Addictions Case Study Part 1 Case Conceptualization

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CHAPTER 5

Focusing “Where Are We Going?”

If you don’t know where you’re going you might wind up somewhere else.

—Yogi Berra

The engaging skills we described in Chapter 4 can be helpful on their own. Sometimes a good listening-to is all that a person needs. The gift

of being deeply heard is so rare and rewarding that people happily continue talking with a good listener.1 The art of empathic listening is a solid foun- dation of MI.

Yet people may need more from you than good listening. They may be looking for information or advice, guidance in considering a baffling array of options, or ideas for getting unstuck from persistent patterns. At the beginning of a helping exchange, it may be unclear what the topic of conversation will be. In this chapter, we proceed to a second task in help- ing people to change and grow: focusing. The underlying question here is, “Where are we going?”

A first step in focusing is determining the topic of conversation. This could even precede the engaging task and can happen in many ways. An initial electronic or phone contact may indicate what the person would like to discuss. A customer service worker asks, “How can I help?” A counselor might begin with, “What would you like to talk about today?” In health care we often asked, “What brings you in today?” (One client responded quite concretely: “A bus.”) Seeing distress on your friend’s face, you might ask, “What’s wrong?” Listen well to understand the person’s concerns and hopes, which give you a sense of where the conversation is headed.

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70 PraCTiCing Mi

Sometimes the topic of conversation is predetermined by the context. If you specialize in helping people to prepare a will or to stop smoking, there’s a good chance you already know the general topic of conversation when someone comes through the door. The range of possible topics is broader in a law firm, primary care clinic, or counseling practice. In such settings, usually a narrowing-down process happens early in a visit.

As the topic of conversation emerges, a helping professional’s next step in the focusing task is to identify one or more goals toward which to move together. It is well established that having clear goals is a fundamen- tal component of human motivation.2 One characteristic of more effective counselors and therapists is that they have well- defined goals in mind and a coherent plan for reaching them.3 Finding agreed-upon goals is a key ele- ment of the working alliance that consistently predicts better therapeutic outcomes.4 A common practice in behavioral health care is to develop a clear treatment plan and then keep track of progress toward accomplishing it.

Once you clarify shared goals, you face the further challenge of staying focused on them. This can be particularly important in time- pressured con- texts where you have a limited length or number of visits. Finding that you are a good listener, people can wander off topic into chatting about seem- ingly unrelated matters. Particularly when distressed, clients may be dis- tracted by ongoing events and will lose sight of the horizon toward which you have agreed to move. Of course you listen to arising concerns, but if you just follow wherever their attention is resting at the moment, that is the wandering trap described in Chapter 2. You need to maintain a balance here between engaging and focusing. Listen well while also keeping your eyes on the horizon toward which to move. A certain amount of chat can maintain friendly rapport, but wandering off topic in a service setting can compromise progress toward goals.5 When your work together strays from shared goals, you can gently bring the conversation back into focus.

Of course, the focus of your help- ing relationship can also shift over time. At least within ongoing helping relation- ships, focusing is not a one-time event. Priorities may shift. Accomplishing a goal makes room for new ones. A focus, like a treatment plan, should unfold over time, adjusting to changing needs and conditions. That’s nor- mal.

Three Focusing Scenarios

As you listen and engage, possible directions for future change or growth can emerge from the client’s early statements; for example:

Listen well while also keeping your eyes on the horizon.

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Focusing: “where are we going?” 71

• “I don’t know what to do about this relationship I’m in.” • “I need more education or training so I can get a better job.” • “We want to start saving for our children’s education and also for

retirement.” • “I know I have a short temper, but I don’t want people to think I’m

weak.”

Remember that MI is a particular way of having conversations about change. Within MI, then, focusing means clarifying what change(s) the person might make. Sometimes this is a simple step, as when someone asks you for a particular kind of help to reach a clear goal. In other situations,

focusing is a more complex task— such as making a choice from among several good options or even clarify- ing with the client what a desired out- come would be.

Straightforward Goal(s)

One possibility is that the goal(s) to be pursued together seems clear at the outset. As in deciding on a broader topic of discussion, the focus may be straightforward:

• “I’d like to get a driver’s license.” • “I want to apply for a loan.” • “I need to lose weight.”

In this case, little further focusing may be required, although some clarification is likely to be helpful. Has the person had a driver’s license before? What type of loan, how large, and for what purpose? What, if any- thing, has the person already tried for weight loss and with what results? With a clear goal in focus, you can begin to evoke the why and how of change (Chapters 6 and 7) and consider what additional help you might offer. When behavior change is the subject, sometimes it is sufficient just to clarify the goal and evoke the person’s own motivations for change.6

Choosing a Path

In a second type of focusing, there is a clear longer-term objective with vari- ous possible ways to help accomplish it:

• “I want to keep healthy and fit as I get older.” • “This time I want to stay out of prison.” • “How can I improve my chances for being accepted?”

Focusing means clarifying what changes the person might make.

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The overall goal is apparent, but it’s less clear how best to pursue it. You can develop a list of possible paths toward the change goal and then choose among or prioritize them. We have sometimes used a bubble sheet to lay out the possibilities visually. You could draw and fill in topic bubbles together or use a prepared sheet with common options. For example, Fig- ure 5.1 is an illustration we have used when talking with people newly diagnosed with diabetes.7 A nurse educator might introduce this bubble sheet to a patient in this way:

“Probably this is all new to you, having just been diagnosed. One good thing about diabetes is that there are so many things you can do to manage it and stay healthy. Here’s a sheet that shows some of them. We have already talked about checking your blood sugar levels, and

FIGURE 5 .1. A sample bubble sheet. From Marc P. Steinberg and William R. Miller (2015, p. 17), Motivational Interviewing in Diabetes Care. Copyright © 2015 The Guilford Press. Reprinted by permission.

Diabetes Health Topics

Physical activity and

exercise

Checking my blood

sugar

Healthy eating

Managing stress

Blood pressure

Mood and

depression Smoking Foot care

Insulin Alcohol use

Medications other than

insulin

Eye care ?

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Focusing: “where are we going?” 73

from your chart I see that your blood pressure has been fine. What are two or three topics here that you might like to discuss today? Or perhaps there is something else not mentioned here that you want to talk about, and that’s what this bubble with a question mark is for.”

Or a busy practitioner could use the bubble sheet this way during a routine visit:

“So those are your lab results, which generally look good. We still have a few minutes left and I wonder if there is something on this sheet that we could discuss in the time remaining. Do you see something here that you might work on next to help manage your diabetes in the long run?”

In freely choosing among topics, people are more actively involved in their own care and are considering what they can do to improve their health.

Clarifying

In a third type of focusing scenario, there is no well- defined change goal to begin with or even a set of change options to choose from. You ask what’s wrong, and the person says, “Everything.” Whatever hopes the person may have for change are vague:

• “My life is a mess.” • “I don’t think there’s any hope.” • “Actually, I think our relationship is fine, but for some reason she’s

not happy with it.”

This feels a bit like trying to see your way through a fog or a cloudy wind- shield. It’s hard to see where you’re going.

Clarifying often begins with a general concern or distress. A longer engaging period of good listening may be needed. Part of the task may be alleviating crisis, stress, and confusion.8 After engaging and listening to the broader interest or concern, this kind of focusing involves identifying possible changes and exploring the person’s priorities among them. Focus- ing here tends to move from generalities to more specific goals. We offer an example of this third kind of focusing task at the end of this chapter.

Whose Goals?

Where do goals originate in a helping relationship? By far the most com- mon source is the person seeking your assistance. What does the client, student, customer, or patient want? This may not be completely clear at the

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74 PraCTiCing Mi

outset, but the prime directive is the person’s best interest and well-being. This consideration can broaden beyond the individual to the well-being of a family, group, or community. A first consideration, then, is what you are being asked for, what kind of help is requested. A related question is, “Who is my client?”9 Who actually wants this change to happen?

Sometimes the range of goals is affected by limits of the context and your own expertise. An attorney doesn’t ordinarily offer mental health guidance, nor is a psycho- therapist likely to give dental advice. A factor in focusing, then, is the range of goals available within an agency’s mission or a helper’s competence. Some addiction treatment services may work only within a goal of lifelong abstinence from all psychoactive drugs, whereas others embrace a range of harm- reduction goals.10 Specific pregnancy counseling services may include or proscribe certain contraception and abortion options. Thus, the context can constrain what helping goals are feasible.

Yet another source of potential goals is your own expertise. A physi- cian may discern that a patient’s persistent gastrointestinal complaints are exacerbated by dietary choices and may therefore recommend a change in eating habits. An unusually short temper may be related to underlying depression or drug use. A financial advisor may be able to suggest invest- ment options not previously considered. A psychologist may recognize that the client’s presenting concerns are consistent with a known condition such as narcolepsy or posttraumatic stress. Such possibilities for focus were not within the person’s original request for help, but they can arise as you become better acquainted with their situation.

Here, for example, is a conversation between a pastor and a young parishioner named Paul whom she knows well, who appeared at her office door and asked if she had some time to talk.11 She had recently married Paul and Chelsea, another member of the congregation, and now a crisis has arisen. In the midst of a heated argument in their kitchen he grabbed her arm, pushed her, and she fell backward. She then fled the apartment. He does not know where she went, although she left a message on his phone to say that she is OK. The pastor has been listening well for 15 minutes or so, and Paul is calming down.

PASTOR: There’s a lot going on for you right now. You’ve told me about some conflicts at work and that you haven’t been sleeping well. Now this has happened. What are you hoping for at this point?

PAUL: I’m just so embarrassed. I can’t believe I shoved her, and I’m worried about her and I don’t ever want to hurt her again. It’s my fault and I feel terrible.

What are you actually being asked for?

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Focusing: “where are we going?” 75

PASTOR: I agree with you that what you did was wrong, and we don’t want it to happen again. I’ve known you and your family for a long time, so I also know many good things about you and how you love Chelsea. [Affirming] How do you understand what happened? [Open question]

PAUL: I don’t know. I’m stupid. Like you said, there’s a lot going on right now. I just hope she will forgive me. (Tears come and the pastor waits a bit.)

PASTOR: You know, Paul, I’m wondering about something here.

PAUL: What’s that?

PASTOR: [Summarizing] It’s never been like you to hurt someone. You’ve told me you can’t think straight, and you wake up in the middle of the night and can’t get back to sleep, so you’re exhausted and don’t have any energy.

PAUL: Right. I’m really screwed up.

PASTOR: You’re feeling bad about yourself, and you’ve had some arguments at work lately. [Reflecting] All of that seems different from your nor- mal self.

PAUL: It is.

PASTOR: I’m no psychologist or doctor, but all of that sounds a lot like what I know about depression. As I try to make sense of all this, I wonder whether that could be what’s going on here because sometimes depres- sion can make people edgy and irritable. I know that depression is very treatable, and it can make a big difference. Is that something you’d be willing to learn more about?

PAUL: I guess so. Would I have to take medicine?

PASTOR: I know that’s one possibility, but there are other things that help, too. Would you be willing to talk to a professional who knows a lot about this? There is also a member of our congregation who’s recov- ered from depression and would probably be willing to talk to you about his own good experience.

Paul hadn’t come in to talk about depression. It just seemed to him like his world was falling apart, but using her experience, the pastor helped him to focus on what could be an important piece of the puzzle. In the process of clarifying and in the midst of crisis, these “I wonder whether” moments can open the door to considering possibilities and taking a next step. She also honored the limits of her own professional expertise and arranged an appropriate referral.

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76 PraCTiCing Mi

FOR T HER A PIS T S: MI and Trauma

Providers and services are increasingly asked to deliver “trauma- informed” services that recognize and address signs of the lingering effects of traumatic experience. People entering treatment for sub- stance use disorders, for example, are far more likely than the general population to have a history of significant trauma.12 This is not prob- lematic in itself; not everyone who is exposed to adverse childhood experiences is psychologically injured by them, and those who are can recover and often show posttraumatic growth.13 It is the persistence of trauma- related suffering that deserves attention and that can compro- mise the treatment of other conditions. As General Peter Chiarelli has suggested, we should embrace the term posttraumatic stress injury (PTSI) rather than posttraumatic stress disorder (PTSD). A disorder is something that’s wrong with you, whereas an injury is something that happened to you.

The gentle guiding style of MI may be particularly well suited in engaging and treating people with enduring PTSI.14 Core MI practices such as affirming strengths, respecting choice, evoking hope, and lis- tening with accurate empathy may help clients to enter into, collabo- rate with, and persist in treatment that can be quite stressful in itself.15 MI has been used effectively to enhance readiness for and participa- tion in cognitive- behavioral treatment of posttraumatic stress.16 MI has also been found to facilitate adjustment and functioning after post- traumatic brain injury.17

An Example of the Focusing Task in MI

Remember that clarifying usually begins with a broad general goal or con- cern and moves toward more specificity. Here is such a focusing conversa- tion between a schoolteacher and a fitness coach who is trained in MI. The teacher is considering enrolling in a local gym where the coach works. There was a prior period of welcome and engaging before getting down here to the business of focusing.

COACH: So, tell me what you’d like to do for yourself.

Open question

TEACHER: I teach school and I spend most of my life sitting, especially this year when I’ve been teaching online in front of a computer screen.

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Focusing: “where are we going?” 77

COACH: You haven’t been very physically active lately.

Reflection

TEACHER: For quite a while, actually. I just feel so out of shape, like I’m losing muscle.

COACH: There was a time when you were in better shape.

Reflection (a guess)

TEACHER: Yes. When I was younger, I was much more active.

COACH: What kinds of activity have you enjoyed?

Open question

TEACHER: Traveling, going places. I played golf and did some running. I liked dancing.

COACH: You enjoyed a good mix of things! You were active and energetic.

Affirmation

TEACHER: Back then, yes.

COACH: Well, let me ask you this. There are different reasons why people would like to be in better shape. I don’t know what yours are yet, but for some people it’s about longevity—living longer. For others it’s quality of life or physical health, looking good, pain relief, or ability to do things they want to do. What do you need fitness for?

Here the coach could draw circles on a page (a bubble sheet) and write in these circles possible goals; or the coach could wait to see what the client says.

TEACHER: Good question! I have two boys, 11 and 14. I need to be able to keep up with them physically, and I want to be there for them as they become adults and have kids of their own.

COACH: Being able to keep up with your boys, and also longevity—being around for a while. What else?

Reflection

TEACHER: Heart disease runs in my family.

COACH: Uh huh. To keep your heart healthy. Reflection

TEACHER: And like you said, quality of life. I want to be able to enjoy life when I get older. I already have some back pain that bothers me.

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78 PraCTiCing Mi

COACH: OK—you have lots of good reasons. Keeping up with two young boys and staying healthy to be there for them, especially since there’s a history of heart disease in your family. You want to be able to enjoy your life and not be slowed down by pain. So let’s talk about what you might choose to do. OK?

Summary: The coach summarizes the reasons given, already getting into the why of change (Chapter 6).

TEACHER: Sure. That’s why I’m here.

COACH: OK, good! I think it’s a question of where you want to start and how much time you want to commit to getting fit. You don’t have to do everything all at once. There’s cardiovascular fitness, keep- ing your heart in shape and building up your endurance. There’s core strength, particularly the abdomen, for your spine, hips, and posture. There’s lower body strength in your legs, and upper body strength in your arms, chest and shoul- ders. There’s also balance to prevent falls and injuries, and flexibility to stay limber. Which of those sound more important to you as a place you might want to start?

And then begins to narrow the focus Offering a menu of options to choose from

TEACHER: I probably need some work on all of them, but I guess cardio could be a good place to start.

COACH: Given your family history. Reflection

TEACHER: Right. And you said core strength; might that help with my back?

COACH: Definitely. People often don’t connect it, but these abdominal muscles here keep your spine aligned and help prevent lower back pain. So where you’d like to start, then, is with improving your cardiovascular fitness and building some core strength. Is that right?

Giving information

Summary of beginning change goals

TEACHER: Yes. That sounds good to me.

Notice that the coach here is not being prescriptive— telling the teacher what to do—but rather is offering a menu of options to find out what is important and starts from there. It’s a good example of how the focusing

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Focusing: “where are we going?” 79

and evoking tasks can intertwine. The coach’s opening question is not “What can I do for you?” but “What would you like to do for yourself?” From the dialogue above, this discussion would move on to more specific consideration of how to improve core strength and cardio fitness. We will continue this conversation in Chapter 9. For now, notice the basic pattern of clarifying within MI. It began with a somewhat vague general concern about being out of shape. The coach next explored possible purposes of fit- ness—the why—to understand the client’s priorities and consider where best to begin. The focusing task centered on two starting fitness priorities and will next (in Chapter 9) become more specific with particular activities.

You see the gradual clarifying process from general to specific, always keeping the client’s own interests at the center.

As mentioned earlier, shared goals in a helping relationship can evolve over time. In

the dialogue above, the coach and client established a beginning focus on specific types of fitness, but the focus may shift over time. An injury or a change in health might alter priorities. The client’s available time may wax and wane, and other life priorities take their place next to physical fitness.

In summary, the focusing task clarifies shared goals toward which to move, and your skill lies in the moment-to- moment ability to keep these goals in mind and gently refocus on them if you veer off. Such drifting is common in helping relationships. There are many ways to refocus, bringing attention back to your shared goals while maintaining good engagement. Your guide is always the person across from you who will tell you whether you’re on the right track if you pay attention and listen well. This close attention to language is key as we turn to the evoking task in Chapter 6.

PERSON A L PERSPEC T IV E : Is MI Manipulative?

Sometimes people ask, “Isn’t MI manipulative?” One meaning of manipulate is to work with astute skill, much as a physician adroitly manipulates robotic surgical implements. A second definition, how- ever, is to behave unfairly or unscrupulously. The concern behind the question seems to be whether MI is somehow like posthypnotic suggestion or subliminal advertising, trying to trick people into doing things without their conscious awareness or consent, perhaps for self- serving ends. My own experience is that unless the focus, the shared goal, is consistent with people’s values and in their own interest, MI techniques will be to no avail. MI is about mobilizing a person’s own motivations, not installing different ones.

In practice, focusing and evoking can intertwine.

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Consider an attempt to use MI in Danish “departure centers” with refugees whose applications for asylum had been denied. Though not deported, such refugees were subjected to “mandatory monthly motivational interviews” with police employees trying to motivate them to leave the country.18 In my mind, this is a blatantly inappropriate application of MI,19 done within a power differential to promote action that may not be in the person’s best interest. Happily, it did not work. “According to police interviewers, [refugees] in general do not respond well to motivational interviews. In their experience, only a few [refu- gees] sign the voluntary return form and those who do rarely end up leaving.”20 Both the interviewers and the refugees found the sessions to be frustrating and aversive.

I know of no scientific evidence that MI-related techniques can cause people to do what is inconsistent with their own motivations and values. It is vital to understand and practice the method of MI within the underlying autonomy- honoring spirit of partnership, acceptance, compassion, and empowerment.

—Bill

K E Y C O N C E P T

• Bubble sheet

K E Y P O I N T S

• Having clear shared goals is an important component of a working alliance that in turn predicts whether positive change will happen.

• The focusing task is about finding shared goals for your work together: “Where are we going?”

• Sometimes a goal is straightforward, and at other times it’s a matter of choosing among alternative paths.

• It also happens sometimes that goals are initially ambiguous and a process of clarifying is needed to refine shared goals.

• Goals may be influenced by your client, the context in which you work, and your own professional expertise.

Notes and References

1. Schofield, W. (1964). Psychotherapy: The purchase of friendship. Prentice-Hall. 2. Ford, M.  E. (1992). Motivating humans: Goals, emotions, and personal agency

beliefs. SAGE.

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Focusing: “where are we going?” 81

Locke, E. A., & Latham, G. P. (1990). A theory of goal setting and task per- formance. Prentice-Hall.

3. Miller, W. R., & Moyers, T. B. (2021). Focus. In Effective psychotherapists: Clini- cal skills that improve client outcomes (pp. 66–79). Guilford Press.

4. Flückiger, C., Del Re, A. C., Wlodasch, D., Horvath, A. O., Solomonov, N., & Wampold, B. E. (2020). Assessing the alliance– outcome association adjusted for patient characteristics and treatment processes: A meta- analytic summary of direct comparisons. Journal of Counseling Psychology, 67(6), 706–711.

Horvath, A.  O., & Greenberg, L.  S. (1994). The working alliance: Theory, research, and practice. Wiley.

Tryon, G. S., & Winograd, G. (2011). Goal consensus and collaboration. Psy- chotherapy, 48(1), 50–57.

5. Bamatter, W., Carroll, K. M., Añez, L. M., Paris, M. J., Ball, S. A., Nich, C., et al. (2010). Informal discussions in substance abuse treatment sessions with Spanish- speaking clients. Journal of Substance Abuse Treatment, 39(4), 353–363.

6. This was an early surprise from research, showing that after an MI session often people proceed to make the change on their own. MI was clearly more effective than no help at all, and often it was just as effective as longer interventions.

Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motiva- tional interviewing: A meta- analysis of controlled clinical trials. Journal of Con- sulting and Clinical Psychology, 71(5), 843–861.

Hettema, J., Steele, J., & Miller, W.  R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91–111.

7. Steinberg, M. P., & Miller, W. R. (2015). Motivational interviewing in diabetes care. Guilford Press.

8. Susan Gilmore in The counselor-in- training (1973, Prentice-Hall) described three broad potential goals in counseling: choice, change, and confusion reduction.

9. Monahan, J. (Ed.). (1980). Who is the client? The ethics of psychological interven- tion in the criminal justice system. American Psychological Association.

10. Gleghorn, A., Rosesnbaum, M., & Garcia, B. A. (2001). Bridging the gap in San Francisco: The process of integrating harm reduction and traditional substance abuse services. Journal of Psychoactive Drugs, 33, 1–7.

Miller, W. R. (2008). The ethics of harm reduction. In C. M. A. Geppert & L. W. Roberts (Eds.), The book of ethics: Expert guidance for professionals who treat addiction (pp. 41–53). Hazelden.

Tatarsky, A., & Marlatt, G. A. (2010). State of the art in harm reduction psy- chotherapy: An emerging treatment for substance misuse. Journal of Clinical Psy- chology, 66, 117–122.

11. Wherever actual case material is used in this book, names and other details are disguised to protect confidentiality.

12. Simpson, T. L., & Miller, W. R. (2002). Concomitance between childhood sexual and physical abuse and substance use disorders. Clinical Psychology Review, 22, 27–77.

13. Henson, C., Truchot, D., & Canevello, A. (2021). What promotes post traumatic growth? A systematic review. European Journal of Trauma and Dissociation, 5(4), 100195.

Jayawickreme, E., Infurna, F. J., Alajak, K., Blackie, L. E., Chopik, W. J., Chung, J. M., et al. (2021). Post- traumatic growth as positive personality change: Challenges, opportunities, and recommendations. Journal of Personality, 89(1), 145–165.

Michael, C., & Cooper, M. (2013). Post- traumatic growth following bereave- ment: A systematic review of the literature. Counselling Psychology Review, 28(4), 18–33.

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-02 05:39:02.

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14. Avruch, D. O., & Shaia, W. E. (2022). Macro MI: Using motivational interview- ing to address socially- engineered trauma. Journal of Progressive Human Services, 1–29.

Greenwald, R. (2009). Treating problem behaviors: A trauma- informed approach. Routledge.

Motivational Interviewing and Intimate Partner Violence Workgroup. (2010). Guiding as practice: Motivational interviewing and trauma- informed work with survivors of intimate partner violence. Partner Abuse, 1(1), 92–104.

Sypniewski, R. (2016). Motivational Interviewing: A practical intervention for school nurses to engage in trauma informed care. NASN School Nurse, 31(1), 40–44.

15. See the section “Trauma- Informed Practice and MI” in Hohman, M. (2021). Inno- vative applications of motivational interviewing. In Motivational interviewing in social work practice (pp. 204–223). Guilford Press.

16. Darnell, D., O’Connor, S., Wagner, A., Russo, J., Wang, J., Ingraham, L., et al. (2016). Enhancing the reach of cognitive- behavioral therapy targeting posttrau- matic stress in acute care medical settings. Psychiatric Services, 68(3), 258–263.

Murphy, R. T., Thompson, K. E., Murray, M., Rainey, Q., & Uddo, M. M. (2009). Effect of a motivation enhancement intervention on veterans’ engagement in PTSD treatment. Psychological Services, 6(4), 264–278.

Seal, K. H., Abadjian, L., McCamish, N., Shi, Y., Tarasovsky, G., & Wein- gardt, K. (2012). A randomized controlled trial of telephone motivational inter- viewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans. General Hospital Psychiatry, 34(5), 450–459.

17. Bell, K. R., Temkin, N. R., Esselman, P. C., Doctor, J. N., Bombardier, C. H., Fra- ser, R. T., et al. (2005). The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: A randomized trial. Archives of Physical Medicine and Rehabilitation, 86, 851–856.

Bombardier, C. H., Bell, K. R., Temkin, N. R., Fann, J. R., Hoffman, J. M., & Dikmen, S. (2009). The efficacy of a scheduled telephone intervention for ame- liorating depressive symptoms during the first year after traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(4), 230–238.

18. Kohl, K. S. (2022). The stalemate: Motivational interviewing at a carceral junction. Incarceration: An International Journal of Imprisonment, Detention and Coer- cive Confinement, 3(1), 1–18. This report by a sociologist reads like an exposé of the practice.

19. Miller, W. R. (1994). Motivational interviewing: III. On the ethics of motivational intervention. Behavioural and Cognitive Psychotherapy, 22, 111–123.

20. See note 18 (Kohl, 2022, p. 11).

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-02 05:39:02.

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