“I really want to stop. I have to,” said Brett, with tears in his eyes. Two weeks later, Brett did not appear for his scheduled appointment. Attempts to reach him on his cell phone were to no avail, and efforts to reach his emergency contacts were unsuccessful as well. After one month, Brett returned to the clinic, unscheduled, asking to meet with me.
“I am glad you are here,” I said. “I was worried about you,” I added. “I’m so sorry, Dr. Sidor. I relapsed. I was so ashamed that I just didn’t have the courage to talk to you. I also asked my brother not to answer your calls, because, frankly, I didn’t know what you’d think of me. But I got to a point, where I couldn’t take it anymore. I just stayed home, got high, and it has not been working, so, I decided to come back.” “Thank you for coming, Brett. How can I be the most helpful at this time?” I asked. “Well, I just need an appointment. I’m ashamed, I’m embarrassed, but I need to do this. I have no choice but do it.”
In a previous article, entitled, Socratic Motivational Therapy: Systematizing an Innovative Treatment Model, I explained how engaging patients and clients and helping them make the change they wish to see has been a challenge for all of us. I also described how common it is for us to respond negatively to this, especially when it comes to working with patients and clients with challenging conditions and circumstances, like those involved in the criminal justice system, those with substance use disorder, and those with borderline personality disorder.
In that previous article, I also offered a solution, integrating and systematizing the use of the Socratic method and Motivational Interviewing into one treatment approach, to better work with patient and client populations that present with challenging syndromes. Below is a brief overview of Motivational Interviewing, along with the rationale that supports the need for an innovative and complement approach.
A brief overview
Motivational Interviewing is defined as a counseling approach, originally utilized in work with people affected by alcoholism. William Miller first described it in 1983, and he, along with Stephen Rollnick, elaborated and developed it further about eight years later, in 1991. This approach is designed to facilitate change in your patients and clients, by engaging their intrinsic reason for that change. In a nutshell, we are indebted to Miller and Rollnick for working on changing the ways clinicians view, interact, and work with patients and clients with substance use disorders. They have been able to show how confrontation (the frequently used method in clinical practice when working with people with substance use disorders) is the least effective way to help people make changes. On the other hand, through the research conducted by Miller and Rollnick, empathy and active participation were found to be the two most important factors leading to change.
I have studied Motivational Interviewing (MI), and I have used it with good results. However, in the area of healthcare, the randomized clinical control trials conducted using MI have historically excluded people who are homeless and those involved in the criminal justice system, two groups that represent the majority of the people we serve in the public mental health system. These are two groups that surely need to be engaged, to be assisted in making changes, and to be helped with their substance use disorder.
Just like Aaron Beck has discovered the limits of psychoanalysis for a group of patients with depression, I have discovered the limits of MI and a way to use both the power of the principles of MI and the Socratic method to complement each other. This model can be used for the homeless population, for justice-involved individuals, and beyond healthcare, in education and training. The Socratic Motivational Method (SMM), an innovative model using a combined approach of the Socratic method and MI, can be found useful and helpful by anyone, from clinicians to supervisors, educators to managers, and coaches to politicians. It is a model designed to support, engage, and help everyone make the changes needed to progress towards recovery, including those whom many people have given up on.
These people are never going to get better,” says Paula. “Yes, they just do not listen and I just don’t know what to do with them anymore,” says Alan. “I no longer know what to try. They say one thing and then do something else,” adds Claude.
We all share these frustrations, especially when working with people involved in the criminal justice system, those who are homeless and patient populations with the most challenging symptoms. Caring for people with difficult to treat conditions does not have to be this frustrating, especially if clinicians use the innovative Socratic Motivational Method.
For more in this series of articles, check below!
Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, coaching, and management, experience. Some of his passions are public speaking, leadership, entrepreneurship, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past-Medical Director for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.
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Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations". American Journal of Nursing. October 2007.
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Rollnick, Miller and Butler: Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing). Guilford Press, 2008.