Modeule 1Spirit of Motivational Interviewing.” -DYC 707A
After reading and watching the Motivational Interviewing content, in 4 pages (NOT INCLUDING TITLE PAGE AND REFERENCES) and in APA 7th edition format, create a study that demonstrates your thorough understanding of Motivational Interviewing, including the meaning and concept of the “Spirit of Motivational Interviewing.” Be sure to include all key tenets of Motivational Interviewing including OARS and Elicit Provide Elicit, as well as any other key points to include in your discuss and understanding of Motivational Interviewing.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Use scholarly sources to support your claims. PEER REVIEW ARTICLES ONLY. Scholarly articles from 2021 to 2026 only. (Within the last five years) Please review your spelling and the rubric. Please use North American peer-reviewed journals ONLY.DO NOT use any European Journal.
William Miller on Motivational Interviewing
https://www.kanopy.com/en/dyc/watch/video/95212#:~:text=00%3A00,Thank%20you%2C%20Bill.
Transcript-WILLIAM MILLER
00:00
CARLSON: Welcome to our program on addictions.
00:03
Today we'll be talking to William Miller about
00:06
Motivational interviewing.
00:08
Judy, what kind of a contribution has this approach
00:11
made to the field of addictions?
00:14
LEWIS: It's only revolutionized it, that's
00:16
all-I think because as counselors as therapists we're
00:20
accustomed to working with clients in a way that's
00:23
respectful, collaborative we're used to the idea of
00:27
working with clients to agree on what should be the goals
00:32
and the treatment plan.
00:33
And now I think, finally, people feel as though they
00:36
have permission and some backing to use these same
00:39
kinds of attitudes when they're working with
00:42
addictions clients.
00:43
And so many people just use this at the beginning- this
00:46
empathy, respect.
00:49
Dr. Miller's approach uses these conditions and focuses
00:52
on these conditions throughout the treatment process, and
00:55
really helps people move from this ambivalent state into the
01:00
state of really wanting to bring about self-change.
01:02
Yeah, exactly.
01:03
Let's bring out Dr. Miller, and learn about this approach.
01:05
Bill, welcome.
01:11
LEWIS: Hi.
01:13
Bill, could we start out getting a general overview of
01:18
your revolutionary approach?
01:21
MILLER: I don't know that it's revolutionary, but often, in
01:26
the addiction field, the model has been you need to put
01:28
something into the person, or change them, or convince them,
01:32
or confront them and this is more of a
01:34
drawing-out-of-the-person approach.
01:36
And you mentioned ambivalence just a moment ago-it's a place
01:41
where people get stuck.
01:42
They want to, they don't want to.
01:44
And they have trouble moving off that space.
01:46
This is a way of helping people to resolve that
01:49
ambivalence and move on toward behavior change.
01:53
It's both client-centered and directive, which is an odd
01:57
combination in some folks' minds but very interested in
02:01
the person's own perspective very concerned with how they
02:04
understand things and what they want with their lives.
02:07
And at the same time, it's not just following the person it's
02:10
moving the person along in the direction of change.
02:15
LEWIS: So you do have an idea about where you hope the
02:19
person will go?
02:21
MILLER: Yes, and that's the sense in which it's directive.
02:24
When you're sitting with a person who's using crack
02:26
cocaine, you do have an idea about where you'd like them to
02:29
go which is away from that direction.
02:31
That may or may not be where they are at the moment.
02:34
This approach starts with the person where they are but then
02:39
moves them in a direction of healthy change.
02:41
So you hope they'll move toward healthy change, but you
02:44
recognize that if you try to convince them to move in that
02:47
direction, it wouldn't be productive.
02:49
It may even do the opposite.
02:51
When a person is ambivalent, they have inside them both
02:55
arguments in a way-the argument toward health, the
02:58
argument toward continuing what they've been doing.
03:00
And if you as a counselor take the side of health you leave
03:04
the client the role of arguing against it.
03:06
And the client may indeed talk him- or herself into
03:09
continuing the behavior rather than changing.
03:12
And what we do is almost the opposite of that- is to draw
03:16
out of the person their own motivations for change, their
03:19
own desire for health, their own interest in doing
03:22
something different.
03:23
CARLSON: So there is an assumption that people really
03:26
do, at some level, want to be healthy.
03:29
MILLER: Absolutely, yeah-that that's inherent in the person
03:32
and that they have in them the resources to do that.
03:35
It draws on the person's inner resources rather than assuming
03:38
that I, as the therapist have the wisdom I need to give them
03:42
to fix them.
03:43
So it's very democratic in the fact of, given a choice,
03:47
people can find their own best way.
03:49
And that that's the natural way.
03:51
It's almost if we don't get in the way of changing, people
03:54
will move along naturally in that direction.
03:57
CARLSON: How do you conceptualize
03:58
the addiction process?
04:01
MILLER: It's an interesting one to put together with this
04:02
because addictions are fundamentally ambivalence.
04:06
What are they?
04:07
It's doing something that's pleasurable or in some way
04:10
reinforcing even though it's having adverse consequences.
04:14
And that's the diagnostic definition of what addictive
04:18
behavior is about, whether it's gambling or drug abuse or
04:21
whatever it is continuing to do something that's in one way
04:25
enjoyable and in another way destructive.
04:28
And people who are engaged in those behaviors know both of
04:32
those things.
04:32
It's not that they don't know there are negative
04:34
consequences to what they're doing.
04:35
They're ambivalent.
04:36
They're caught in this place of ''I want it and I don't
04:41
want it,'' and that's where they get stuck.
04:43
Traditional approaches that have been more confrontive
04:47
about addictions have assumed that part of addiction is
04:54
denial and that you need to confront that
04:57
and break it down.
04:58
So you're seeing the assumptions that we make about
05:01
addictions, I think, a little differently.
05:04
And that grew out of my own experience, really.
05:06
I started working in the addictions field without
05:08
knowing that that was the way you're supposed to do it, and
05:13
after a couple of years began hearing about this confrontive
05:16
model and I thought, ''Gee, that's not my experience with
05:18
the people I've been working with.'' Looked at the research
05:22
on personality and there really is no consistent
05:25
personality associated with addictive behaviors.
05:27
So people don't walk through the door with all the same
05:32
personality.
05:34
So if the clients in my office are all behaving the same way
05:37
it's not because they came through the door that way.
05:40
It's something about the interaction.
05:41
And so it focused me very much on motivation as something
05:45
that happens between two people as a kind of dance in
05:48
which two people engage.
05:50
LEWIS: So what you are saying is that something that the
05:53
counselor or therapist was doing was feeding into this
05:59
sense of the client being in denial.
06:02
MILLER: And the opposite is true, too.
06:04
I mean, I know how to behave as a therapist if l want my
06:07
client to be very resistant and denying and backing away
06:10
from change and that's to be very directive, very
06:14
confrontive, very teaching.
06:16
If you take a more client-centered approach and
06:19
listen reflectively you find that resistance goes down.
06:23
And there even has been research with counselors
06:25
changing their style every 12 minutes within a session and
06:28
you can see client denial going up and
06:30
down within a session.
06:31
So denial really isn't a client problem-it's a
06:34
therapist or an interaction problem.
06:36
CARLSON: Are there some principles or some guidelines
06:40
or steps that underlie your practice.
06:42
MILLER: Well, as a matter of fact, there are five of them.
06:45
And empathy is the first one that Steve Rollnick and I have
06:50
emphasized in that it's very important to do the very
06:54
things that Carl Rogers was talking about-to listen to
06:58
understand the person's perspective, to be interested
07:00
in how they see it and to try to get inside that.
07:03
And the skills of reflective listening are very
07:06
much a part of that.
07:07
So that's one of them.
07:08
So you have to express the empathy-you just can't be
07:10
there and be empathic.
07:12
It's got to be fed back some way?
07:14
It's not a feeling.
07:15
This is a behavior.
07:16
And it's something that you do.
07:19
And the skills of reflective listening that so many of
07:21
Rogers' students have talked about are exactly the thing
07:24
that one does there.
07:25
You must be good at that to do Motivational Interviewing
07:28
really can't do it without that reflective skill.
07:31
So that's one.
07:31
That's one.
07:32
And then developing discrepancy is the second one
07:35
where- What does that mean?
07:37
What you're hoping is that you'll develop in the client's
07:40
mind a growing discrepancy between where they are and
07:44
where they want to be.
07:45
So it's coming to understand what their hopes and goals and
07:48
desires are and then saying, ''How does that fit together
07:52
with crack use or with alcohol use'' So many clients really
07:58
think that they are where they want to be until they really
08:00
think about it and realize that there is a real
08:02
discrepancy?
08:03
Until they start talking about it.
08:05
What often happens is a client will think of one reason pro
08:08
and one reason con, and sort of stop thinking about it.
08:11
And this has the person follow the thoughts of, ''What is
08:15
this costing me and why would I want to change'' And it's
08:20
also as much going toward something as
08:21
going away from something.
08:23
Just stopping everything you can do with general anesthesia
08:27
but people are wanting to move toward something.
08:30
And so it's bringing to life the thing that the person
08:33
wants to move toward and then putting that together with
08:36
their current behavior and saying, ''How does that fit?'
08:39
It's goal directed.
08:40
It's very goal directed, and you're hoping that in the
08:42
client's mind, the discrepancy is growing.
08:44
And the more the client describes the difficulties and
08:48
describes what it's costing them to continue the addiction
08:52
and describing where they would rather be instead the
08:54
more that discrepancy begins to open up.
08:57
CARLSON: Okay.
08:57
What about the third one?
09:00
MILLER: Avoiding argument is a piece of that.
09:04
And I alluded to that earlier, that the one thing you don't
09:07
want to do in this approach is be in the position where
09:10
you're arguing for change and the client is
09:12
arguing against change.
09:14
It's a script that any counselor can write.
09:16
Been there, done that.
09:18
That's right.
09:19
You know how it goes, and you can write the client's lines
09:22
that are counterarguments.
09:23
So don't get yourself in that position of arguing with and
09:26
pushing against the client because it actually takes you
09:29
in the other direction.
09:31
MILLER: In the wrong direction, that's right.
09:33
CARLSON: And what's the final one?
09:36
MILLER: Well, there are two more, actually.
09:37
One is roll with resistance.
09:39
So rather than arguing or pushing against, when you meet
09:44
what we call resistance and I think actually it's not a good
09:46
term, I'd like to find a better way of talking about it
09:48
but when the client begins arguing against change, you
09:51
don't push against that.
09:53
You don't try to overwhelm it or come up with a brilliant
09:57
counterargument to it but roll with it in very much the
10:00
manner that Satir and Haley and other people have talked
10:03
about in family therapy, and to use the momentum of that to
10:07
then redirect the person in the direction of change.
10:11
And then the last of them is to support self-efficacy which
10:14
has a lot to do with optimism.
10:16
Because if you've developed a discrepancy and you've caused
10:19
the person to feel like they're in danger but they
10:23
don't see anything they can do about it, you really haven't
10:26
taken them anywhere.
10:27
You've just made them distressed.
10:29
So an important piece of it is that it's possible to change,
10:33
and to hold up that hope.
10:34
CARLSON: So that hope-it seems like that's a
10:36
real important element.
10:37
MILLER: It is.
10:38
So that's the five things that we've talked about that come
10:41
together to form Motivational Interviewing.
10:44
So you're hopeful, and ideally the client will be more
10:50
hopeful and have a greater sense of self-efficacy about
10:54
being able to resolve the issue.
10:57
You need to have the hope in you for the clients.
10:59
It's very contagious.
11:00
There's a wonderful experiment from 20 years ago in which
11:04
therapists were caused to be particularly optimistic about
11:07
certain clients, who, as it wound up,
11:10
were chosen at random.
11:12
And those clients for whom the therapists had particular hope
11:15
and belief got better at a much higher rate
11:18
than the rest did.
11:19
If we see in the client the possibility of getting better,
11:23
it's contagious, and it actually draws
11:26
it out of the person.
11:27
CARLSON: That would seem to be so important in this field.
11:29
It is.
11:30
So many of the people who come to us are down and out.
11:32
Yes.
11:33
We see them as down and out.
11:35
They need to borrow your hope for a while.
11:37
In a way, haven't we sometimes done the opposite of what we
11:41
need to do around self-efficacy?
11:42
MILLER: I think so often, working with addictions
11:45
clients, therapists will focus so much on the negative of the
11:51
problems that are part of the person's life that they move
11:57
the person away from a sense of self-efficacy
12:00
instead of toward it.
12:01
I think it's very useful to focus on the positive-on the
12:05
person's strengths on what they want in their life, on
12:09
the direction that they feel, on their future on what's been
12:13
good about their past.
12:15
The negative is true enough and most clients know it well
12:18
enough, that they don't need to be beaten with it.
12:20
MILLER: Yeah.
12:21
Now, the client in this approach is really in charge
12:24
of his or her treatment plan, finally with the therapist
12:29
being an expert consultant at helping with that, but then
12:33
the client is really in charge of deciding on what the
12:37
outcome of the interview should be, right?
12:40
Well, and of course, how could it be otherwise' We really
12:43
delude ourselves if we say, ''Well, you can't let a client
12:46
make choices.'' Who are we that we can't let
12:51
someone make choices?
12:52
In the end it is what the client decides to do that
12:55
makes the difference.
12:56
And this simply acknowledges and respects that fact.
12:59
CARLSON: Do you hope for abstinence as your goal?
13:01
Is that your outcome or the outcome that you hope for?
13:04
MILLER: Well, it's more important for some clients
13:07
than others, certainly.
13:07
There are good data on people for whom abstinence seems like
13:11
the way in which they're going to make it in the long run,
13:14
and that's information I share with people.
13:16
So given what I know about them, if they're hoping for a
13:20
non-abstinence goal and the data tells me they don't have
13:23
a very good chance of that, I'll share that information.
13:26
That doesn't mean that makes the decision for them.
13:28
And I'll work with them where they are and at least move in
13:31
the right direction.
13:32
The emphasis on harm reduction these days is wise I think-to
13:36
move to less dangerous drugs and less dangerous routes of
13:39
administration.
13:40
So even if they're not willing to go all the way to what I
13:42
would hope for them I'm willing to help them take
13:45
steps in that direction.
13:47
It's common for therapists and clients not to
13:50
have the same goal.
13:51
CARLSON: How does this approach work with clients who
13:54
come in with dual diagnosis they have a psychiatric
13:58
problem as well as an addiction problem?
14:02
MILLER: Well, most people with addictions
14:04
have multiple problems.
14:05
I don't personally care a lot for ''mentally ill''
14:12
dual-diagnosis terms.
14:14
But when you're heavily involved with alcohol or crack
14:18
or heroin, you've got a ton of problems.
14:20
So it's never as simple as just treating the drug problem
14:23
itself which is one reason why I really encourage mental
14:26
health professionals to be involved in primary treatment
14:31
of addictions, because the very skills that you learn in
14:35
the process of becoming a health professional are
14:37
exactly what you need in the process of treating this.
14:40
This is not a special, secret club that you must be
14:43
initiated into.
14:45
The problems are very much interrelated and interwoven
14:48
with everything else in the person's life.
14:51
LEWIS: I once heard somebody who was working with both
14:53
mental health clients and addiction clients say that the
14:56
difference in how he approached them is if it was
15:00
any other client he assumed the client was telling the
15:02
truth until he learned he was lying but if it was an
15:05
addiction client he assumed he was lying until he made sure
15:09
he was telling the truth.
15:11
MILLER: Yeah, what's wrong with this picture' When you
15:14
look at the way addiction treatment was done 20 years
15:16
ago, at least, it was very harsh confrontational
15:20
therapy-hot seats and so forth.
15:21
We wouldn't do that to anybody else.
15:23
And that's not a part of the way in which you would treat
15:26
depression or battle with distress or anxiety disorders.
15:29
We've somehow reserved the very harsh treatment believing
15:32
that was necessary for this population and in fact if you
15:35
treat people like they're going to lie to you, they do.
15:37
Yeah.
15:38
And if you treat people as if they are trustworthy they tend
15:42
to be trustworthy.
15:43
It doesn't mean you're never lied to, but-
15:44
CARLSON: So you're bringing the person back into
15:46
treatment, aren't you?
15:47
Rather than just seeing them as this drunk.
15:50
LEWIS: See, I told you it was revolutionary.
15:54
MILLER: Of course.
15:57
LEWIS: What about when you're working with clients who might
16:01
benefit from participation in a 12-step group Alcoholics
16:05
Anonymous or one of the other self-help groups?
16:08
Are you able to integrate this approach with that work?
16:11
MILLER: Absolutely.
16:12
We've used Motivational Interviewing in programs where
16:17
the whole heart of the program was 12-step.
16:19
And one of the nice things about this respectful
16:21
client-centered approach is it seems to fit pretty well
16:25
whether your treatment orientation is
16:27
cognitive-behavioral or 12-step.
16:29
If you read the Big Book and the way in which Bill W.
16:33
talked about working with alcoholics it wasn't harsh and
16:36
confrontational.
16:37
It wasn't argumentative.
16:38
It was very respectful, very patient, very person centered.
16:43
So I find this entirely consistent with the 12-step
16:46
approach at least as it's understood in
16:48
the original writings.
16:50
CARLSON: One of the questions --
16:52
This all sounds good but does it work?
16:55
Is there a research base for this model?
16:58
MILLER: Well, that's one of the things that's kept me
17:00
going in this area because I've been frankly very
17:03
surprised at how well this has worked.
17:06
There are about 20 controlled trials now, not just in
17:09
addictions there's some in diabetes management,
17:11
cardiovascular rehab, and so forth.
17:14
And 20 years ago l would never have believed that in a single
17:17
session which is the way this is usually done, you could see
17:21
such behavior change.
17:22
It boggles the mind.
17:24
But very consistently, we're finding both an additive
17:28
effect that is, when you put a session of Motivational
17:31
Interviewing at the beginning of a treatment program, you
17:33
get much better outcomes.
17:34
And you get much better participation in treatment
17:36
along the way.
17:37
Over time, too.
17:38
Over time.
17:39
And also as a freestanding approach, when you're just
17:42
doing Motivational Interviewing compared to
17:45
nothing- compared to no intervention you also get a
17:47
substantial behavior change.
17:49
So the studies have been predominantly positive.
17:52
There's only been one negative trial so far.
17:54
And the strength of that effect is just amazing to me.
18:01
CARLSON: In a couple minutes we're going to watch you work
18:04
with a young man named Mike.
18:06
Can you help our viewers just to focus on what it is that
18:13
they might be looking for in your work some of the
18:16
techniques or some of the strategies that
18:18
you might be using?
18:19
MILLER: Yeah.
18:20
Well, besides the principles that I talked about before the
18:25
way that one usually opens a session like this is with an
18:28
open question one that invites the person to tell you about
18:32
themselves.
18:33
And not just one of those, but a series of open questions.
18:36
I try not to ask closed-ended questions very often, but to
18:42
give a question where the client can move around a bit,
18:46
and then follow with reflective
18:48
listening, very much.
18:49
You and I were talking how easy he makes this look, so
18:52
it's important that the viewers know that there are
18:56
really strategies that you're using.
18:57
Oh, yes, and it does take a while to learn this.
19:01
Also, in what I'm reflecting and Rogers did this too
19:06
although he wasn't aware of it- I'm differentially
19:10
reflecting back the client's own statements that are moving
19:13
in the direction of change acknowledging the other side
19:16
as well, but helping the person move along.
19:21
There's acknowledgment of the person's freedom to choose,
19:25
and respect for that position.
19:28
But listening for the person's own motivation, for their own
19:33
goals, for their own desire to change and reflecting and
19:37
encouraging and moving that along as we go and providing
19:40
the encouragement and the hope that that can happen.
19:43
LEWIS: And this client was very ambivalent, wasn't he?
19:46
MILLER: Yeah, and that's not uncommon.
19:48
For some reason we pathologize that in the addiction field,
19:51
but ambivalence is very human and in fact is a normal part
19:55
of the change process-that when you go from not thinking
19:57
about change to beginning to think about it you must pass
19:59
through a period of ambivalence.
20:01
And it's just that that's where people get stuck.
20:04
And this is a particularly interesting case because he's
20:06
very aware of being there and very aware of how
20:10
uncomfortable it is to be at the ambivalent place and very
20:13
aware that he has to move one way or the other.
20:15
He has to move forward and resolve the ambivalence by
20:18
changing his behavior or move backwards and resolve the
20:22
ambivalence by shutting down and saying it
20:24
isn't really a problem.
20:25
Well, since ''I'm not sure'' are three of my favorite
20:28
ambivalent words l'm looking forward to watching this.
20:32
CARLSON: So let's watch your work with Mike.
20:33
MILLER: Okay.
20:35
MILLER: So, fill me in a little bit.
20:38
What is it that brings you here today?
20:40
MIKE: Well, actually I'm doing a favor for a friend of mine.
20:44
MILLER: Uh huh.
20:45
MIKE: And he told me about a study you guys were doing, and
20:47
so I figured I'd participate in it, and they told me you
20:50
were basically an addiction counselor, and he thought I
20:53
might be an interesting subject.
20:55
MILLER: Uh huh.
20:56
MIKE: Okay?
20:56
MILLER: Okay.
20:57
Well, tell me about where you are now with the addictions
21:00
that you?ve been?
21:01
MIKE: Well, what do you want to know in particular?
21:05
MILLER: Well, are you in recovery now, or
21:07
MIKE: No, I'm not.
21:08
MILLER: Okay.
21:08
Alright.
21:09
So what are the drugs or what it is you struggle with?
21:13
MIKE: Well, honestly cigarettes.
21:15
MILLER: Okay.
21:16
MIKE: That's the biggest.
21:17
MILLER: Okay.
21:17
MIKE: Alcohol to a degree, but I think I've had more of a
21:21
problem with that two or three years ago, you know, it seems
21:24
to have gone down to a degree and probably simply because of
21:29
the environment.
21:30
MILLER: So That's kind of settled down.
21:31
MIKE: Well, not all that much.
21:34
Okay, but enough, it's gone down simply because I'm
21:38
getting too old to do this stuff anymore if that make any
21:41
sense to you.
21:41
MILLER: It does.
21:42
You can't keep up with it anymore.
21:43
MIKE: I don't think I can.
21:44
I really don't think I can.
21:46
MILLER: And then the cigarettes are still a real
21:48
addiction for you?
21:50
MIKE: Yeah, I really do.
21:51
I think they are worse.
21:51
In the past I've done cocaine.
21:54
I've even done crack cocaine.
21:56
I've heard That's one of the most addictive drugs around.
21:58
Quite frankly, from my own personal experience, I don't
22:01
find it addictive at all.
22:02
MILLER: Yeah, it's interesting how it is different for
22:03
different people.
22:04
MIKE: Yeah.
22:04
MILLER: Yeah, but for you it's tobacco and alcohol.
22:07
MIKE: Yeah.
22:08
Yeah, and coffee.
22:09
MILLER: Yeah.
22:09
MIKE: I mean if we want to get that specific.
22:12
MILLER: How far do you want to go there'
22:13
MIKE: How do you want to go?
22:14
I got a lady That's supposedly addicted to Chapstick.
22:21
MILLER: It gets used for almost anything these days.
22:24
MIKE: Right.
22:24
MILLER: Yeah.
22:25
Well, how might you like things to be different?
22:27
I guess That's a good place to start.
22:31
MIKE: Well, basically, you know, I don't,
22:33
see That's my problem.
22:34
I don't think I'm really all that committed to making
22:36
things all that different because I'm not seeing that
22:38
much harmful benefit.
22:40
I was told that you are not able to slow down.
22:42
It's progressive.
22:43
You get worse and worse and worse and worse, and that just
22:45
doesn't seem to be the case with me.
22:47
Okay?
22:48
I think that there are certain things in my lifestyle that
22:50
just preclude me not using, okay?
22:52
MILLER: Right.
22:53
MIKE: And that, and smoking has become a problem because
22:56
I'm starting to play soccer, okay?
22:58
MILLER: So you can't breathe.
22:59
MIKE: So I can't breathe.
23:00
The kinds are younger and younger.
23:02
They are half my age, twice my size.
23:04
I'm having a problem with it.
23:05
MILLER: You are noticing it.
23:06
MIKE: Okay.
23:06
Yeah.
23:09
MILLER: So, I mean the message that you shouldn't use at all
23:11
is like somebody out there telling you that, but that
23:13
doesn't fit your experience.
23:15
MIKE: I don't know.
23:16
Use at all.
23:18
What does that mean?
23:19
What do you mean by that?
23:21
MILLER: Well, I guess maybe I misunderstood you.
23:22
I thought you were saying people tell you that you can't
23:27
use or shouldn't use or whatever.
23:29
MIKE: Oh yeah.
23:29
Yeah, they've told me that before, you know.
23:32
I've been through, I guess you know nothing about me do you?
23:36
MILLER: Nothing at all.
23:37
MIKE: Okay, I'm sorry about that.
23:38
I though at least they filled you in on some
23:40
MILLER: No, I asked not to be.
23:42
MIKE: Okay.
23:43
Well, no.
23:43
Alright, here's what happened.
23:44
I got a DUI a while back.
23:46
I think it was back in '93, and I had one prior to that in
23:49
'85 and went though some counseling.
23:52
It was mandatory, state-driven.
23:53
Basically you go through the counseling, and after you
23:58
successfully complete it, you are rehabbed.
24:01
Actually rehabbed.
24:03
MILLER: Right.
24:03
MIKE: Then you get your driving privileges back.
24:05
And I guess what I'm trying to say is that I've had some bad
24:07
experiences.
24:08
Not bad experiences with the counselors, but I found them
24:11
to be not less than professional but just very
24:16
rigid in their approach.
24:17
MILLER: Okay.
24:17
And that didn't work for you, that didn't fit.
24:20
MIKE: It didn't fit at the time, and at the time I don't
24:23
think I was really all that committed to quitting, and
24:26
then I was, but at another time, but the other time was
24:29
because I was earning $40 an hour, and I was working ten
24:33
hours a day five days a week, so guess what?
24:36
You're not supposed to be able to quit, you see.
24:39
That's what those counselors told me.
24:41
That was strange that I was, wasn't it?
24:43
So I mean, I guess what I'm saying is that I do probably
24:46
have a rather negative attitude about some of the
24:48
things I've been through as far as the
24:50
state program is concerned.
24:53
I don't know how I could explain that more,
24:55
or if you have any.
24:57
MILLER: Well, I think I've got it.
24:58
It sounds like your experience doesn't match what you were
25:01
being told.
25:02
MIKE: No.
25:03
MILLER: They are telling you this is how you are, and you
25:05
look at yourself and say, no.
25:07
MIKE: Yeah, That's not necessarily true.
25:09
And then there too you are supposed to say well I'm an
25:13
alcoholic and I've always had problems and I have to quit
25:16
and I can never drink again and this, that,
25:17
and everything else.
25:18
And you had to really say that, see.
25:20
Or else you weren't fitting in the role they
25:23
wanted you to play.
25:24
Without fitting in the role they wanted you to play you
25:27
could not get your license back.
25:28
So, you know, I played the game basically, and I went to
25:31
AA, and I also found that just to be a little bit on the, you
25:36
know, it didn't work for me.
25:37
It's bumper sticker therapy.
25:39
Fake it till you make it.
25:41
Wow, how profound.
25:43
Man, you guys are deep, you know.
25:46
MILLER: Alright.
25:47
MIKE: And you know, yes seriously, I've been there and
25:49
these guys didn't do anything all day, but they
25:52
didn't drink that day.
25:53
You know, I would rather, let's say, lift weights, maybe
25:57
build a patio, maybe program R base, and then drink instead
26:01
of just not drink and do nothing else.
26:03
I just, I found that you know, certain aspects of it I like,
26:10
but I think you have to have a deep seated religious belief
26:15
for it to work for you.
26:17
MILLER: Well, and it sounds like you want to have an
26:19
active life.
26:20
Not drinking is not doing something, it's doing nothing.
26:23
MIKE: Yeah, it's doing nothing.
26:24
MILLER: So, for you the question is what am
26:26
I going to be doing?
26:27
How do I spend my time' Playing soccer, and
26:30
MIKE: Yeah, That's good.
26:31
Actually I was thinking myself the way I can best quit
26:37
smoking is not by quitting smoking but playing soccer
26:40
three times a week.
26:41
Okay?
26:42
Now, I'm going for something, okay?
26:44
MILLER: That's right.
26:45
MIKE: And then all of a sudden I'm having a problem
26:46
breathing, okay?
26:48
So guess what?
26:49
You're gonna quit smoking.
26:50
You're not going to say I gotta quit smoking, you know.
26:53
But to me that doesn't work for me.
26:56
MILLER: It might even less than not work.
26:59
It might make it less likely.
27:01
MIKE: I think it's less likely.
27:02
I quit smoking before for about four months.
27:06
Then I blew out my knee, and you know, I went down to see
27:10
my brother, and boom, right back to it.
27:12
And you know, it's the same thing with drinking.
27:14
I think I was actually more, how shall I say, I seem to
27:20
have more of a craving when I was going through counseling.
27:24
MILLER: Right?
27:24
MIKE: Then when I wasn't, okay?
27:26
So, it's like okay, reverse effect.
27:28
Guys you really helped me a lot, you know.
27:31
MILLER: Well, I wonder if it isn't being told you can't or
27:34
like being in prison in a way.
27:36
MIKE: Yeah, it could be just immaturity on my part.
27:39
You know, if you tell me I can't do something, I'm going
27:40
to do something.
27:41
MILLER: Right.
27:42
MIKE: You know, maybe what they should say is you better
27:44
drink every day goddammit.
27:45
I want you to drink a fifth before noontime.
27:48
Then maybe I'd say "Screw you guys," you know.
27:51
I don't know.
27:51
Maybe there is something about my personality
27:54
that is like that.
27:55
So, you know, what shall I say?
27:58
One size doesn't fit all.
28:00
MILLER: Yeah, exactly.
28:02
MIKE: One size doesn't fit all.
28:03
MILLER: And for you what matters is having something
28:05
that you are going toward, not something you run away from.
28:08
MIKE: Right, right.
28:09
MILLER: And one of those things is soccer.
28:11
MIKE: Yeah.
28:11
MILLER: What else?
28:13
MIKE: Well, tennis.
28:14
How about backpacking.
28:16
You know, how about just waking up clear-headed.
28:19
MILLER: Yes, That's right.
28:21
MIKE: I mean, don't you think That's kind of...
28:23
MILLER: That's great.
28:23
MIKE: ...pleasurable, sometimes, you know?
28:26
MILLER: So just getting up in the morning and being able to
28:28
think clearly.
28:30
MIKE: Yeah but I'm telling you one thing right now.
28:32
You know, sometimes I won't drink four, five, six days.
28:35
If I smoke two packs of cigarettes, I
28:37
wake up with a hangover.
28:39
I thought it was the booze, but it isn't.
28:42
MILLER: Even without the booze.
28:43
MIKE: Oh, yeah.
28:44
It's carbon monoxide, man.
28:45
You got no oxygen in your system.
28:48
So.
28:48
I guess That's my real problem right now is the cigarettes.
28:54
MILLER: Uh huh.
28:55
MIKE: So.
28:55
MILLER: It sounds like you are not that worried
28:56
about alcohol really.
28:57
MIKE: No, it's bad, but it's not as bad.
28:59
MILLER: Not causing you problems
29:01
MIKE: Well, it is.
29:02
It will cause anyone problems.
29:04
MILLER: Hm, how so?
29:06
MIKE: Have a six-pack of beer, wake up, try
29:08
to program a computer.
29:09
MILLER: Okay.
29:10
MIKE: And so, have a six-pack of beer, wake up, find out how
29:13
alert you are for the first two hours of the day.
29:15
MILLER: Right.
29:16
MIKE: It's going to cause anyone problems.
29:18
You know, have a six-pack, have a twelve-pack, try to
29:21
play soccer the next day.
29:23
MILLER: Right.
29:23
MIKE: Okay.
29:23
It's
29:23
MILLER: It's amount and the after-effects of that.
29:27
MIKE: Right.
29:28
Right.
29:28
And I think my tolerance is up so high that it takes me too
29:31
much to get the same buzz, and unfortunately, the recovery,
29:37
it's getting to the point where it is just not worth it.
29:40
If I could get like a 12-pack high on three beers, then I
29:45
only have three ounces I've got to process.
29:47
If it's taking me 12 to get the same which I got three on,
29:51
now I got 12 to process you see.
29:53
MILLER: Yep.
29:54
MIKE: So we are at a balance point where we are getting
29:57
diminishing returns on ever expanding, how shall I say,
30:00
quantities.
30:02
MILLER: Like the slot machine doesn't
30:03
pay off so much anymore.
30:05
MIKE: Well, you know, it's addictions, so you're stupid,
30:07
so you keep on playing it, you know.
30:09
MILLER: It is amazing.
30:10
How long you keep going.
30:12
MIKE: Yeah.
30:13
MILLER: But you're, with alcohol, you are kind of
30:16
hitting a point where this isn't worth it anymore.
30:19
MIKE: Yeah, yeah.
30:20
But it is not because anybody is telling me from the
30:24
outside, because I'm being forced to do that.
30:27
It's just because I gotta wake up in the morning, and I know
30:32
how I feel.
30:33
Period, Okay?
30:34
And I think what has happened is before I used to drink all
30:39
the time, and I was always drinking.
30:42
And then I stopped and found out how good I felt, okay?
30:46
Now I have a compare and contrast whereas before I
30:49
never had a compare and contrast.
30:51
MILLER: Now you know.
30:51
MIKE: Now you know.
30:52
Now you know, hey wait, wasn't it a lot better when I was
30:54
clear headed then when I was, so, and to me then it does
30:59
become a problem because now at least you have something
31:01
you can you know, you can relate to.
31:04
You can say this is how I am without it.
31:06
This is how I am with it.
31:07
This is my performance without it.
31:08
This is my performance with it, you know.
31:11
MILLER: It's only when it's a problem for you, really, that
31:13
it matters.
31:13
MIKE: Right.
31:14
MILLER: If somebody else is telling you
31:16
MIKE: Yeah, it doesn't work.
31:18
MILLER: Or worse.
31:19
More likely you back away from it.
31:21
MIKE: Well, then why is the approach the opposite?
31:24
That's what I, I don't mean to be belligerent toward
31:27
addiction counseling, but I can't help but be.
31:29
Why, sometimes I wonder if these people didn't do more
31:33
bad than good
31:33
MILLER: It doesn't make any sense to me.
31:35
It's human nature to push against something when they
31:39
push against you.
31:40
MIKE: Well, I always heard in AA too, is the dumbest things
31:43
I ever heard.
31:44
Some of the comments I heard that were
31:46
just god awful stupid.
31:48
And these people were just complete idiots.
31:50
We alcoholics don't like to be told what to do.
31:54
I'm thinking wait.
31:55
We alcoholics.
31:56
What are you some special breed of people' No one likes
31:59
to be told what to do.
32:00
You know what, I really got tired of that kind of like
32:04
we're special because we have this disease or come feel
32:08
sorry for us because we have a disease.
32:10
And quite frankly, the more I read about alcoholism, no one
32:14
knows what the hell it is.
32:15
So I'm not going to say I am cause until there is a
32:18
definitive area that we can agree on, you know, I could
32:24
say alcohol dependent.
32:25
Now that makes sense.
32:25
It's a bit more clinical
32:26
MILLER: That you can understand.
32:28
MIKE: Yeah, That's understandable, but that's one
32:30
of the things I didn't like about AA is they
32:35
wore it like a badge.
32:37
It's nothing to be proud of, but it's nothing
32:40
to be ashamed of.
32:41
But you certainly don't do some reverse pride on it, and
32:44
you know, we're special because we're this.
32:47
We're different.
32:48
I didn't see any difference between those people and
32:50
normal people.
32:51
MILLER: It seems to work for some people, but that's not
32:53
going to help you.
32:54
MIKE: Well, who do you think it works for?
32:56
Apparently highly religious people who believe in higher
32:58
powers and miracles and some deity is going to come down
33:02
and save them anytime they have problems.
33:05
I'm not that type of person.
33:07
MILLER: That's not you.
33:09
And for you it has to be some reason that you see that
33:13
persuades you, okay, it's time.
33:16
MIKE: Yeah, a little bit.
33:18
MILLER: A little bit.
33:18
MIKE: A little bit more realistic, okay.
33:21
No nonsense, no bumper sticker stuff.
33:24
MILLER: And not being able to breathe on the soccer field is
33:26
no nonsense.
33:26
MIKE: I think that's kind of, I don't know if you can get
33:29
too much more guttural than that you know, and so that's
33:31
where it is.
33:33
MILLER: So, it's having something to pursue, having
33:35
something to live for really.
33:38
MIKE: Yeah, yeah.
33:39
That's it in a nutshell.
33:41
I've read a couple of books, and the one thing I really
33:44
enjoyed was the book Positive Addiction.
33:49
You know, having been a runner before, being cross-country, I
33:53
can see exactly how that worked.
33:54
Basically, this guy was saying what had happened is he was
33:58
under the suspicions that a lot of people running were
34:00
actually, had drinking problem and ran
34:03
themselves out of those.
34:04
Now I think that is actually true because after I run, I
34:10
have about this much desire to drink, and I have about that
34:13
much desire to smoke.
34:15
MILLER: Yeah.
34:16
MIKE: You got endomorphins, you feel good, you are alert.
34:19
MILLER: Yep, yep.
34:20
MIKE: Why would you want to pollute yourself, you know?
34:23
MILLER: Makes sense to me.
34:23
MIKE: So, That's my deal on that.
34:28
My read on who I am.
34:30
But am I committed?
34:31
No.
34:32
Total abstinence?
34:34
No.
34:34
Not at all.
34:35
MILLER: Oh, to total abstinence.
34:35
Okay.
34:36
Because I am hearing a lot of commitment in what you are
34:39
saying, that it's worth it to me to, in order to be able to
34:46
breathe on the soccer field...
34:47
MIKE: Right.
34:47
MILLER: ..to do something about cigarettes.
34:49
MIKE: Yeah.
34:49
MILLER: To quit smoking even.
34:50
MIKE: Yeah.
34:52
MILLER: So there I was hearing some commitment.
34:54
MIKE: Yeah, I think there is.
34:55
You see when I quit smoking, I quit drinking, too, you know.
34:58
MILLER: Is that right?
34:59
MIKE: Well, you have to.
35:00
Well, I mean at least I have to.
35:02
MILLER: Uh huh.
35:02
MIKE: Cause I can't like drink.
35:05
If I drink I'll have a cigarette.
35:07
MILLER: Okay, they are that tied together.
35:09
MIKE: Yeah.
35:09
MILLER: You do them together so many
35:11
MIKE: Well you
35:12
MILLER: tens of thousands of times.
35:13
MIKE: Yeah.
35:14
Well, even coffee.
35:15
You know coffee, cigarette, just association.
35:18
Yeah, I think like when you drink, you lose your judgment
35:21
and your willpower just goes down.
35:22
I don't know if you call it willpower.
35:23
I think its just judgment.
35:24
MILLER: Whatever it is.
35:25
MIKE: You are going ? "Oh a cigarette sure would taste
35:27
good now." Oh, yeah, okay.
35:28
MILLER: That happens with cocaine too.
35:32
I mean people, drinking is the most common reason why people
35:37
go back to using cocaine when they really wanted to stay
35:39
away from it.
35:40
MIKE: Oh, really?
35:40
MILLER: Yeah.
35:40
So That's exactly what you are talking about.
35:42
MIKE: There is such an association between the two?
35:45
MILLER: Well, whatever it is.
35:46
Or it just kind of dulls down your judgment.
35:49
MIKE: Yeah.
35:49
MILLER: Enough that you say, "Oh that would feel nice."
35:51
MIKE: Should I ask if you drink?
35:54
MILLER: I do.
35:54
Yes, I do.
35:55
MIKE: Well, you know how the judgment goes.
35:56
And let's face it, it goes.
35:58
It goes on everyone, you know.
36:00
They always say oh we alcoholics are different.
36:02
No, no, no, no.
36:03
You feed someone six beers and their judgment
36:06
is going to go down.
36:07
MILLER: It's going to have that effect.
36:08
MIKE: It's a physiological reaction to a toxic drug.
36:11
You know, let's face it.
36:12
MILLER: Yep.
36:13
MIKE: So, it is.
36:15
MILLER: So, you really would be talking about stopping
36:18
cigarettes and alcohol then.
36:20
MIKE: Well, yeah.
36:21
MILLER: In order to breathe.
36:21
MIKE: But I don't want to think about it.
36:23
Huh?
36:23
What's this?
36:24
MILLER: Oh.
36:24
MIKE: I don't want to think about that.
36:26
MILLER: Meaning you just want to do it and not think about
36:27
it, or you don't want to get serious?
36:28
MIKE: Well, I would rather do it and not think about it.
36:32
MILLER: Yep.
36:33
Not much point in thinking about it.
36:34
MIKE: Well, I mean, is there'
36:36
MILLER: No, no.
36:37
MIKE: Do I think about working out every day?
36:39
Do I think about brushing my teeth?
36:40
If I did I wouldn't want to brush my teeth.
36:42
I gotta brush my teeth tomorrow.
36:44
That's going to be pretty bad, you know that.
36:46
I gotta brush my teeth.
36:47
You know what I'm saying?
36:48
MILLER: I do.
36:48
MIKE: I think That's what happens when people do that,
36:52
and I see more procrastination because it is worse to think
36:55
about having to go to the gym and work out.
36:58
My god it's going to hurt and oh I'm going to do those curls
37:01
and my biceps are going to kill me and then I have to
37:04
wake up and brush my teeth.
37:06
I think that when you think about stuff like that, I think
37:09
it actually is more counterproductive than just
37:12
saying, oh screw it.
37:13
Just do it.
37:14
MILLER: Thinking about going to sleep.
37:16
MIKE: Yeah.
37:16
MILLER: As long as you are doing that you are not going
37:18
to be going to sleep.
37:18
MIKE: You're not going to sleep, no.
37:20
I hope that makes sense to you.
37:21
MILLER: Oh, it does.
37:22
No, it wasn't what I had meant by think about it, but I see
37:25
exactly what you mean, that if you are thinking about
37:29
something or like trying.
37:30
In other words if you are trying to do it, you
37:31
are not doing it.
37:32
You either do it or you don't do it.
37:34
But you don't try to do it.
37:36
You don't try to go to sleep.
37:37
You just go to sleep.
37:39
MIKE: You just go to sleep.
37:40
MILLER: So what would be great is if that was just natural.
37:43
You're not thinking about it.
37:45
It's just natural to do it.
37:46
MIKE: I mean, what do you think?
37:47
I'm thinking basically the thing I could best do it just
37:52
start running again and just start really
37:56
substituting habits.
37:57
I don't think, I think substitution of habit and
38:00
making habits so counterproductive or
38:03
contradictory I should say maybe which you just replace
38:09
one habit with another habit rather than just try to get
38:12
rid of one habit.
38:13
I think it kind of comes up to a vacuum state.
38:16
Now what do I do?
38:17
I got rid of this habit.
38:18
Now what do I replace it with?
38:19
You know, so
38:20
MILLER: Well, you are clearly telling me That's
38:22
what works for you.
38:23
That's what is going to do it.
38:24
MIKE: Well, That's what has done it in the past.
38:26
That's what's done it in the past.
38:28
Actually I got to join another soccer team.
38:30
I can play with even better people and that way I will
38:34
really get pissed off at myself, you know.
38:38
So.
38:39
MILLER: And That's what worked for you before'
38:42
MIKE: Mm hm.
38:42
MILLER: Good indication.
38:44
MIKE: Yeah.
38:44
Well, what hasn't worked for me is drug addiction
38:47
counselors, sorry to say.
38:49
MILLER: Yeah, yeah.
38:50
No your reaction to that was
38:52
MIKE: Well, you have to realize first off, most of the
38:55
people there, and I'm not trying to be apologist for
38:57
them, but in a way I am.
39:00
They were good people.
39:01
Most of the people there were forced to be there.
39:03
They weren't there on their own free will.
39:05
So, of course, they are going to be resistant.
39:09
And most of the people there, I mean you are basically, you
39:12
have to talk a certain way, behave a certain way, do
39:16
certain things so they think you are,
39:19
quote, whatever, rehabbed.
39:22
So you learn real quickly how to play the game.
39:24
What are you looking for?
39:25
Okay, what's this counselor looking for, or what's this
39:27
person want me to say?
39:28
Okay.
39:29
I'm supposed to feel this way about something because That's
39:31
the way she's been told that we define this addiction.
39:35
So what I'll do is I'll just play in her bullshit even
39:38
though it isn't true, and as long as I can do it in a
39:40
convincing way and fool her, boom, whappo, I got it, and I
39:43
got my license back.
39:44
And you know That's a game that I was playing the whole
39:47
time, and actually, I kind of lost respect for people
39:50
because they were so easy to fool.
39:52
All I did was I read the addiction counseling books.
39:55
I found out what they are looking for, what the traits
39:57
were
39:58
MILLER: Played the game.
39:58
MIKE: Played the game.
39:59
Found out, you know, what they wanted to hear.
40:02
And to me That's really counterproductive.
40:06
It, if anything, it's a waste of time, and it might even be
40:10
more harmful than it is helpful.
40:12
MILLER: It sounds like it was for you.
40:14
MIKE: Yeah.
40:15
Does anyone quit anything if they are not committed to it?
40:20
MILLER: My own sense is it's that internal reason that
40:22
really makes the difference.
40:23
When instead of there being somebody out there
40:26
MIKE: External.
40:27
MILLER: telling you, what's telling you is something
40:29
inside of you.
40:30
Your lungs or whatever it is.
40:31
MIKE: I think this time it's my body.
40:33
MILLER: Hey, yeah right.
40:35
MIKE: My brain is saying hey, I'm stupid, but your liver
40:38
doesn't like you too much.
40:40
Your lungs are a little pissed, you know?
40:42
MILLER: Yeah.
40:42
MIKE: So.
40:43
MILLER: So, what gets in the way of your
40:45
sticking with that?
40:46
What gets in the way of running?
40:48
MIKE: You know, I don't know.
40:49
I think it may be a fear of failure.
40:51
I really do.
40:53
Could be that.
40:54
Could be just the amount of effort.
40:56
Like I say it's been going down, going down, going down,
41:00
but I seem to really have a problem totally committing to
41:03
just okay this is the year man.
41:04
Let's do it.
41:05
MILLER: Yeah, well because it is pretty total.
41:08
I mean, that was what I was picking up earlier.
41:11
At least the way you are thinking about it.
41:13
It means stopping cigarettes and stopping drinking.
41:17
MIKE: Well, you know, it used to be a fear of withdrawal
41:18
with drinking, and when I quit I found out
41:21
MILLER: It's not a big deal.
41:22
MIKE: It's not.
41:23
And That's another thing.
41:25
Don't tell people about DT?s because quite frankly that
41:27
doesn't happen all that often.
41:29
MILLER: It's pretty rare.
41:30
MIKE: I mean, what do you get?
41:31
You get maybe higher energy level and That's it.
41:34
And you feel better, okay?
41:36
I mean, whoa, you are going to get DT?s, you are going to go
41:39
through withdrawal.
41:39
Oh, you are going to have to have doctor?s supervision.
41:41
By telling someone that you are just scaring
41:43
the fuck out of them.
41:44
You know?
41:45
Excuse my French, but that's what you do.
41:47
MILLER: That is something that happens to some people
41:48
but not very many.
41:49
MIKE: Yeah.
41:50
Yeah.
41:51
But I'm really worried about the smoking because I remember
41:53
last time I got just violent.
41:55
I mean I was bad to be around for five days.
41:57
I mean really bad.
41:59
I mean I was just blowing up on everything.
42:01
Every little thing I was just, everything was
42:04
just ticking me off.
42:05
And then after five days I was pretty cool, and after two
42:08
weeks I was real cool.
42:09
And I was kind of, yeah, but I'm thinking my god, what if a
42:13
client calls me up.
42:14
What am I going to do?
42:16
MILLER: Like five days in a mountain hut somewhere.
42:18
MIKE: Oh well, you think a kayak trip?
42:22
Just throw me for five days out in a kayak.
42:25
MILLER: That's a nice idea.
42:26
MIKE: No cigarettes, no booze.
42:28
MILLER: Yeah, the Grand Canyon or something.
42:29
MIKE: Well, you see, that would be very good.
42:31
MILLER: It would.
42:32
MIKE: I mean That's what I was thinking of doing.
42:34
MILLER: Something physical.
42:34
MIKE: Yeah.
42:35
Do something like that.
42:37
MILLER: You're committed.
42:39
MIKE: Backpacking.
42:39
100 miles from nowhere.
42:41
And maybe I could reward myself with a cigarette by the
42:45
time I get there.
42:46
By the time I get there it will be ten days and
42:48
I won't want one.
42:50
MILLER: Well, and the trip itself for you sounds like it
42:53
would be a reward.
42:53
MIKE: Oh yeah.
42:54
MILLER: Doing it would be fun.
42:55
MIKE: Yeah.
42:57
MILLER: So it might be a way to get
42:57
through those five days.
42:59
MIKE: Yeah.
43:00
Yeah, like I say, I'm, how shall I say?
43:05
I'm teetering on the edge where you know I've cut down,
43:10
I've cut down, I know how it feels to at least not drink
43:13
that much, but now I'm finding out, hey, it's not the
43:16
drinking That's giving me the hangover.
43:18
It's the cigarettes.
43:19
MILLER: Mm hm.
43:20
MIKE: And the drinking only compounds it because when I
43:22
drink I smoke like a son of a bitch.
43:24
And one of the things is I think I'm cutting down on my
43:26
drinking, not because I'm trying to cut down on my
43:28
drinking, but because I don't want to smoke that many
43:30
cigarettes which is weird, and you're not
43:32
supposed to be that way.
43:33
Not by the definition of drug addiction.
43:36
MILLER: Well, you are breaking all the rules.
43:37
MIKE: Yeah, I know.
43:38
But I mean, I wish they wouldn't tell me rules there.
43:41
If they are not sure, I don't want to hear them.
43:43
MILLER: Uh huh.
43:44
MIKE: You know, I mean it's like I think a lot of this
43:47
crap is self-fulfilling prophecy.
43:48
You have given people false information and they are
43:52
taking this false information to heart because these experts
43:55
in the field, so called experts, and it's really funny
43:57
how many different variations of the definition of
44:00
alcoholism we have.
44:02
All of them almost contradictory.
44:05
You get some poor slob That's going to say well so- and- so
44:08
says this, and they've been a leader in their field for the
44:11
last 20 years.
44:12
So, therefore, because they say this, I
44:16
have to be this way.
44:17
And instead of defining themselves as individuals,
44:20
they go into the stupid pattern or whatever type of
44:24
behavior that is supposed to be attached to them, and they
44:26
assume that behavior is theirs.
44:28
And that's why I don't like, it's not, it doesn't work.
44:32
And I don't think it ever will.
44:34
I mean, do you agree with me, or am I...
44:39
MILLER: Well, you know more about
44:40
you than I do, obviously.
44:41
MIKE: Well, That's the whole thing.
44:42
MILLER: I believe you.
44:43
MIKE: Yeah, but I mean how many people have you counseled
44:45
in your lifetime' I mean you?ve had to see certain
44:48
things works for certain people and certain things work
44:50
for other people, and it's not going to be one size fits all.
44:54
MILLER: No it isn't.
44:55
MIKE: It just, it's not there.
44:57
MILLER: I've worked with people who have done really
44:58
well in AA.
44:59
And I've worked with a lot of people who have said, "Ah,
45:01
it's not for me.
45:02
That's not my cup of tea."
45:03
MIKE: And I'm not trashing them.
45:04
I mean if it works for you, fine.
45:06
MILLER: There you go.
45:07
MIKE: If it works for you that's fine.
45:08
And I've seen it help a lot of people, and I know the type of
45:11
person it is going to work for.
45:12
It is not going to work for me.
45:14
MILLER: Now, tell me about this
45:14
teetering on the edge business.
45:17
MIKE: Don't know.
45:17
I think it's, like I said, I think it's fear of failure.
45:19
I think on my part it's a fear of failure, and it's also the
45:22
fear of withdrawal, especially from nicotine.
45:24
Because I know how I get.
45:28
MILLER: Mm hm.
45:30
MIKE: And I'm committed and then I'm not.
45:32
It's this ambivalent feeling.
45:33
MILLER: Yeah.
45:34
MIKE: And I can't seem to, you know, and
45:38
that's where I'm stuck.
45:39
That's where I'm stuck.
45:41
I'm stuck in that ambivalence which I guess is a
45:46
good thing in a way.
45:47
I mean, it's better than just being not committed at all.
45:49
MILLER: Well, That's exactly right.
45:50
It's a step forward.
45:51
MIKE: Yeah, it's a step forward, but it's still
45:53
MILLER: Becoming ambivalent is the first step toward change.
45:55
MIKE: Yeah, but let's face it, That's cognitive dissonance.
45:58
The ambivalence I really want to get over it, but I can't
46:01
seem to, I can't seem to just say okay, today's the day.
46:05
This is it.
46:06
MILLER: Right.
46:07
MIKE: So maybe, I don't know.
46:09
See I don't know even what to do, quite frankly
46:14
MILLER: Well, you mentioned a couple of things.
46:16
MIKE: Yeah, see I'm thinking I could cut down slowly.
46:19
See, look it, if I quit cigarettes,
46:23
drink is going to go.
46:24
It's going to have to go.
46:25
MILLER: Mmm hmm.
46:26
MIKE: Okay, so then That's it.
46:27
That's out.
46:27
Now that I know isn't that hard.
46:30
MILLER: Right.
46:30
You've done that.
46:31
MIKE: Yes, but the nicotine, ooooh, That's a scary thing
46:34
for me, man.
46:35
MILLER: And you've done that before also.
46:37
Yes?
46:38
MIKE: Playing.
46:39
Yeah, I was playing around.
46:40
I was playing two games a week.
46:42
MILLER: Okay.
46:44
MIKE: Now I would have to start running every day, an
46:47
hour a day five days a week.
46:49
I would have to gradually cut down, okay?
46:52
And then I would have to set a date, and I guess go on the
46:55
patch, and I would have to stay away from anyone that
46:59
wants to have a beer with me, because if I
47:02
have one beer, boom.
47:03
Right back to smoking.
47:04
Now I'm telling you what happened with smoking.
47:07
What was it, four months?
47:09
Whatever it was, blow out the knee.
47:11
As soon as I started again, now this is, as soon as I
47:14
started again, I was back up to two packs within a day.
47:19
MILLER: That's scary isn't it?
47:20
MIKE: Within a day.
47:21
It wasn't like this gradual, "Oh I'll just have one." It
47:25
was just like boom, and I was just right back in there, and
47:29
then I feel the lungs quit on me, yeah I
47:31
guess a fear of failure.
47:32
I don't know.
47:33
Maybe it was fear.
47:33
I don't know what it is.
47:34
Maybe it's fear of failure.
47:35
I don't know.
47:36
MILLER: How confident are you that you can do it?
47:38
MIKE: That's the problem.
47:39
I don't know.
47:40
MILLER: You're not sure.
47:41
MIKE: I'm not too sure.
47:42
I'm really not too sure.
47:45
MILLER: It's not so much the wanting to do it as, "I don't
47:48
know if I could if I make the decision."
47:49
MIKE: Right, right, right.
47:50
MILLER: Mm, okay.
47:52
MIKE: It's confidence probably.
47:54
MILLER: Well, and That's what would help.
47:55
Something that you could really be confident in.
47:59
Like the way you lit up when we talked about the Grand
48:02
Canyon or something.
48:03
Like I could get through five days that way.
48:05
I could do that.
48:07
MIKE: Am I supposed to spend maybe a year out there?
48:10
MILLER: No, I'm just using that example.
48:12
MIKE: Wait a second, if I made a lot of money, that would be
48:15
a good
48:16
MILLER: How long would it be' Well, the first five days you
48:18
said are the tough ones.
48:19
MIKE: Yeah, the first five are tough.
48:21
But really what it is, what basically what it really is
48:23
just not hanging around Chris because Chris will come over
48:26
and he'll want a beer.
48:27
I don't care if he has a beer, but if I have a beer, boom.
48:30
I'm going to light up.
48:30
I'm going to have to stay away from Bogden.
48:33
That's another guy on my soccer team.
48:35
It would have to be like really staying away from a lot
48:38
of people I know.
48:40
You know, maybe I'm just making excuses for myself.
48:42
I don't know.
48:43
I don't know.
48:43
But I would have to do that, and then I would really, I
48:48
would have to watch myself and not let myself talk to any
48:51
clients for five days.
48:52
Because I know how I get.
48:54
MILLER: Oh that five day period.
48:55
Yeah.
48:55
MIKE: Yeah, I don't know.
48:57
I don't know.
48:57
I'm still ambivalent.
48:59
MILLER: Well, that clearly is where you are.
49:01
And you are right that That's a normal
49:03
place people pass through.
49:04
You are saying, "Well let's get through," you know.
49:06
MIKE: I still want to
49:07
MILLER: It's an unpleasant place to be.
49:09
MIKE: Yeah.
49:09
MILLER: You either want to go back to not being able to
49:11
MIKE: Which is more comfortable.
49:12
Let's face it.
49:13
Which is more comfortable.
49:14
And I'll tell you that right now.
49:15
That's a hell of a lot more comfortable saying, "Ah, I'm
49:17
not going to quit smoking." That's more comfortable.
49:20
MILLER: Either side is more comfortable.
49:21
MIKE: Either side is more comfortable than the
49:22
ambivalence.
49:23
The ambivalence is the hell.
49:25
MILLER: It is.
49:25
MIKE: That's the hell.
49:26
Okay, cause well I know I shouldn't but I will and I
49:29
don't know if I should.
49:30
Here's what it is.
49:32
It's knowing that you are taking a carcinogen, a known
49:34
carcinogen, and you are putting it in your lungs.
49:36
You know that it's upping your blood pressure.
49:38
You know it is increasing your chance of lung cancer.
49:40
You know it's really screwing up your soccer.
49:42
It's that, it's doing that is pissing me off.
49:46
It's knowing that you are taking a poison, a poison
49:48
called alcohol.
49:49
You know the second drink your judgment is
49:51
going to go to hell.
49:53
And why am I doing this?
49:54
Let's just bang that head against that brick wall some
49:57
more too please.
49:59
And That's what pisses me off.
50:00
I mean if I was stupid, I could forgive myself for it.
50:04
If I define myself as an addict, you know, and I think
50:08
a lot of people do, then they can forgive themselves for it.
50:11
But that's, no.
50:14
MILLER: That is not a way out of you.
50:15
MIKE: No.
50:15
That out doesn't work.
50:17
That's a cop-out.
50:18
I mean, and see I wish I was stupid and I could just say,
50:24
didn't know any better.
50:25
MILLER: And you could sit back here and
50:27
MIKE: Yeah.
50:28
MILLER: be comfortable.
50:29
MIKE: Yeah, right.
50:30
MILLER: Now the place where you are is real uncomfortable.
50:33
MIKE: Yeah.
50:33
MILLER: And moving either way from it is more comfortable.
50:35
MIKE: Of course.
50:35
Of course.
50:36
Moving up or back.
50:39
MILLER: But staying in the ambivalence, because you are
50:40
conscious of it, you are conscious of taking in the
50:43
poison or the carcinogen or whatever it is
50:44
MIKE: That's the problem.
50:46
MILLER: Boy.
50:47
MIKE: That is, what are you doing this for?
50:50
You know, what are you doing this for?
50:52
And
50:53
MILLER: And That's the teetering then. "Which way am
50:55
I going to move off of this"
50:55
MIKE: Right.
50:56
MILLER: "because I don't want to stay here."
50:57
MIKE: And not only that.
50:58
You know the guys at soccer they always kill me. "Hey, you
51:03
smoking again" Oh yeah.
51:05
You're stupid, man?
51:06
So I got a little peer pressure going there.
51:08
MILLER: So they are not all pulling you into
51:10
drinking and smoking?
51:10
MIKE: Oh, no, no.
51:11
They wouldn't, well it all depends.
51:14
This is the Polish soccer team.
51:19
Most of these guys are right off the boat, okay?
51:21
And they do drink a lot, so
51:24
MILLER: They just give you a hard time about smoking?
51:25
MIKE: Right, and they don't smoke.
51:27
MILLER: Oh, okay.
51:28
MIKE: And I say, "Well listen, you know, hey, if you want me
51:31
to quit smoking, I'm going to have to quit drinking." "Oh no
51:34
you could." "No," I says, "I can't." It doesn't work that
51:37
way for me.
51:38
And then having never done it they don't know.
51:40
So I'm going to have to like, if I do this, I'm going to
51:43
have to stay away from them at least long enough to establish
51:46
some type of
51:47
MILLER: There you go.
51:49
People who make it through change usually do it, I mean
51:52
you've got it.
51:53
Usually do what you are saying which is for a while avoid the
51:58
valley of the shadow of death, you know.
52:00
I mean avoid the difficult place.
52:02
And then it gets more okay. you've got to not rush too
52:05
quick back in there, but it gets to be okay.
52:07
You don't then have to stay away
52:09
MIKE: Forever.
52:10
MILLER: Right.
52:10
So it's not forever and ever.
52:12
But for a while you are probably right.
52:13
MIKE: Yeah.
52:14
MILLER: Or, somehow, get them to, say, "Help me out guys." I
52:17
mean, if they won't do it, then you are right.
52:20
MIKE: No, it's not like they are bad guys.
52:22
They just don't know.
52:23
See, they're not
52:25
MILLER: Haven't done it.
52:26
MIKE: You know, they don't know.
52:29
I mean I think if you don't smoke, you don't smoke
52:34
cigarettes, you don't know.
52:35
You're not going to know.
52:37
And how could they possibly help it?
52:40
MILLER: Well, I only meant that if they could get it in
52:44
their heads that what you are saying is right
52:45
MIKE: Yeah, right.
52:46
MILLER: That if they want to help you stop smoking, they've
52:48
gotta also not encourage you to drink.
52:51
MIKE: Don't come over with the 12-pack and want something.
52:54
MILLER: Yeah.
52:55
MIKE: You know, come on.
52:56
MILLER: So if you could ask them to do that, help you out
52:58
that much, then
52:59
MIKE: They're guys.
52:59
They're guys.
53:00
MILLER: They won't
53:01
MIKE: These are guys, okay?
53:02
They're guys.
53:03
I'm single you see.
53:04
If I was married I could blame it on my wife.
53:06
In fact, I'm thinking of getting married,
53:09
well I'm just kidding.
53:10
But I'm thinking of a rent-a-wife situation.
53:13
See you rent a wife and you tell all your guy friends,
53:15
"Hey, I'm a married man.
53:17
My wife will kill me if you guys come over." Then you get
53:19
to get then the hell out of your place.
53:21
If you are a bachelor, they're trying to get away from their
53:23
wives, guess who they come over and hang around with?
53:25
You.
53:26
MILLER: Yep.
53:26
MIKE: And guess what.
53:27
That excuse doesn't work.
53:28
The only thing they understand is some bitchy lady with a
53:32
skirt, okay?
53:34
MILLER: That would work.
53:34
MIKE: And then you could clear them out of the place.
53:36
Otherwise, you can't clear them out, man.
53:38
See, then you have no excuse but to do what
53:41
they want to do.
53:41
MILLER: Yeah.
53:42
MIKE: That's the way guys are.
53:44
At least the guys I know are that way.
53:46
MILLER: So, you are right.
53:46
You would have to stay away from them for a while.
53:48
MIKE: Right.
53:48
Right.
53:49
I hope I'm not babbling here.
53:51
MILLER: No, no.
53:51
MIKE: I seem to be all over the place here.
53:53
MILLER: I mean you are giving me a real good
53:55
sense of who you are.
53:56
MIKE: Yeah.
53:56
MILLER: I mean I love to read a book to the end, and I'd
53:58
love to know which way you are going to go from this place.
54:00
MIKE: I would like to know myself.
54:01
I don't even know.
54:02
You know, I don't even know.
54:07
Like I say, I'm still at the ambivalent stage, and it's
54:11
getting to the point where I'm going to have to make
54:14
MILLER: It's too uncomfortable.
54:16
MIKE: Well, yeah.
54:16
But what do you want to go back?
54:18
I mean, where's back?
54:19
Where's back going to take you?
54:21
MILLER: Yeah.
54:22
You know.
54:23
MIKE: Yeah.
54:24
Yeah.
54:25
MILLER: But it's that "Can I do it?" obstacle.
54:27
MIKE: Well, that's, it's a confidence problems.
54:30
MILLER: So something that would
54:31
help you be more confident.
54:32
MIKE: Yeah, well, yeah, yeah.
54:36
MILLER: To be able to look at it and say, "I could do that.
54:39
I can see myself doing that."
54:41
MIKE: Well, yeah, but what's that going to do?
54:43
MILLER: I'm not sure.
54:45
MIKE: It's going to have to be internal if it's
54:46
going to work for me.
54:47
MILLER: Mm hm.
54:47
MIKE: It can't be anything external.
54:49
I can't deal with cheerleaders.
54:51
I can't deal with, Oh you can do, it you can do it.
54:56
Hey, come on.
54:56
I'm a little too old for that.
54:58
MILLER: There is certainly nobody pushing you.
55:00
MIKE: Well, you know, I'm going to have to figure out
55:02
that I can do it myself or just not going to
55:05
be able to get done.
55:06
And That's just, the long and the short of it is That's what
55:08
it's really going to take.
55:09
MILLER: That's the bottom line.
55:10
MIKE: Yeah.
55:10
I mean for a person like me, that is the bottom line.
55:13
And it has to be important enough.
55:16
But I think it is important enough now or else I wouldn't
55:19
be thinking about this in the first place.
55:20
MILLER: That's how it sounds.
55:23
MIKE: You know, as far as I'm concerned, I don't care if I
55:25
die tomorrow.
55:26
This is not about my health.
55:28
MILLER: Mm hm.
55:30
MIKE: Boy I can't stand, if I'm not the fastest guy out
55:33
there, I have an identity crisis, okay?
55:36
It's my arrogance, okay?
55:38
It's my conceit.
55:40
It's my pride, okay?
55:42
So I am using all the negative stuff you're never supposed to
55:45
have in AA to help me
55:47
MILLER: Challenge.
55:47
That's what will get you through.
55:51
Sheer cussedness.
55:52
MIKE: Yeah just sheer, you know, if anything, arrogance.
55:58
If anything, probably That's all it is.
56:00
And it really has nothing to do with health.
56:02
It really doesn't.
56:03
I mean I hate to admit it, but as far as longevity and life,
56:07
I don't really care about it.
56:09
High quality of life' Well, everyone dies.
56:11
Everyone makes such a big goddam deal out of it.
56:13
I'm so goddam tired of these people who, "Oh I eat these
56:16
healthy food, and I do this, and I know go out in the sun,"
56:19
and yeah, yeah, you're 400 pounds overweight,
56:21
you don't work out.
56:22
You know, don't give me this live forever, but live what?
56:26
MILLER: We're all going to die anyhow.
56:27
MIKE: We're all going to die anyhow.
56:28
What are you going to do?
56:28
Just never go out in the sun?
56:30
MILLER: But while you are here, you want to be the best.
56:32
MIKE: Well, you know, it would kind of be nice to wake up,
56:34
you know, and feel healthy and be able to do
56:37
what you like to do.
56:38
MILLER: It is.
56:40
MIKE: Uh, well, yeah, if you could do what you like to do
56:42
forever, hey.
56:43
I would like to do that.
56:44
But I know That's not going to happen, and I accept that, and
56:47
to me it's not so much a longevity issue as it is a
56:51
quality of life issue.
56:52
And so That's the deal.
56:56
MILLER: You know the funny thing is it sounds to me like
56:57
you have made up your mind.
56:59
MIKE: Possibly.
57:00
MILLER: Maybe.
57:01
MIKE: Yeah.
57:01
I think I'm swaying.
57:03
MILLER: Leaning just a little.
57:04
MIKE: Swaying.
57:05
I hope it's not a pendulum, you know.
57:08
MILLER: I don't know though.
57:09
It's kind of back there.
57:10
MIKE: Yeah, back there is more comfortable.
57:11
At least it's known.
57:12
It's known.
57:13
See That's
57:14
MILLER: It's predictable.
57:14
MIKE: That's all it is.
57:15
It's known.
57:15
MILLER: It is predictable.
57:16
MIKE: That's all it is.
57:18
It's known.
57:21
Yeah, someone told me and it made a lot of sense.
57:23
Bang your head against a brick wall, you start to miss that
57:27
brick wall when you quit banging your head against it.
57:29
You know, I think That's what everything is.
57:33
Not just smoking, not just drinking, not just doing
57:35
whatever, cocaine or anything else, but everything else.
57:37
I think bad relationships are like that.
57:39
MILLER: Mmm, hmm.
57:41
MIKE: I think bad jobs are like that.
57:42
I think living in bad areas of town are like that.
57:45
I think, it's familiar.
57:47
Because it is familiar it is predictable.
57:49
MILLER: Right.
57:50
MIKE: You are comfortable with it.
57:51
It's not that terrible change, you know,
57:54
That's a scary thing.
57:56
And you know, maybe That's what it is.
57:57
So.
57:58
MILLER: What if you stopped smoking and drinking and you
58:00
still couldn't keep up with the young guys?
58:02
MIKE: Oh, I don't think that is going to be a problem.
58:04
MILLER: That's alright.
58:06
MIKE: I already can.
58:07
That's the thing.
58:10
It's just that you know I'm getting older, and this is not
58:14
going to last forever.
58:15
I put a lot in a bank account.
58:16
I had a scholarship, marathon scholarship, when I went to
58:20
college which I didn't take.
58:21
Ran a 4:32 mile, always been fast.
58:23
MILLER: Really.
58:24
MIKE: But I always had, the way I'm looking at it, I
58:26
always had a bank account, and I put a lot in that bank
58:28
account, that cardiovascular bank account.
58:30
Well, I've been drawing off that bank
58:31
account for a long time.
58:33
Now it's just about
58:35
MILLER: Balance is getting low.
58:36
MIKE: Balance is getting low.
58:37
So I have to kind of start filling it up again.
58:39
And
58:41
MILLER: That's a nice image.
58:42
MIKE: Well, I think That's exactly what's going on.
58:44
MILLER: That works.
58:46
MIKE: You can only do this stuff so long before you are
58:48
going to start feeling the effects.
58:49
I'm starting to feel the effects.
58:51
Maybe I always was but I was too stupid to realize it.
58:54
I'm not too sure.
58:55
MILLER: You don't want to go into debt.
58:57
MIKE: No.
58:57
I don't want to go into debt.
58:59
MILLER: Makes sense to me.
59:00
Well, I'd love to know how the story comes out.
59:02
I see that we are running out of the allotted time for this
59:05
filming session.
59:06
MIKE: Well, should we do a follow up?
59:08
MILLER: I'd like to know.
59:09
MIKE: You know, I tell you.
59:10
If I do this, it's not going to be for two to
59:13
three weeks, you know.
59:15
Everyone says, "Oh do it tomorrow." You know what?
59:18
No.
59:19
MILLER: You are going to set a date out there somewhere.
59:21
MIKE: Well, yeah.
59:22
MILLER: Not tomorrow.
59:23
MIKE: Not tomorrow.
59:24
Not tomorrow.
59:25
Not today, not right now.
59:27
I mean, you know, I'm just not going to do that you know.
59:32
It's going to be, here's what happens to me.
59:37
When I start doing shit That's contradictory to bad habits,
59:41
the bad habits start disappearing almost naturally.
59:45
And I start getting a roll.
59:47
MILLER: Beautiful.
59:47
MIKE: And then I start getting to the point where I want to
59:50
continue this good habit.
59:51
Bad habits, I'm not really thinking about.
59:52
They are starting to go away.
59:54
So I want to kind of like steamroll this turkey, and
59:57
then as soon as I got that steamroll thing going and I
01:00:01
got this thing on the run, it's okay baby, and now we're
01:00:05
going to get you.
01:00:06
Now you are vulnerable.
01:00:08
Now you're going to die.
01:00:09
That's
01:00:10
MILLER: That's the plan that works for you.
01:00:11
MIKE: Yeah.
01:00:13
MILLER: Good.
01:00:13
MIKE: Does that work for other people or am I strange'
01:00:16
MILLER: No, people are real different in terms of the way
01:00:19
they find, and it's kind of your personality and what
01:00:23
grabs you and what's the thing that finally tips
01:00:25
the seesaw for you.
01:00:26
MIKE: I was told, "That doesn't work." I was told,
01:00:29
"Well no, no.
01:00:29
One size fits all.
01:00:31
This is how we have to do this.
01:00:32
This is the only way we do it." You know, that's what I
01:00:34
was always told.
01:00:35
It made no sense to me, and I just really lost respect for,
01:00:39
you know, anyone in the industry because, do you have
01:00:43
any intuition?
01:00:44
Do you ever listen to your clients?
01:00:46
Have you ever thought that there could be something
01:00:48
called individuals out there?
01:00:50
Hey, bell shaped curve, guys.
01:00:52
Hey, you know what it is?
01:00:53
Guess what different IQ levels,
01:00:55
different personality traits.
01:00:57
Guess what.
01:00:57
MILLER: People know something about themselves.
01:00:58
MIKE: Yeah.
01:00:59
MILLER: Mmm hmm.
01:00:59
Yeah.
01:01:00
MIKE: So, but I never got that far.
01:01:02
Of course, like I said, it was state run.
01:01:04
It was a little bit different, so.
01:01:08
MILLER: Well, I wish you well.
01:01:09
I'd like to know how the story comes out.
01:01:14
CARLSON: Bill, was your work with Mike a good example of
01:01:16
Motivational Interviewing?
01:01:18
MILLER: It was, yeah.
01:01:19
He offered some unique challenges, I think, and gave
01:01:23
me a chance to really settle into the style, and I felt
01:01:27
pretty good about that interview.
01:01:29
How do you know in a case like that that you're not being
01:01:32
conned or you're not being deceived by someone' Well, you
01:01:35
don't, of course.
01:01:37
I tend to go with the person rather than
01:01:40
pushing against them.
01:01:42
And you get more honesty when you do that, as it turns out.
01:01:46
I wasn't particularly concerned about dishonesty in
01:01:49
this case but I often will acknowledge to the person that
01:01:52
they can deceive me if they choose and not much I can do
01:01:58
about that.
01:01:58
And that very acknowledgment somehow decreases the need and
01:02:04
desire to do that.
01:02:06
But l really liked this guy and it felt
01:02:09
very genuine to me.
01:02:10
He was talking exactly about where he is, in that stuck
01:02:14
place and in that contemplation stage of ''Do I
01:02:19
go forward or back now?''
01:02:20
CARLSON: And he really liked you too.
01:02:22
After the session was over, I noticed he
01:02:25
didn't want to leave.
01:02:26
He wanted to keep talking with you.
01:02:28
MILLER: Yeah, we were chatting out in the hall.
01:02:30
And he wanted some ideas and things.
01:02:33
It seemed like he wanted some action steps,
01:02:36
where he might go next.
01:02:38
Yeah, and I think he'll be taking them.
01:02:40
CARLSON: Where would you go if you were to meet him again?
01:02:43
Where do you think the story's going to end?
01:02:47
MILLER: I think he's headed for making a change.
01:02:50
And the first thing I would do, of course, is check in on
01:02:54
where he is.
01:02:55
Sometimes people get the sense that once you've cracked this
01:02:59
motivation thing then you just get right to business and you
01:03:02
change them.
01:03:03
But the ambivalence continues throughout the process of
01:03:07
treatment and change, and so it may very well be that when
01:03:12
he comes back in, even if he may have gone a few days
01:03:16
without drinking or something, trying it out, he's still
01:03:19
going to remember the old days and have some ambivalence.
01:03:22
And so I would deal with that.
01:03:24
But I would start checking out whether he'd like some ideas
01:03:28
about other things to try.
01:03:30
This guy probably won't need them.
01:03:32
He's got lots of good ideas.
01:03:34
And usually the ideas that the client comes up with are
01:03:37
better than the ones I would come up with.
01:03:38
But if he wants suggestions, I could certainly make some.
01:03:41
I noticed, too, that there were several times when he was
01:03:46
convincing you that he needed to make a change-like he was
01:03:50
the one that said, ''Try drinking a six-pack and then
01:03:54
program a computer.'' He was the one that said, ''Well, if
01:03:59
I'm going to quit smoking I'm really going to have to
01:04:07
drinking, too.'' Right.
01:04:08
Now, is that something that's pretty typical?
01:04:11
LEWIS: Did you ask him something to put him in the
01:04:13
position of convincing you that he had a problem?
01:04:16
MILLER: Well, it's an interaction.
01:04:18
We're dancing together.
01:04:20
In fact, when we're looking at videotapes of therapists, one
01:04:24
of the scales we use is the dancing-wrestling scale.
01:04:27
Are these two people dancing with each other, or are they
01:04:29
wrestling with each other?
01:04:30
And we were dancing.
01:04:32
It had that sense of moving with him.
01:04:35
So I think I had something to do with the fact that we wound
01:04:39
up there and it certainly is where I want to be.
01:04:43
I want the person telling me about change rather than me
01:04:47
being the authority and telling them about change.
01:04:50
But that also has very much to do with his willingness in the
01:04:52
place he is to be ready to move.
01:04:55
So in a sense I just made it possible for him to move in
01:04:59
the direction that he was already headed anyhow.
01:05:02
You can't trick people into changing.
01:05:04
LEWIS: Although you did reflect or summarize positive
01:05:07
statements that he made statements that were oriented
01:05:11
toward change rather than against it.
01:05:14
I know there are a lot of places where he had ambivalent
01:05:18
statements that he made and the one that you picked up on
01:05:21
was the positive one.
01:05:23
MILLER: Right.
01:05:23
And that's a good example.
01:05:25
My role in that is to accentuate the positive.
01:05:30
But they're his words.
01:05:31
So he says it, and I reflect it.
01:05:35
He hears me say that he says it.
01:05:36
And I'll come back later, maybe, and summarize with it a
01:05:39
little bit too, or reflect it again.
01:05:42
But they're his words to begin with.
01:05:44
And it's that kind of process that seems to trigger change.
01:05:49
CARLSON: I like when he said, ''I can't change for at least
01:05:53
two or three weeks,'' which seemed to me to be quite
01:05:57
optimistic.
01:05:57
I would have been inclined, though, to say, ''Well, how
01:06:00
will that work?
01:06:00
How will you do that?'' And yet you resisted.
01:06:02
You kind of let back and let him just accept that fact.
01:06:07
''You've got time in the future that you'll do this.''
01:06:10
MILLER: Yeah.
01:06:10
It would be fine to say, ''Tell me what that will look
01:06:13
like,'' too, or, ''How would you do that?'
01:06:15
Nothing wrong with that.
01:06:16
I didn't know whether that would be pursuing too much,
01:06:19
because it seems like the more you pursue, the more they
01:06:21
distance, and when you stop pursuing they seem to move
01:06:24
toward you.
01:06:25
Well, the nice thing is that your clients
01:06:27
teach you this style.
01:06:28
That's where I learned it in the first place.
01:06:30
So if you're pursuing too much you find out right away.
01:06:35
You can judge whether you're doing the right thing by what
01:06:38
the client's doing.
01:06:39
You get immediate feedback.
01:06:41
So if the client is moving toward change, is talking
01:06:45
about how they might change or envisioning how it might be,
01:06:50
or the costs of the way it's been before you're doing fine.
01:06:53
All you have to do is agree.
01:06:54
You're on coast at that point.
01:06:56
But if you try something like that and the client suddenly
01:07:01
backs off, then it's, ''Oops I pushed a little too hard.''
01:07:05
You can recover from that.
01:07:07
But you use the client, always and respect the client's
01:07:11
presence as the feedback for whether you're doing the right
01:07:14
thing or not.
01:07:16
CARLSON: Well, we have a studio audience who has lots
01:07:19
of questions.
01:07:20
So what we'd like to do now is take some specific questions
01:07:24
about the interview, and then in a little while we'll have
01:07:28
some general questions about the approach, Motivational
01:07:31
Interviewing.
01:07:34
AUDIENCE: You talked about dancing with your client
01:07:38
versus wrestling.
01:07:39
And it seems to me that your approach is more appropriate
01:07:43
to talkative, outgoing clients of this type.
01:07:47
What about if you had one who was wrestling, who was not as
01:07:51
talkative and who was quieter?
01:07:55
How would this approach fit?
01:07:58
Because I'm interested in goodness of fit, like more
01:08:00
research here.
01:08:02
And I'm wondering if you had someone who is
01:08:04
the opposite of dancing.
01:08:06
You obviously enjoyed yourself.
01:08:08
But if you had a wrestler, as most alcoholics are could you
01:08:15
just project a little bit how you would have
01:08:17
approached the client?
01:08:19
MILLER: Well, there are really two pieces-
01:08:21
AUDIENCE: And you would have to do this in the
01:08:22
abstract, I know that.
01:08:24
MILLER: Well, no.
01:08:25
There are two pieces.
01:08:27
One is, what if your client's less verbal?
01:08:28
I can talk about that in a bit.
01:08:30
But dancing and wrestling are interpersonal behaviors.
01:08:34
We could have been wrestling real easily.
01:08:38
There were lots of invitations to wrestle all through the
01:08:41
time, and all you would have to do is a little bit of
01:08:43
confronting, a little bit of pushing a little bit of
01:08:46
shaming or criticizing, and you'd have professional
01:08:49
wrestling on your hands.
01:08:50
It would be very dramatic.
01:08:51
So it's not that people come in wrestlers or dancers.
01:08:56
It's what you invite them to do with you.
01:09:01
So, sure, some people come through the door mandated by
01:09:05
the court, angry, defensive, but do they stay that way?
01:09:09
What happens over the course of the
01:09:11
session is in your hands.
01:09:13
So those aren't client personality traits.
01:09:16
Those are interactions of two people.
01:09:19
But the less verbal client, it's fine, really.
01:09:23
On another set of videotapes that I made, we had a very,
01:09:26
very nonverbal client.
01:09:28
And Rogers demonstrated the same thing-that even with a
01:09:32
client who's not talkative and not high on the verbosity
01:09:37
side, you can still stay with them and be very much a part
01:09:41
of their experience, reflect nonverbals, anticipate what it
01:09:48
might be that's going on and if you're wrong they tell you.
01:09:50
There's no penalty for missing here.
01:09:57
This sounds a little bit arrogant, but I really haven't
01:10:00
yet found a client with whom I couldn't do this.
01:10:03
Because it's not a trick.
01:10:05
It's not a technique.
01:10:07
It's a way of being with people.
01:10:08
And you offer that to the person, and you
01:10:10
see how they respond.
01:10:11
And how they respond is right.
01:10:13
The client's always right.
01:10:15
AUDIENCE: It's interesting that you mention Rogers.
01:10:19
How close is this approach to Rogers's approach?
01:10:22
Because as you said, Rogerian therapy indeed does a lot of
01:10:27
reflection, but for alcoholics, they require that
01:10:30
the alcoholic be in recovery for two years so they can
01:10:33
bring these things to the table that
01:10:36
this gentleman brought.
01:10:37
But how close are you to that?
01:10:40
MILLER: Very grounded in Rogers.
01:10:42
The work that Rogers did, we wouldn't be doing Motivational
01:10:46
Interviewing without that.
01:10:47
It's just fundamental to this approach.
01:10:50
The difference is the consciously
01:10:54
directive aspect of this.
01:10:56
Rogers described his approach as nondirective.
01:10:59
His students, Traux and Carkhuff, were able to
01:11:02
demonstrate that he was very contingently responding to
01:11:06
what clients were saying, and tending to reinforce and
01:11:09
emphasize the positive self-statements, and he wasn't
01:11:11
conscious of doing it.
01:11:13
And he was sort of surprised and shocked when they
01:11:16
demonstrated the operant contingencies
01:11:17
in what he was doing.
01:11:18
So in a way we're doing the same thing.
01:11:21
We're just trying to be very conscious and a little bit
01:11:23
strategic about it and to use reflection as a reinforcer for
01:11:30
the person's own momentum.
01:11:35
AUDIENCE: That leads into my question.
01:11:37
I loved the way, you call it, ''danced'' with him.
01:11:40
To me it was like tai chi, like one of the Eastern
01:11:45
martial arts, because you were so clear not to get engaged in
01:11:50
counterforce with him, and yet it was highly skillful.
01:11:54
But you mentioned before the interview about times that you
01:11:59
reflect and other times you lead.
01:12:01
And at least for me, the trick with this guy would be not to
01:12:04
lead at the wrong time or he would become
01:12:07
oppositional again.
01:12:09
Can you say any more about how you chose to encourage or
01:12:14
empower or lead in ways that wouldn't evoke the
01:12:19
oppositional?
01:12:20
I'm clear if it were oppositional you'd
01:12:22
know to back off.
01:12:25
MILLER: You see right away the person's response- they begin
01:12:27
moving in the other direction.
01:12:31
It's almost like interpretations in classic
01:12:34
psychotherapy, that you don't jump too far beyond where the
01:12:39
person is, but you go a little bit beyond
01:12:41
where the person is.
01:12:42
In this case, my suggesting of a five-day outback kind of
01:12:52
trip was consistent with what he'd been talking about, but
01:12:55
it was something new.
01:12:56
So it was a suggestion, an invitation
01:12:59
to think about this.
01:13:00
And he seemed to like it.
01:13:02
Later on, he said, ''Well, a year?
01:13:06
How long am I going to be out there''' So there I pushed a
01:13:09
little bit too hard.
01:13:10
But that was an example, I think, of understanding his
01:13:15
own perspective, where he is experientially, and making a
01:13:22
suggestion as a suggestion just to see if it's something
01:13:26
he's willing to pursue.
01:13:30
It's not, ''Okay, be quiet, now I know the answer and I'm
01:13:33
going to tell you what you should do.'' That will have a
01:13:36
very predictable result with this fellow and with, indeed,
01:13:40
many human beings- most human beings.
01:13:42
So it's just moving a little bit past, and doing it in the
01:13:45
context of the person's own values what's
01:13:49
important to him.
01:13:50
AUDIENCE: To make it concrete-you said something
01:13:56
about a cabin or outback, and he changed it to the river.
01:14:00
You followed the river.
01:14:02
MILLER: Absolutely.
01:14:02
Always follow the river.
01:14:05
AUDIENCE: Absolutely.
01:14:06
But it would have been tempting to me to say, ''Well
01:14:10
you've got two components you know.
01:14:12
One is to start doing more of a positive thing, like more
01:14:18
soccer whatever it is, more athletic stuff.
01:14:21
And the other is you need to be off alone for a period.
01:14:25
Can you plan more of that?'' You never asked that, and you
01:14:29
never pushed him to really get concrete in his plan.
01:14:34
MILLER: But he is planning.
01:14:36
If you listen toward the end of the tape, there's some of
01:14:40
what we call envisioning of thinking ahead to the time
01:14:43
when he has changed and how he deals with that.
01:14:46
So I don't need to tell him to plan.
01:14:48
He's doing it.
01:14:49
And I don't need him to write it down and
01:14:51
sign it as a contract.
01:14:52
It's happening.
01:14:53
One of the funny things about Motivational Interviewing is
01:14:55
it's not very dramatic.
01:14:59
Sometimes people weep during sessions but you don't have
01:15:02
these dramatic confessions and things in the session.
01:15:05
And if that's what you're looking for, a soap-opera kind
01:15:08
of response, it looks like not much
01:15:10
happened during the session.
01:15:11
And indeed, you sit and watch a session like this you say,
01:15:14
''Well, did anything really happen?'' It's the data that
01:15:17
are persuasive-that when you do this
01:15:19
you really see changes.
01:15:20
Even though the person's not swearing they're going to do
01:15:23
something and laying out plans and signing contracts, they
01:15:27
actually do it.
01:15:27
And that's what matters to me not that they say they're
01:15:29
going to do it, but that they actually go ahead and change.
01:15:33
LEWIS: He did seem to me as though he was ready to wrestle
01:15:36
in the session when it first started that if you'd been
01:15:40
willing to wrestle with him, he was up for wrestling more
01:15:43
so than dancing.
01:15:43
MILLER: Oh, we'd have had a great time, you bet.
01:15:45
And it's what he expected.
01:15:47
This guy has had a lot of experience with addiction
01:15:49
counselors and he came in knowing what
01:15:51
was going to happen.
01:15:52
And it didn't happen.
01:15:57
AUDIENCE: I was more interested in, than anything
01:16:01
parallel between you and your client and we saw the client
01:16:06
and we heard you talking But what I would like to do is
01:16:10
sort of get inside you.
01:16:12
Like when you were making this point, ''freedom of choice,''
01:16:16
what was your freedom of choice when you were in that
01:16:20
counseling relationship as a therapist?
01:16:28
When he said a couple times, ''fear of failure,'' any
01:16:34
beginning Rogerian counselor it would have been a focal
01:16:38
point-this man saying about himself, ''fear of failure.''
01:16:43
But it seemed like you just went along with that.
01:16:47
But what was in you then, in relation to the fear of
01:16:52
failure, as the therapist?
01:16:56
And also any ambivalence in you regarding what are you
01:17:05
doing, taking this counseling relationship in what
01:17:09
direction, or anything in response to
01:17:14
his triggering you?
01:17:17
Did you have any struggle at all?
01:17:22
MILLER: Well, three questions again.
01:17:23
Yeah.
01:17:25
I had a couple reactions to ''fear of failure.'' My first
01:17:27
one was ''psychobabble'' -that this is a phrase he's picked
01:17:31
up somewhere or some counselor's given, or he read
01:17:33
it in some book.
01:17:34
So he wasn't connected to it.
01:17:36
It was an explanation, but he wasn't connected to it.
01:17:39
And yet I assumed he was telling me the truth and it
01:17:41
meant something.
01:17:42
And so my thought was, ''What does it really mean?'' And the
01:17:46
obvious thing to me that it meant was, ''I'm not sure I
01:17:48
can do this.'' So rather than going down the road of
01:17:52
exploring why he feels fear of failure and what his family
01:17:55
history is that would contribute to that and so
01:17:57
forth it really is an issue of confidence.
01:17:59
And if a person knows it's a problem, as he does, but isn't
01:18:04
sure how to do it or that he can do it, then that's the
01:18:08
place where you're stuck, and that is indeed
01:18:10
where this guy is stuck.
01:18:11
He needs something that he can believe in and say, ''Yeah, I
01:18:15
could do that,'' and then he will move forward with that.
01:18:18
I wasn't quite sure about the freedom of choice point except
01:18:23
that I can give you an example of it, which is toward the end
01:18:27
where we were talking about the ambivalent place and that
01:18:31
he can go forward or he can go back, but it's real
01:18:35
uncomfortable to stay where he is.
01:18:37
I didn't make a big deal out of it but that implicitly is,
01:18:41
''You can choose to go back.'' And I somewhere reinforced
01:18:45
that and he said, ''Well, but why would you do that?'' So
01:18:49
he's again making the argument against that.
01:18:52
But it is imbued in the whole approach that of course the
01:18:56
person has freedom of choice about this, and they can
01:18:59
decide to continue doing what they've been doing.
01:19:01
They can decide to do more of it, they can change it, and it
01:19:04
really is in their hands.
01:19:07
And then what's going on with me?
01:19:09
I think that the ambivalence still is that I want to rush
01:19:14
in and fix it.
01:19:16
So it's a constant temptation for me to say, ''Ooh, ooh, I
01:19:20
know what you can do.
01:19:21
I can fix that for you.'' But I've learned enough from my
01:19:27
clients not to do that so often.
01:19:29
If they're asking, sure.
01:19:32
And I'll probably not give one idea, because when you give
01:19:36
one idea, then you know the client's line it's why it
01:19:39
won't work.
01:19:40
I tend to give several ideas and say, ''Which of these
01:19:43
sound like it might make sense for you?' I will ask
01:19:46
permission.
01:19:47
If I have an idea, I will ask permission and say, ''There is
01:19:53
one thing that occurs to me.
01:19:54
I don't know if it will make sense to you, but is it all
01:19:55
right if I tell you about that?'' And then, in that
01:20:00
respectful context, to say, ''This is just an idea.
01:20:04
I don't know if it works or not.'' And in
01:20:09
that way to do it.
01:20:09
But it's still a tremendous temptation to want to rescue,
01:20:14
to want to rush in with the answer.
01:20:16
And paradoxically, that doesn't answer it.
01:20:20
CARLSON: I feel a whole lot better knowing that that
01:20:21
doesn't go away for you, either.
01:20:23
It really helps me a lot.
01:20:26
MILLER: I'm still a fixer.
01:20:30
AUDIENCE: Speaking of paradoxes, I'd like to see you
01:20:32
talk a little bit about how you did not engage him as a
01:20:36
traditional chemical dependency counselor would.
01:20:40
When he started talking, he talked about the fact that he
01:20:42
used cocaine, he talked about the fact that he used alcohol,
01:20:45
he talked about the fact that he used cigarettes.
01:20:48
And he talked about the fact that he doesn't understand
01:20:51
this disease, and no one could give him a
01:20:54
definition of the disease.
01:20:55
And he tried to engage you several times in what his
01:20:59
previous experience had been with whoever his previous
01:21:04
provider was.
01:21:06
And I'd also like to see you talk about it in the fact that
01:21:09
you didn't address those issues, that you let those go.
01:21:13
Because I think a person more rooted in the traditional
01:21:17
training of a chemical dependency counselor or
01:21:19
therapist would have been, ''Look at what
01:21:21
you're telling me.
01:21:22
You're not telling me enough about the cocaine.'' He
01:21:25
mentioned it once.
01:21:26
You never even came back to it, I don't think, except for
01:21:28
one time when you talked about drinking and using cocaine.
01:21:31
And then he also talked about progression, and he didn't
01:21:35
think his disease was progressing and he wasn't even
01:21:39
sure he had a disease.
01:21:41
But then he talked about the fact that he went from one
01:21:44
cigarette or no cigarettes to two packs that day.
01:21:48
And you also let that go.
01:21:50
Or maybe you didn't.
01:21:52
But if you could frame that in terms of the paradox.
01:21:56
Because I think as traditional therapists who would be
01:22:00
looking to jump on those critical statements that he
01:22:04
made and I think that you sort of came around the back door
01:22:08
using the paradoxical approach.
01:22:11
MILLER: It's not paradoxical, really, but I'll come back to
01:22:15
that point.
01:22:15
I've never been a traditional addiction counselor so it's
01:22:19
not like I recovered from that.
01:22:20
I started out with Rogers, and sat with clients with
01:22:28
addiction problems and listened to them and talked to
01:22:30
them, and it was only some time later that I discovered I
01:22:34
wasn't doing it right.
01:22:35
I was supposed to be doing other things.
01:22:37
So I never operated that way.
01:22:40
And what you're talking about as traditional counseling is
01:22:44
changing pretty quickly.
01:22:46
I was surprised at the amount to which that still seems to
01:22:49
be occurring in this area, but it's a peculiarly American
01:22:53
phenomenon.
01:22:54
You don't find this in other cultures that much, and other
01:22:58
cultures look at this as, ''Really?
01:23:00
You do that?
01:23:01
That's very strange.'' But it's a different a model.
01:23:04
The model I think in what you're talking about is,
01:23:07
''I've got to educate this person about the disease that
01:23:11
they have, and it has an inexorable progression to it,
01:23:15
and here's where they are in that progression.
01:23:17
And the most important thing is that they accept that they
01:23:20
have the disease and call themselves alcoholic or
01:23:24
whatever it is, and admit their helplessness to do
01:23:27
anything about it and accept help.'' And it fits into what
01:23:31
sociologists call the sick role, where you accept the
01:23:34
label, you confess that you can't do anything about it,
01:23:38
and you ask for someone else's help to do that.
01:23:40
So there's a long tradition to that role in societies, and
01:23:44
it's a role that we've used in this society to forgive people
01:23:49
for what's happened during their addictions and get
01:23:52
re-integrated into society.
01:23:54
And that's okay.
01:23:54
But the question is, does that really help people' And the
01:24:00
evidence as I read it, at least, indicates that being
01:24:02
willing to accept the label ''alcoholic'' is just
01:24:06
unrelated to outcomes.
01:24:07
You haven't gotten anywhere if you get the person to swear
01:24:11
that they're alcoholic.
01:24:12
Because there are lots of people who stop drinking and
01:24:16
change their drinking without ever taking that label into
01:24:19
themselves- and we all know there are lots of folks out
01:24:22
there who are very willing to say ''I'm an alcoholic'' who
01:24:24
are not doing well.
01:24:25
It's kind of unrelated.
01:24:27
So I'm not pushing for a label.
01:24:29
I'm not pushing for confession or acceptance.
01:24:32
Those just don't seem to be related to successful change.
01:24:37
LEWIS: Actually, avoiding labeling is an important part
01:24:41
of this, if I understand it correctly.
01:24:44
MILLER: In the sense that it's something that's easy to get
01:24:47
into an argument about.
01:24:48
It's easy for you to say, ''You have a diagnosis,'' and
01:24:50
the client says, ''No, I don't,'' and you try to
01:24:53
provide the proof and they give you the counterarguments,
01:24:55
and it's not productive.
01:24:57
If that were the crucial thing, if the made-for-TV
01:25:01
movies were right that it's being able to stand up in
01:25:04
front of people and say 'I'm an alcoholic'' that is the
01:25:07
healing moment-and there probably are people for whom
01:25:09
it is-then you would push hard to do that, but there just
01:25:13
isn't really any evidence that that's worth your time.
01:25:17
And you're much better, I think pulling from the client
01:25:20
their own desires, their own values, their own dreams and
01:25:25
where they're going and following those like the
01:25:27
river, rather than telling them what river they're
01:25:29
supposed to be in.
01:25:32
CARLSON: I'd like to revisit these five points that you
01:25:36
told us at the beginning and just to see
01:25:39
how they were covered.
01:25:40
The first was to express empathy.
01:25:43
I think that was clear.
01:25:46
MILLER: I think you'll see a lot of
01:25:47
reflections in the tape.
01:25:48
CARLSON: And then developing the discrepancy, and you were
01:25:52
doing that quite well at the end when you guys were almost
01:25:55
arguing-you for the addiction and he for the being free of
01:26:01
the addiction.
01:26:02
MILLER: Yes.
01:26:03
And you tend to see that increasing over the course of
01:26:05
a successful session.
01:26:07
And in fact, we have data to indicate that when you see
01:26:10
that, when you see the self-motivational statements
01:26:13
going up in the course of the session, behavior change tends
01:26:16
to follow from that.
01:26:17
So that discrepancy of his saying, ''It doesn't make
01:26:20
sense what I've been doing, and I would be so much better
01:26:23
if I made this change,'' are examples of that discrepancy
01:26:27
starting to open up for him.
01:26:29
CARLSON: And the third one-you could be Teflon Bill as you
01:26:33
avoided arguments.
01:26:35
He couldn't get you on anything.
01:26:37
You were the nonstick surface.
01:26:41
MILLER: Well, there just isn't any point in boxing.
01:26:44
It doesn't change behavior.
01:26:47
CARLSON: Then you rolled with resistance, like we talked
01:26:50
about before.
01:26:51
Can you talk some more about how you supported
01:26:53
self-efficacy- the self-effectiveness which is a
01:26:57
term Bandura coined?
01:26:58
MILLER: Yes.
01:27:01
Well, emphasizing that he did seem to have made a
01:27:05
decision was one.
01:27:07
Talking about the five-day river trip or whatever as,
01:27:11
''This is something that you could see yourself doing that
01:27:15
would work for you.'' A number of times saying, ''This is
01:27:19
what works for you.'' And even more than that, when he comes
01:27:22
up with a strategy, reinforcing and agreeing with
01:27:26
that and saying, ''Yeah, it sounds like that would work
01:27:28
for you.'' So it wasn't as challenging with him.
01:27:32
He's got a lot of self-efficacy there but
01:27:36
somehow hadn't quite connected all of that yet to being able
01:27:39
to deal with smoking.
01:27:40
CARLSON: How it fits that problem, yeah.
01:27:41
LEWIS: And you go with the client's own
01:27:43
metaphors, I noticed.
01:27:44
Like with this client, he talked about the
01:27:47
cardiovascular savings account that he had, so
01:27:51
you went with that.
01:27:52
MILLER: That was great, I loved that.
01:27:54
And that's one thing that you want to know.
01:27:56
You want to know the imagery system of the person that
01:27:58
you're sitting with because that's the language in which
01:28:01
you can really speak to the person.
01:28:03
And sometimes the deepest reflections, and the
01:28:06
reflections that cause the most movement are those that
01:28:10
draw on the person's own occupation or imagery system.
01:28:14
And that was such a lovely metaphor, the savings account.
01:28:20
AUDIENCE: I think you have an advantage in the sense that
01:28:23
you just said you're not a recovering traditionalist.
01:28:27
So we're still teaching here some of these textbooks
01:28:32
written by these social scientists who promulgate the
01:28:36
preferred defense system of the alcoholic.
01:28:40
And that system is dominated by denial, so we have been
01:28:46
teaching, but I know Dr. Lewis has been encouraging us to
01:28:49
move toward motivational breakdown of
01:28:51
denial in the system.
01:28:57
Maybe I should just ask you, what do we do about the
01:29:00
preferred defense system of the alcoholic which has these
01:29:02
traditional entities such as denial and dichotomous
01:29:06
thinking and so on?
01:29:07
What do we do with that?
01:29:09
This is the question I think Tom was getting at.
01:29:12
What do we do with that from your approach?
01:29:15
I agree with you, I think we should shift our paradigms.
01:29:19
It's not paradoxical.
01:29:20
We should shift our paradigms for the 21st century.
01:29:23
So maybe you want to speak about that from the academic
01:29:26
standpoint.
01:29:27
MILLER: Well, I'll just speak about it from a personal
01:29:30
standpoint.
01:29:30
What I do is teach that the preferred defense mechanisms
01:29:34
of alcoholics don't exist.
01:29:37
AUDIENCE: You threw that through the window.
01:29:39
I figured that.
01:29:42
MILLER: And the books you're talking about probably aren't
01:29:44
written by social scientists, because there's not empirical
01:29:47
evidence that there's a consistent personality and
01:29:50
that, indeed, denial is any higher in alcoholics than it
01:29:53
is in other people.
01:29:54
I mean, alcoholics are as diverse as everybody else.
01:29:58
And it's an interesting question of how have we come
01:30:01
to believe, then, that that's so?
01:30:03
And if you behave in a consistently confrontational,
01:30:06
suspicious, aggressive, pushing fashion, people behave
01:30:14
in a denying resisting, oppositional way.
01:30:18
So if you do that constantly, every client is in denial.
01:30:22
And you just say, ''This is endemic to alcoholism.
01:30:25
Every client behaves this way.'' But they didn't come
01:30:29
through the door like that.
01:30:31
It's something that happens in the room.
01:30:33
Now, that' s radical.
01:30:35
Compared to traditional teachings in the United
01:30:38
States, that's radical.
01:30:39
But I really believe it's true.
01:30:41
AUDIENCE: I totally agree with you there, but we're not doing
01:30:43
it in treatment programs.
01:30:44
I have found that treatment programs in this state have
01:30:48
remained primitive as they were 25 years ago when I was
01:30:51
out there in the field.
01:30:53
They have not changed.
01:30:54
And people who lead these programs are primitive, and
01:30:57
still stay in that traditional mode.
01:31:00
So I'm encouraging what you're saying in the sense that, how
01:31:05
do we impact these treatment programs that are around this
01:31:10
state, or even in the culture of this country that are not
01:31:13
going anywhere.
01:31:14
LEWIS: Can I add to that question?
01:31:15
It seems as though maybe you're saying that even when
01:31:19
we talk about within the addictions profession, you're
01:31:23
having to learn to roll with the resistance as people try
01:31:29
to make some changes in how they see
01:31:32
addiction treatment going.
01:31:35
MILLER: Well, it's a different question-what's going to be
01:31:38
the best way to change the field and how do you deal with
01:31:40
people who are already in place and doing this?
01:31:45
Highest priority for me is that we not teach that
01:31:48
anymore, and that we start teaching the new people coming
01:31:51
into the field a different way of being with their clients.
01:31:53
So let's not promulgate any more of this stuff.
01:31:56
But changing counselor behavior is harder than
01:31:58
changing client behavior.
01:31:59
There's a tremendous investment.
01:32:02
And I always remember the story of the doctor who
01:32:05
discovered that if he washed his hands women didn't die in
01:32:09
childbirth from fever and just developed a tremendous passion
01:32:15
to tell other doctors this.
01:32:17
Couldn't get accepted, was eventually committed by his
01:32:20
colleagues to a mental institution.
01:32:22
It was just too hard to say, ''Because I didn't wash my
01:32:26
hands, hundreds of women have died.'' So it's such
01:32:32
dissonance to change your very model of thinking about
01:32:36
people, to say, ''Denial isn't out there in the client.''
01:32:39
That's very tough.
01:32:41
So I want to put my time particularly into training the
01:32:46
next generation of counselors for this field so we don't
01:32:49
have more of the same.
01:32:52
CARLSON: We don't want you to be in a mental institution.
01:32:55
Be careful.
01:32:56
LEWIS: I think you do roll with the resistance.
01:32:59
MILLER: Well, of course that's what you do in teaching.
01:33:01
When I teach Motivational Interviewing to addictions
01:33:05
counselors, this is the only-well, no, doctors would
01:33:08
be the other one-where it comes up that you get a lot of
01:33:10
skepticism about whether this happens.
01:33:13
It's my job in teaching to show what I'm talking about
01:33:17
doing clinically.
01:33:18
It's my job to be respectful and to understand the person's
01:33:22
perspective and speak to that.
01:33:24
So in my teaching, I'm trying to do the same thing that I'm
01:33:27
encouraging trainees to do in counseling.
01:33:32
AUDIENCE: My question has some overlap with this.
01:33:35
I was wondering what your sense was of how Motivational
01:33:40
Interviewing has impacted treatment.
01:33:43
And also a little more specifically I'm assuming this
01:33:49
is implemented in substance abuse treatment programs at
01:33:54
University of New Mexico, but I'm curious about how that's
01:33:58
been implemented and how that's been worked with.
01:34:05
MILLER: It's interesting that this approach took much more
01:34:08
quickly in Europe and Australia and Britain than in
01:34:11
the United States, and now there's really substantial
01:34:15
increase in the United States in this approach.
01:34:17
And not just in the addiction field.
01:34:20
And I guess one of the things I hope will be a contribution
01:34:23
of my career is a humanizing of addiction treatment.
01:34:28
The manner in which people have been treated honestly has
01:34:36
been shameful.
01:34:37
And if that can change, if we can begin to treat people who
01:34:43
have addictive behaviors with the same respect and
01:34:45
compassion and joining that we do other kinds of physical and
01:34:50
mental problems, that's good.
01:34:53
And I think Motivational Interviewing teaches you that,
01:34:57
that if you practice it, even just start rudimentary trying
01:35:01
some parts of it, your clients teach you.
01:35:04
And I see that happening.
01:35:06
Treatment is very different in New Mexico than it is here.
01:35:09
We're a smaller state, but we have been teaching the new
01:35:15
generation of counselors for about 12 years now by
01:35:18
operating the state's principal training program for
01:35:23
counselors.
01:35:24
So this is fairly widespread there, and even to some extent
01:35:29
taken for granted.
01:35:30
I can no longer do controlled studies on Motivational
01:35:33
Interviewing at my own center because it's all through the
01:35:35
center and you can't have a control group.
01:35:40
And I think the change to professionalization of the
01:35:44
field, where treatment is now more often provided by people
01:35:47
who have been trained as mental health professionals,
01:35:51
has also helped because this is very natural to folks who
01:35:54
have been trained as counselors or psychologists or
01:35:56
social workers.
01:35:57
It was folks who were addiction counselors and that
01:36:01
was it, I think who had the hardest time with that kind of
01:36:04
paradigm change.
01:36:06
And it's kind of natural.
01:36:08
So it's happening and I feel very good about it, mainly for
01:36:13
our clients that they're being treated more humanely, more
01:36:17
respectfully.
01:36:20
AUDIENCE: There's been a concern expressed about the
01:36:24
fact that the teaching isn't really changing right now.
01:36:27
But another barrier, too, is the courts and their beliefs,
01:36:29
and what they consider as an addiction.
01:36:31
And then they're almost setting down treatment.
01:36:34
And then they send the addiction counselors an actual
01:36:38
goal of abstinence-this is what they're told, especially
01:36:42
with adolescents.
01:36:43
They're told, ''This is bad, this is wrong, you will go to
01:36:46
jail.'' So they come in with that approach and whatever our
01:36:50
beliefs are and where we want to work with them at what
01:36:53
stage they are they've been told their goal has to be
01:36:56
abstinence.
01:36:56
And it's in a very short time where they will go to jail.
01:36:59
Can Motivational Interviewing work with that population?
01:37:03
You can want to work with them but yet behind them there's
01:37:06
someone telling them, an external source saying, ''This
01:37:10
is what you need to do.'' How do you work within that
01:37:13
limitation?
01:37:15
MILLER: Actually, it works particularly well.
01:37:16
So the more defensive or resistant or reluctant the
01:37:23
population you're working with, the more beneficial this
01:37:26
is relative to charging into a change approach.
01:37:30
Half the clients that we see at our center are court
01:37:32
mandated, so it's very common.
01:37:35
The largest effect size that we've seen with Motivational
01:37:37
Interviewing has been with an adolescent population, 100
01:37:40
percent of whom were being brought into the program
01:37:43
against their will.
01:37:46
Because you're not an officer of the court.
01:37:52
You can and have to acknowledge the reality of it.
01:37:55
''The court situation is, they say if you're not abstinent
01:37:59
within this time, you're going back to jail.
01:38:01
What do you want to do about that?'' And
01:38:04
work with the person.
01:38:05
You acknowledge-Glass sure knows this- you acknowledge
01:38:08
the reality of the situation and you also
01:38:11
work with the person.
01:38:12
Because the court's goal isn't necessarily the client's goal.
01:38:15
What's the client's goal?
01:38:17
And with adolescents and offenders, it's often, ''To
01:38:20
get the court off my back.
01:38:21
To be free.'' ''Well, how could you do that?' And work
01:38:26
with the person to move along to a plan that they will
01:38:30
accept, that also moves in the direction of doing what they
01:38:34
need to do in terms of the courts.
01:38:36
But it's still their choice.
01:38:38
We get the idea that because the court has said, ''You must
01:38:41
do this,'' the client doesn't have a choice.
01:38:43
But that's wrong.
01:38:44
They have a choice.
01:38:45
They can do it.
01:38:46
There are consequences of those choices.
01:38:48
You can talk about those, you can consider "what's likely to
01:38:51
happen if you do this and this, and which of those do
01:38:53
you want, and how do you want to proceed here".
01:38:55
But it certainly doesn't cause me to switch into an
01:38:59
authoritarian mode.
01:39:00
Usually by the time clients get to us, they've had quite a
01:39:03
lot of that already and if it were going to
01:39:06
help, it would have.
01:39:08
So I want to offer something different.
01:39:12
Well, we're getting near the end of our time and wanted to
01:39:16
know if you have any final comments or questions or
01:39:19
things you'd like to share with our audience that we
01:39:21
haven't touched on yet.
01:39:24
I think it's only to say that the skills that you learn and
01:39:29
practice in dealing with all other kinds of problems-the
01:39:34
things that you learn in training as a counselor social
01:39:37
worker, psychologist, or nurse- are the very things
01:39:41
that you use here.
01:39:42
And it's an exciting place to work.
01:39:45
There's been a tendency for health professionals and
01:39:48
mental health professionals to refer out-that as soon as you
01:39:52
run into an alcohol or drug problem, ''I can't treat this.
01:39:56
I need to send this person off to the specialist program.''
01:39:59
And that's not right.
01:40:01
You have many of the skills that you need in order to be
01:40:05
able to be very helpful.
01:40:07
And the very kinds of things that you have to offer are the
01:40:10
kinds of things that people need who are struggling with
01:40:12
addictive behaviors-in part because they've got lots of
01:40:14
other problems that aren't going to go away necessarily
01:40:17
just because the substance abuse gets resolved.
01:40:20
So rather than just sending these people away some place,
01:40:24
work with them.
01:40:24
Now, there's some basic stuff you need to learn, to be sure.
01:40:28
But you have the things that you need in order to be able
01:40:32
to work compassionately and effectively with people with
01:40:36
addiction problems.
01:40:37
So use what you know.
01:40:39
Use your heart, use your compassion.
01:40:43
CARLSON: Well, this is a refreshing,
01:40:44
revolutionary approach.
01:40:46
It's very fortunate that you weren't trained as a
01:40:49
traditional addiction counselor and that you did not
01:40:52
have to go through that particular
01:40:53
recovery process yourself.
01:40:56
I appreciate your helping us with ambivalence.
01:40:59
And I look in the preface of your book, and
01:41:01
you quote from Romans.
01:41:03
And you said, ''I do not understand my own actions, for
01:41:07
I do not do what I want but I do the very thing I hate.''
01:41:11
And I think that's something we can all identify with along
01:41:15
with our clients and appreciate the humane way that
01:41:18
you help us to deal with that.
01:41:19
Thank you, Bill.