knew he was alone and forgotten because his parents were getting divorced and always fighting.So really he had good reason to be angry and take it out on other kids.                      In the old days, the principal would call the parents up and there would be a big emergency meeting in his office. At that point the principal would tell the parents to figure out how to control their kid. So the parents would yell, and hopefully the kid would get the message and straighten out.  But bullying is different in today’s world. All the kids are screwed.Cell phones keep everyone isolated and separate because kids interact with glass screens all day.                       And a lot of kids are angry and they don’t know why.But it’s easy to bully other kids by sending a text message dart making fun of someone’s hair or shoes.Only no one gets to see the kid’s reaction when the dart lands, so you might as well send another one, just for the fun of it… This podcast will offer counter-intuitive solutions that you will either love or hate – but would never have thought of in a million years….  

Acceptance and commitment therapy (ACT) was developed in the 1980s by psychologist Steven C. Hayes. His ideas emerged from his own personal struggle with panic attacks. Eventually, he recognized that it was not productive to avoid or run from his own discomfort. He vowed that he would learn to accept himself and directly address problematic feelings and thoughts. The ACT method seeks to develop and expand psychological flexibility. Such flexibility encompasses emotional openness and the ability to adapt thoughts and behaviors in a way that aligns with the person’s goals and values.It is an action-oriented approach that is based on behavioral and cognitive therapies. Clients learn to stop avoiding inner emotions and thoughts. He learns to accept his inner struggles that have kept  him stuck. As part of the process he commits to making necessary behavioral changes that override these difficulties. The idea is to move forward in his life regardless of what is happening around him or how he feels and thinks about it. The intent here is to go in a positive direction by practicing  taking concrete steps in behavior that reflect one’s true goals and values.The podcast will explore the ACT approach and assumptions behind it. As we will see, the ACT process inherently reinforces the assumption that therapy and change is difficult. The question is whether the process of change needs to be as difficult as ACT makes it out to be?