Motivational Interviewing 101*

“Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence**.”  

Stephen Rollnick and William R. Miller

Motivational Interviewing is more about mindset than techniques. The traditional mindset has been to “make” our clients change. It’s an “us” (the experts) against them (the “damaged in need of fixing”). We rationalize this this approach because their behavior heroin use, heavy drinking, cigarette or pot smoking, better living through shopping, gambling, or self-starvation, or couch-potato-ing themselves into a heart attack is dangerous if not deadly and we think we are responsible for their lives because clearly they are not handling things well. (This also sounds a lot like co-dependency.) And it doesn’t work.

One key to the Motivational Interviewing mindset is to trust that our client’s actually want to live healthier, more fulfilling lives and just need help to find their own internal motivation to change. Rather than assuming that our clients are somehow mentally deficient to engage in behaviors that are not rational, the Motivational Interviewing mindset pushes us to see that our clients engage in destructive behaviors as a strategy to get their needs met even when those behaviors are not effective. Therefore, it is the client’s job, not ours to explore and work through their ambivalence to change. Our job is simply to help them articulate the conflict inherent in their ambivalence to change by helping them explore the costs and benefits associated with each side of the conflict.

This is easier if you can remember your own internal conflicts – the “angel” on your right shoulder that says, “Don’t start reading your Facebook newsfeed. You have work to do,” while the “devil” on your left shoulder counters, “If you don’t check it out, you might miss something. Besides, it’s only a few minutes. You can’t be all work and no play. You deserve a little bit of pleasure….”

The reality is that attempts to “make” our clients change by threatening, bullying, or “persuading,” simply triggers their resistance. Sure, the rational response to, “If you don’t start working out and stop eating high cholesterol foods you’ll be dead of a heart attack in a year” is to join the gym, get a trainer and start on a healthy diet plan. But, the more likely response is, “F-you, I’m doing just fine. I don’t need your advice.” Or, “Get off my back.”

From a Motivational Interviewing standpoint, “resistance” and “denial” highlight our failure as therapists to meet our clients where they are at rather than about our clients’ inherent traits. Through the lens of Motivational Interviewing, client “resistance” and/or “denial” is great feedback that tells us that we need to change our strategy to be more in line with where our clients are at in terms of change.

Another key to the Motivational Interviewing mindset is the shift in how we frame the therapeutic relationship. Rather than viewing the relationship as one of “expert” verses “damaged client,” the relationship is seen as a partnership rooted in respect for the client’s autonomy and freedom of choice. The therapeutic relationship has repeatedly been shown to a larger impact on client outcome than particular treatment interventions. Respect is a cornerstone of relationship. Respect demonstrates to our clients that we value them – that we and recognize that they are worth something, even if their behavior has been destructive to themselves and/or others. This particularly important given that many of our clients don’t respect or value themselves and have experienced disrespect and rejection from others.

It’s only when we approach working with clients from a standpoint of respect for their autonomy and freedom of choice that we can be directive and help them explore the pros and cons of making changes and find their own internal motivations for doing so.

Built on this philosophical mindset, Motivational Interviewing techniques involve engaging in acceptance and affirmation, empathy, and reflective listening. It is helpful to help clients explore their own motivation to change whether it’s a desire to avoid negative consequences such as incarceration, relational conflict, or guilt, or to pursue positive consequences such as better mental and physical well-being, better self-esteem, improved finances, or the ability to pursue deeper, more fulfilling dreams. Motivational Interviewing requires us to be able to monitor our clients’ motivation to change and work with them where they are at on the change continuum.

Why Action Methods?

Psychodrama, Sociodmrama and Socimetry are action methods developed by JL Moreno. They are particularly useful in cutting through rationalization, denial, justification and various other defenses that people use to avoid change. When you do things in action your body takes over and your mind gets out of the way. Experiential methods such as these move the client from a highly cognitive and intellectual process into a lived experience that engages them both cognitively and emotionally.

Psychodrama and Sociodrama enliven the Motivational Interviewing process by concretizing clients’ ambivalence to change and helping them see for themselves the discrepancy between their current unhealthy behavior patterns and their goals and values. Clients are able to identify the results of destructive behavior patterns, experiment role-playing different choices; experience how things could be if they changed, and practice doing things differently.

Furthermore, clients can step into the shoes of someone they love and experience how their current or past behavior has impacted this person.   More than simply helping clients think about how their loved one feels, role reversal allows clients to feel the impact of their behavior at the body level. Clients have reported that reversing roles with their loved one has increased their desire to change.

*Originally posted on http://www.hvpi.net/category/articles-of-interest/

**Stephen Rollnick, Ph.D., & William R. Miller, Ph.D.

What is motivational interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334.

From http://www.motivationalinterview.net/clinical/whatismi.html

 

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Positive Psychology and Psychodrama: The Virtual Gratitude Visit

An Evening of Psychodrama

Hudson Valley Chapter of the American Society for Group Psychotherapy and Psychodrama

Friday, March 18, 2016

7:30 PM

Boughton Place  150 Kisor Road Highland, NY

Presenter: Dan Tomasulo, PhD, TEP, MFA, MAPP

 

Positive Psychology is informed by the Science of Happiness. Psychodrama is the soul in action. Please join us for an evening using traditional psychodramatic methods in the expression and exploration of positivity.

Dan Tomasulo headshot

About the Director:  Dan is a pioneer in integrating action methods and Positive Psychology. Dan holds a PhD in psychology, an MFA in writing, and is the first licensed psychologist and psychodramatist to graduate from the Master of Applied Positive Psychology program from the University of Pennsylvania in 2012. He is on faculty at New Jersey City University and is an assistant instructor for Martin Seligman, The Father of Positive Psychology, at UPenn for the MAPP program. He has also been a training consultant for the Gerry Spence Trial Lawyer’s College in Wyoming, and developer of the Dare to be Happy experiential workshops for Kripalu. He recently became the Director of the New York City Certification in Positive Psychology for the Open Center and teaches Positive Psychology in the graduate program of Counseling and Clinical Psychology at Columbia University, Teachers College.

He writes for Psychology Today as an expert on group therapy (The Healing Crowd) and authors the daily column, Ask the Therapist, for PsychCentral.com and their Proof Positive blog on practical applications of positive psychology. Honored by Sharecare* as one of the top ten online influencers on the topic of depression, he joined the staff of Answers.com as their depression expert and writes their Healthyway Blog.

He is the creator of Interactive-Behavioral Therapy, the most widely used form of group therapy for people with intellectual and psychiatric disabilities, and is working on his next book: American Snake Pit, a memoir about his involvement in deinstitutionalizing the residents of Willowbrook. For more information visit his website Dare2BeHappy.com

*The website was launched in 2010 by Jeff Arnold, founder of WebMD, and Emmy–award winning host, Dr. Mehmet Oz, in partnership with Harpo Studios, Sony Pictures Television and Discovery Communications.

Open sessions are two to two and a half hour psychodrama sessions offered by certified psychodramatists to the general public. You may participate as little or as much as you want.

Contribution: $10/ $5 for students and those on limited income 

In case of questionable weather or for more information please call:
(845) 440-7272
Email us at ASGPPHV@gmail.com  and we will notify you electronically of upcoming events each month!

 

 


 

 

Posted in Dan Tomasulo, Gratitude, Mental Health, Positive Psychology, Psychodrama, Relationships, Sociometry | Tagged , , , , , , | 2 Comments

Why I Became a Psychodramatist

True confession:  When I started out, I didn’t want to be a therapist.  I was an activist and I wanted to save the world.  I wanted to be an academic because I believed that if I could gather the right data and write the right paper, I could make a difference.

And then I had a student.  I’ll call her Vanessa.  Vanessa changed everything.   She called me from the hospital to tell me that she needed to make up the mid-term.  She said that her father had “kind of gotten mad” at her.  Per university protocol for make-up exams, I had her bring in the medical paperwork.  I can still feel the kick in the gut I felt when I read the report.  She’d been sexually assaulted by her own father.  I didn’t know how to respond.  I talked to my advisor.  She had no clue what to do or say to a human being who had gone through that sort of trauma.  Academics, at least in my department, did not “do” feelings.  She told me to refer her to someone else.  And that was the beginning of my journey.

I called the local rape crisis line to make sure that it was safe to refer them to Vanessa and they were wonderful.  I realized that this is the way we actually save the world — one person at a time.

I don’t know if Vanessa ever contacted them**, but I became a volunteer.  I answered the rape help line, facilitated rape education and prevention programs at schools, colleges, and in the community and worked on fundraising to keep the crisis center’s doors open.   And then I got an opportunity to be an intern with the self-defense instructor and was able to teach feminist based self-defense. It was awesome.   I was creating a space for people to talk about their experiences, teaching them how to set boundaries, and most importantly, helping them empower themselves.  I felt like I was really able to make a difference in people’s lives.

And, I also began to see the limitations of teaching self-defense.  There’s only so much you can do in a class focussed on self-defense and some of my students had traumatic experiences from childhood or adolescence that haunted them and prevented them from moving forward in life.

I wanted to do more, but didn’t have a clue what that might look like.  And then, a friend of mine invited me to a psychodrama workshop.  She’d been in the psychodrama training group at St. Elizabeth’s Hospital in Washington, D.C.  She described how psychodrama helps people work through the emotional blocks that keep them stuck by putting their stories into action, giving them a chance to experience their stories in a safe space, and having a chance to practice doing things differently.  I didn’t go to the weekend workshop but I did start researching psychodrama and the more I read about it, the more I was convinced that it was what I wanted to do.

I still remember the first Psychodrama intensive I went to after deciding that I was going to become a psychodramatist.  The Hudson River Psychodrama Institute (HVPI) run by Co-Directors Judy Swallow and Rebecca Walters was one of the closest programs to Ohio, where I lived at the time, so I e-mailed them to ask about the particulars of their training program.  Rebecca responded within a day.  Her answer was thoughtful and detailed.  She said that the first step to joining HVPI’s training program was going to a Psychodrama Intensive.  The clarity of expectations spoke to a structure that I thought I could work with so I immediately signed up for their next intensive.

Talk about a mind-blowing experience.  As an academic, I lectured on groups and group dynamics  in theory.  Rebecca  and Judy showed us how to facilitate groups and make them functional.  In the first few hours, they taught us group building skills including some basic sociometric tools that created a positive and safe group dynamic.  The simple techniques they taught changed the way I taught and the way I understood groups.  As a bonus,  even though that intensive was 12 years ago I am still connected to some of my fellow group members!

Judy and Rebecca worked from a well-structured curriculum that allowed them to teach us the history of psychodrama, basic pyshcodrama theory, and psychodrama tools in a clear and yet concise way.  Still, the intensive was far from academic.  To learn psychodrama, one must do psychodrama.  They gave us exercises so that we could practice doing some basic elements of psychodrama such as doubling and role reversal.

Taking on new roles, doing things one has never done before, can be nerve-wracking, but Rebecca and Judy made it safe to try these new exercises by their constant support and feedback focused on what we did well as well as how we could improve.   I left with tools I could use with my students and clients.

And as psychodrama is an experiential method, to really understand it, one must experience it.  Judy and Rebecca facilitated several psychodramas each day so that we all got to experience what it was like to be a protagonist – the person playing the principal role in an enactment, an auxiliary – a person who participates as someone or something in the protagonists life, and an audience member.  In the process, I was able to work through some of the emotional blocks that impacted my teaching as well as my work with clients.  And by observing other group members work, I was able to connect my own experiences to the larger, human experience and see different ways of responding to shared problems.

Now I’ve come full circle.  I am a therapist with a growing private practice.  I see individual clients, couples, and groups.  And the tools I learned from Rebecca and Judy are the infrastructure of what I do.  I use psychodrama to help clients move from stuck to free, from road blocks to building blocks.

**I did see Vanessa several years later.  She was a brown belt at the martial arts dojo I attended and seemed to be doing well.

Posted in Getting Unstuck, Groups, Mental Health, Psychodrama, Sociometry, Uncategorized | Tagged , , | Leave a comment

How Psychodrama Can Help You Live a Juicy Life

Living Juicy is:  Jumping for joy on the inside.

Sark

To live a juicy life is to live in the aliveness — your own aliveness — of the present moment, aware of the miracles and wonders that are all around you.  To live juicy is to freely express your creativity and focus on those beautiful moments that uplift and inspire your spirit.  To live juicy is to take time to savor the beauty of the setting sun and the wonder of a flower pushing up through the sidewalk.  Living juicy is doing what makes your heart sing.  To live a juicy life, you must find or create opportunities to feed your creative soul.  

Psychodrama can help you live a juicy life by connecting you to a group so that you see that you are not alone – that other people share struggles that are in some form or another similar to yours.  It provides you with tools to take back the power you have given to your inner critic and exercises to help  you become more spontaneous.  And it provides a space to heal the old wounds that get in the way of living joyfully.   

You can explore how psychodrama can help you live a juicy life this Friday, May 17, 2013 with Jenny Salimbene at the Hudson Valley Chapter of the American Society for Group Psychotherapy’s  May open session.   Jenny Salimbene will facilitate Living Juicy:  An Evening of Psychodrama.  The event begins at 7:30 at Boughton Place —  150 Kisor Road, Highland, NY 12528.   Contribution: $8 / $5 for those on limited income. No reservation needed!

 

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Boston Marathon Explosions: Understanding Your Emotional Responses

Boston Marathon.  Explosion.  Wounded.  Amputations.  Bomb.  Dead.  Chaos.

This is pretty much how my brain took in the information about the recent bombing of the Boston Marathon.  The gaps are places where my brain was fighting over whether to take in the information or not.  I wanted to know everything that happened so that perhaps I could analyze it, make sense of it, and make myself feel safe by reassuring myself that it couldn’t happen to me.  And yet, I didn’t want to know.  I didn’t want to see the images – not even in my mind’s eye.  I didn’t want to read about the terror or the devastation or the chaos.   I didn’t want to think about what it would be like to lose someone I loved in a random, unexpected attack.  I didn’t want to imagine what it would feel like to lose my legs or my ability to do something that I loved to do.  I didn’t want to lose the illusion that I/we are generally safe as long as we take precautions and do the right thing.  And I certainly didn’t want to feel fear.

I resisted looking up information, but there it was, Boston Marathon Explosion on my newsreel.   The headlines were devastating.  Not knowing was even more uncomfortable than knowing.  So I read the reports that I’ll summarize here.  Two blasts, one about 10 seconds after the first, killed three people including an 8-year-old boy and injured over 1oo (the number is now over 170) people.  The bombs contained a number of fragments that in the explosion severed several people’s legs off and mangled many other people’s legs and other limbs so severely that they had to be amputated.  Officials don’t know who is responsible.

In this sanitized account, which doesn’t mention names or provide graphic details, I can retreat to the safety of my head.  This is a defense mechanism.  It lets me stay a little bit numb.  I’m guessing that lots of other people are using this strategy as well – hence the hunger for more and more information.  The problem is that numb isn’t grounded.

Besides, the explosion wasn’t sanitized.  The news reports and visual footage portray a chaotic scene.  And my body (and your body) knows that.  Our bodies, via our limbic system which has little recepters spread out around the heart and gut, tune into the fear around us.  They tune into what it might be like to die, or lose someone else, or lose our own limbs.  And for people who have experienced trauma in the past, feeling this fear can unleash all sorts of sensory memories from past traumatic experiences.  And, because the hippocampus often gets shut down during a traumatic even, those old traumatic experiences don’t get fully processed.  The elements of the memory – taste, touch, smell, sound, and sight, emotional response and thought – don’t get tied together in a neat little package with a time date stamp that tells us, when the memory gets evoked, that it happened in the past.  That means that reading, hearing about or seeing images of another traumatic event can cue up elements of traumatic events from the past as if they are happening now.

You may find yourself feeling irritable or angry, vaguely uneasy or even full blown terror.  You may feel numb.  You may feel really sad – beyond what might be reasonable for the tragedy, and not understand why.  You may even be flooded with memories of something awful that happened to you in the past.  This is normal.  It may not feel OK, but you are OK.   It’s very likely that this crisis has ripped open some old wounds and that some of the numbness, anger, grief, and fear that you are feeling relates as much to these old wounds as it does to the present horror.

I’d like to invite all of you to look beyond the obvious reasons for your feelings this week and search your past.  Try asking yourself, “What does this remind me of?”  Going back into your past will not only help you to heal from past wounds, but it will also help you to better cope with your current feelings, whether they involve day to day issues or the recent tragedy. In the meantime, be gentle with yourself and the people around you.  Give yourself time to heal from traumatic events and know that healing is possible.

 

 

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Group Dynamics

Most of our lives happen in groups.  We are born into a group (aka our family).  We work in groups.  We spend our leisure time in groups.  We practice our spiritual beliefs in groups.  We play sports in groups.  And we watch other groups, be they musicians or athletes, perform in groups.  And yet, most people haven’t the foggiest idea about group dynamics.

The Cult of the Individual:

We live in a culture that celebrates the individual.  We think in terms of “I” and “me”, and “they” and “them”.  We believe in the myth of Horatio Alger and the ideal of the self-made man.  And we see groups as the spheres in which competitions are played out.  As children, we competed for attention in our families and in our classrooms.  As we got older, we competed to be the best, whether it was the best athlete, the prettiest girl, the smartest, the most popular, the funniest, the most delinquent, the biggest trouble-maker, etc.  And even if we weren’t likely to be the best, we fought not to be the “worst” – to avoid being the biggest geek, the ugliest, the least popular.  We live our lives as if Social Darwinism is the only guiding principle.

The Other Evolutionary Theory:

But fifty years before Darwin presented his theory of evolution, a French scientist named Jean-Baptiste de Lamark gave us a different theory of evolution.  He argued that organisms evolve via cooperative interaction  in their environment.  So, for example, there is a species of hermit crab that carries a pink anemone on its shell.  The anemone protects the crab from predators and the anemone gets the crab’s left over food.  What this suggests is that while it’s true that there is competition for survival, there is also cooperation.  The implication is that evolution may be  a matter of survival of the fittest groups rather than the fittest individuals.

Principles of Group Dynamics:

Anyone who has ever played on a successful sports team or performed with an ensemble knows that working together is the key to success.  And anyone who has been on a board or committee knows that not working together leads to disaster.  It doesn’t matter if it’s the PTA, the planning committee at a local church, synagogue or yoga studio, or a national board of directors, breakdowns in group communication can derail the group.

The following elements are necessary in order for a group to function effectively.

1.  Clarity of purpose:  It should be obvious, but the purpose of the group has to be clear.  It’s important to establish what the group is about and what the goal is.  If the goal isn’t mutual, you’re going to have problems.  For example, a football team needs to be clear on it’s goals.  Is the team simply focussed on having fun or is its primary focus to win the league championship?  Whatever the goal, everyone needs to be on board.

2.  Safety:  People need to feel safe in order to reveal themselves and take risks.  Group leaders need to establish rules of engagement and help establish ongoing communication norms.  Most people put respect at the top of the list.  Freedom from judgement is also important.   Leaders also have to do their best to provide equity so that everyone has an equal chance to be seen and heard.

3.  Transparency:  There’s an old saying, “You’re only as sick as your secrets.”  This  applies to groups as well as individuals.  Secrets and secret meetings rot groups from the inside out.  They leave people feeling unsafe, unseen, and unimportant.  Secrets also create a void which people fill by making shit up.  People not involved in the secret meeting, should said meeting become revealed, often assume that the meeting was about them, think they are being judged and criticized which leaves them feeling scared, hurt, and angry.  They lose some of their commitment to the group.

And it’s not just the obvious secrets that can be problematic.   It’s important for group members to understand the relationship connections between group members.  For example, if some members of the group have known each other for years and other members of the group don’t know anyone in the group, it’s important to make these relationships transparent so that the group can both reach out to the new people and understand that long standing relationships may take precedence in  matters like who goes to lunch with whom.  If there are couples in the group, this also needs to be clear.  Otherwise, things can get sticky very quickly.

Inclusiveness:  In order for a group to function effectively, everyone needs to feel “part of” and valued.  Individual group members need to be seen and peripheral members need to be invited into the center.  If a group member is struggling, or simply not feeling well, they need to be acknowledged and maybe even comforted, or at least offered a tissue if their nose is running, or sympathetic pat on the back if they sprain their ankle.

Group Conflict:  Finally, to maintain a healthy group, there must be suitable structures in place to manage group conflict in a way that provides safety for the group and for the conflicting parties.  This means that the conflict needs to be acknowledged in the group and norms regarding respect and safety must be followed.  It can be helpful to note that conflict does not have to be bad unless it is managed poorly.  Managed properly, conflict can actually make the group closer and help the group pursue its goal.  Managed poorly, conflict can destroy the group.

It’s important for group leaders to understand these principles.  Putting them in place makes the group more cohesive and pleasant (which makes life more pleasant in general).  These principles, when followed, will also improve productivity and helps the group attain its goals.

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What Dogs Can Tell Us About Love

Valentine’s Day is just around the corner.  Hallmark and other gift card companies have convinced us that cards, flowers and gifts are required for those of us in relationships and have the potential of landing a mate for those of us who are sitting the bench in the game of love.  We feel pressured to find the right card and give the right gift.  To do this, we have to figure out what message we want to send and anticipate how that message will be received.  Will a diamond seal the deal or send the recipient running?  Will a book or cd say, “I love you” or “I couldn’t think of anything else to give you and I get a 30% discount at Barnes and Nobles”?  Will a drill be thrilling or the source of a fight about expectations?

On the other end, we have to figure out what that gift or card really means.  And the story we spin about what the gift means can make us deliriously happy, piss us off or send us spiraling into dispair.

But what if we have it all wrong?  What if all those cards, gifts, boxes of chocolate and bouquets of flowers are just symbols of romantic love?  What if they have nothing to do with the love we actually want?

Here’s where we can learn a lesson from dogs.  When dogs find a human they call their own, they love them unconditionally.  Sure, they love presents and treats.  They’ll beg for table scraps, do tricks for a Beggin’ Strips, and rejoice over a bone, a hunk of rawhide or even an empty pizza box.  But you don’t have to buy your dog’s love.  They just give it, unconditionally.  Come home from the gym smelling like something died inside your sweatpants, they won’t care.  Wake up with Einstein’s hair and breath of death and fart at the table, they’ll stand by you.  Don’t do the dishes for a month, stop cleaning the toilet, or let the yard become a prairie, they won’t nag.  Leave them at a kennel while you’re on vacation for a week, they’ll still love you when you get back.  Miss their feeding time by hours, they’ll still welcome you home.  Sure, they might have ripped up the couch to let you know they were upset, but they’ll still love you.

With dogs, love isn’t about how you look or smell, what you do or don’t do, or buy or don’t buy.  Love is unconditional.

This is what we should focus on this Valentine’s day – learning to love others unconditionally.  This is the key that will make relationships that are meant to be last and make those that aren’t end gracefully.

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