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Finding Your Way to Change
How the Power of Motivational Interviewing can Reveal What You Want and Help You Get There
By Allan Zuckoff, Bonnie Gorscak
The Guilford PressCopyright © 2015 The Guilford Press
All rights reserved.
I have spoken to many groups of mental health, medical, addictions, and social work practitioners about how people change. Each time, I've asked those present to think of an area of their own lives in which they'd been considering whether or not to make a change and then to say how long they'd been considering it. With just a little prompting the majority of these therapists, counselors, doctors, nurses, caseworkers, and other professionals call out (sheepishly, forthrightly, or sometimes defiantly) "a few months," "a year," "2 years," "3 years," and then (to the increasing amusement and knowing nods of their colleagues) "5 years," "10," "20. ..."
When faced with important life decisions, it's normal for people to get stuck. This is as true for professional helpers as it is for you (and for everyone else, for that matter): they routinely, frustratingly, often exasperatedly get trapped in the all-too-human state known as ambivalence.
When one direction seems much preferable to another, most people have little trouble making a choice and pursuing the preferred option. But often the choice doesn't seem so clear. Ambivalence arises when people are confronted with a choice between two or more options, both (or all) of which are appealing or unappealing.
In some cases you are ambivalent when you're confronted with a choice between two things you really want—two good job offers or exciting relationship possibilities, say. In other cases, it's the opposite —you're unhappily forced to decide which is the lesser of two evils, like a person who's being blackmailed and has to choose whether to pay the blackmailer or have his secrets made public, or (to take an everyday example) a person who must decide between doing unpleasant chores or suffering the consequences of not doing them.
The most difficult kind of choice to make, though, is between two or more options, each of which has its good points and not-good points, or aspects that make you want to move toward it and aspects that make you want to move away.
Simple examples or abstract descriptions of this kind of conflict can't do it justice and won't help you work your way out of your own ambivalence. Instead, allow me to introduce five people who, like you, are caught in a dilemma. Their stories will bring home just how complex and sticky ambivalence can be and set the stage for a closer look at your own ambivalence—which will also be your first step toward understanding what it will take to resolve it.
MEET ALEC, BARBARA, COLIN, DANA, AND ELLIE
Alec: "People Want Me to Change, but I Don't Need To"
Alec is 39 years old and lives with his wife, Wendy, and 11-year-old daughter, Jen, in the near suburbs of a small city. A salesman with a technology-based company, Alec is successful at his job, but it's a high- pressure position and he often feels stressed by it. He loves his family but doesn't get to spend as much time with them as he'd like to. He has a few friends but wouldn't say he's especially close with any of them. Most of the time Alec is either working or socializing with clients. Although he does have a hobby of gradually restoring an old muscle car (he bought it because it was the car he wanted as a kid), he doesn't seem to have much time to spend on this anymore either.
Alec is stuck in deciding what to do about his drinking. He would never identify himself as an alcoholic and would have choice words for anyone who described him that way. Most of the time he doesn't see his alcohol use as a problem at all—especially when others are trying to tell him that it is a problem. At those times he insists that he's a social drinker: part of his job is making connections with people in the companies he's trying to sell to, and getting together over a few drinks is the best way to make that happen. In fact, quitting drinking (as some people have been telling him he should do) would probably hurt his ability to do his job. He never misses work because of drinking, although he'll admit that on some days he might get off to a slow start after a late night entertaining clients. He rarely gets drunk; most often he gets (as he puts it) "relaxed." And that seems like a good thing to him; he's always been kind of a high-strung guy who has a hard time sitting still, and drinking helps settle him down as well as acting as a great social lubricant.
As he sees it, Alec's biggest problem is that people in his life have been bugging him about his drinking recently, and he needs those people to believe that he takes what they're saying seriously so they'll back off. Wendy, his wife, is the main one. She's been giving him a hard time because he often comes home late after a few drinks, and when he finally does get home he's not in the mood to spend time with her or their daughter. She complains that she hardly sees him since either his evenings are taken up with client meetings or he's too tired after a few drinks for any quality time. She also thinks he's more likely to be irritable and start yelling after he's been drinking; he counters that he only gets mad because she just won't leave him alone to have some time to himself when he comes home, even though she knows he needs it and deserves it.
The other person who's been on his case lately, in Alec's view, is his primary care physician, who told Alec that he should cut down on his drinking because his cholesterol and blood pressure have been rising and he's put on some weight. While none of these issues are immediate threats, the doctor said, staying on this track would put Alec's health more at risk the older he gets. Alec got irritated with his doctor and dismissed the warnings, telling himself that he's still in great shape and doesn't need to start acting like an old man just yet. But a couple of weeks ago a friend at work, who is a few years older than Alec, and whom he respects as an excellent salesman and someone he can talk to about life and its hassles, told Alec about a scare he'd had recently —"not a heart attack, just some fibrillations"—and added that his doctor had told him he needed to stop drinking if he didn't want to have a much more serious event in the future. This got Alec thinking that he might want to cut down a little bit, kind of ease off for a while and maybe drop a few pounds too. He feels pretty sure that he could do that without much trouble, so he's started to think about it, even though a part of him doesn't want to give Wendy the satisfaction of saying "I told you so" or his doctor the idea that he thinks the warning was anything other than alarmist.
Barbara: "I Can't Go On Like This, I Must Go On Like This"
Barbara is 51 years old and lives with her husband of 30 years, Steve, in a gated community outside a large city. They have three children; the youngest, a daughter, just went off to college. Barbara met Steve in college; they got married at the end of her junior year (Steve had just graduated and gotten an entry-level position with a good company). She'd planned to go to law school after graduation but put it off when she got pregnant. When Steve's career began to take off, along with his income, she decided it was time to carry through with her plans and start law school. But when she became pregnant with their second child the demands became too great and she didn't go back to school for her third year.
Although she was disappointed not to have finished law school, Barbara happily threw herself into her life as a wife and mother. She became involved with all her children's activities—driving them to lessons after school, serving as an officer in the PTA, helping to coach her daughter's volleyball team and the robotics club after her older son showed an interest in it. She developed strong friendships with several of the mothers of her kids' friends and a wider circle of other women in the community. At the same time, as a result of her husband's often being away for work and her thorough involvement in her kids' lives, she and Steve had gradually drifted apart over the past two decades.
Barbara is stuck in thinking about ending her marriage. Steve is a good man and a good father; she feels fond of him and pictures them growing old together. She doesn't really want to leave him, and when she thinks about it she feels afraid of losing not only her financial security, but also the emotional security of knowing Steve cares and that she can count on him in a time of crisis. She also thinks about how ending the marriage would hurt him and also their children and how selfish it would be of her to tear apart their family; when she imagines it, her heart aches and she feels like a bad person.
And yet ... in the empty house with Steve at work or traveling and her children gone she is acutely aware of how quickly time is passing and of how fast she is aging. She feels something in her life is missing and increasingly thinks this could be her last chance at developing a sense of passion about either a career or a relationship with a man—which she feels might be possible for her but which, she now admits to herself, she has never really experienced. In fact, she has recently had a mild flirtation with another man, a divorced father she'd known for a while through her daughter's volleyball team, who had complimented her on her outfit and asked if she'd like to have coffee sometime. She'd said no, but it scared her that she couldn't stop thinking about the encounter and wondering whether she should have said yes. When she's honest with herself, she realizes that she's afraid of life being the same forever, of missing out on opportunities for growth and excitement, and of growing old without ever knowing what it's like to experience them.
Barbara finds herself thinking about her situation almost constantly. Telling herself she must choose between her family and her own needs, she cannot accept having to give up either. When she talks to her sister, Sue, the only person she trusts enough to confide in, she feels intensely guilty, because her sister thinks Steve is such a good man. But her husband is also a conventional man, who seems happy with the state of their marriage and with knowing that she is there, at home, taking care of their life—and when she sees couples who are obviously in love, or reads about high-powered women in positions of authority, she feels a lump in her throat, wants to cry, and despairs that life is passing her by. Stymied every way she turns, she comes back again and again to the thought that no matter what she does it will be the wrong thing.
Colin: "Why Am I Still Acting This Way?"
Colin is 32 years old and has been in a stable relationship for the past 5 years with Paul, a man 12 years his senior. He has a good job in a creative field; it's a high-pressure position with long hours but he can't really imagine doing anything else. Paul has a high-level position in finance and works long hours as well. They have a dog but no children and have an upscale lifestyle, sharing a condo in a large and progressive city.
Colin is stuck in what to do about the way he expresses anger. Ever since adolescence his family and friends had known Colin as a person with a short temper. He knew they saw him this way, and at times he had wondered if his anger was too intense and even out of control, yet often Colin has felt as though people were exaggerating the problem. Yes, he might blow up sometimes, but most of the times this happened he believed he had good reason to be angry—someone had treated him disrespectfully, not shown the same consideration to him as he did to others, or failed him in some important way.
The main impetus for Colin's thinking about handling angry feelings differently is coming from his partner. From Paul's perspective, living with Colin is like riding a roller coaster. The highs can be very high: much of the time Colin is sweet, considerate, thoughtful, and affectionate. But the lows—when Colin, as he puts it, "explodes"—are very low. Paul tells Colin that often when Colin gets angry he feels blindsided, as if the anger comes out of nowhere. As a result, he says, he lives with a constant, low-level worry that at any moment Colin could go off on him. At times this has happened in public, and those episodes were especially painful for Paul: mortifying, as well as hurtful. But the cumulative effect of Colin's blow-ups, says Paul, has been to make him feel bad about himself. Worse, Paul has found himself taking these feelings out on others, angrily chastising his subordinates at work and even yelling at their dog for making messes.
When Paul describes what it's like to be the target of his anger, Colin feels sorry and regretful. Yet when he thinks about Paul's complaints, he also feels a certain amount of resentment. After all, he never gets physically violent; other than a few occasions when he might have pounded a table, and once when he threw a glass across the room, all he ever does is yell. Isn't that what people do when they get angry? he asks himself. Isn't that normal? He doesn't expect his partner to act any differently: Paul can yell at him, and does, just as he yells at Paul. And why won't Paul understand that what gets him really incensed is when Paul refuses to acknowledge that he has a right to be angry when he's been treated unfairly? If only Paul would validate my feelings, Colin thinks, so many of our worst arguments could have been avoided, or at least could have been settled much more quickly.
Despite this sense of justification, Colin has come to believe that he needs to do something to change the way he deals with angry feelings. He knows that he has become more frequently irritable and snappish with Paul, so the good times and warm feelings have been fewer and farther between. In fact, recently he's become aware of an increasing emotional distance between them; they seem to connect less often, and their sex life has become more intermittent. And after going for therapy, Paul told him that he doesn't want to live this way anymore—he loves Colin, but unless Colin's outbursts cease he doesn't think he can continue to be with him.
Because Paul said this in sorrow, rather than as an ultimatum, Colin did not feel threatened and doesn't feel like arguing back. He loves Paul, does not want to lose the relationship, and has decided to control himself and handle his anger differently. He believes it should not be too difficult since he knows when his anger is building and is sure he has the ability to restrain himself instead of just giving in to it. Yet he hasn't been very successful at controlling his anger thus far, and this has confused him and allowed some doubt to begin to creep in. He wonders what would happen if he didn't make this change and has become somewhat uncertain about how he's going to do what he needs to do to get himself under control.
Dana: "My Heart Says Yes, My Head Says No"
Dana is 26 years old and single, with no children. She lives alone in an apartment in a medium-size city. Dana was the first in person in her family to get a college degree, and after graduation she took a position as an administrative assistant with a large company. She was earning a good salary for someone with a BA early in her career and felt good about being able to establish her independence. Several of her friends from college, who went on to graduate school, told her how envious they were of her nice apartment and clothes and her ability to pick up the check when they went out for drinks. Her family has also been vocal about their pride in her and their gratitude that she has been able to help out her younger brother as well as several other family members financially. But recently, after almost 4 years on the job, Dana has been wondering about the choices she's made.
Dana is stuck in the decision of whether or not to leave her job and change careers. Her job is steady and reliable, the company stable, the salary sufficient (with regular raises), the responsibilities manageable and familiar. Yet for some time now she's been feeling restless and dissatisfied. Two of her bosses tend to talk down to her and treat her as less capable than she really is, and she's not getting the opportunities for advancement she'd hoped for. She's begun to find her daily routine boring, and the good feelings that come from knowing she's taking care of her family have begun to be outweighed by feeling bad about the lack of respect she receives. Her friends, having finished graduate school and begun working in their fields, are not only catching up to her financially but, as their careers as professionals have begun to take off, their conversation is mostly about their excitement about the work they are doing.
Excerpted from Finding Your Way to Change by Allan Zuckoff, Bonnie Gorscak. Copyright © 2015 The Guilford Press. Excerpted by permission of The Guilford Press.
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Table of ContentsForeword, William R. Miller & Stephen Rollnick Prelude: Considering Change I. You Don't Have to Change 1. Being Ambivalent 2. The Pressure Paradox 3. The Other Side of the Pressure Paradox II. Do You Want to Change? Can You Change? First Interlude: The Language of Change 4. Exploring the Importance of Change to You 5. Exploring Your Confidence for Change 6. Exploring Your Personal Values Second Interlude: Ready or Not? III. Finding YOUR Way to Change Third Interlude: Planning for Change 7. Developing Your Plan 8. Revisiting, Revising, and Regrouping 9. The Far Side of Change Appendix. The History and Science of Motivational Interviewing Resources
Anyone struggling with habits or behaviors they want to change; also of interest to psychotherapists, counselors, health care professionals, and coaches.