by Steven Gledhill for FREEdom from Medom Project
My clients often are looking for answers as to why they have done things that in their right mind they despise.
A New Testament writer wrote, “I do what I don’t want to do… I do the things I hate… I want to do right but I inevitably do wrong… There is another power at war with my mind.” He then when on to say, “What a miserable person I am… Who will free me from this life?”
That power is “my addiction to me”, or as Barack Obama once said (8/16/08), “What I trace this to is a certain selfishness on my part… I am obsessed with me and the reasons I might be dissatisfied.”
What satisfies? What does it take to be content? What am I chasing that I cannot ever seem to catch?
Chasing contentment is like a dog that keeps spinning in circles trying to catch its tail.
There is what I ultimately want (and need) that I believe in my soul satisfies—love, joy, peace, freedom—and then there is what I want in the now that gratifies. I will settle for what gratifies even though it’s temporary and at the end of the day still falls short of contentment. What I settle for proves not to be satisfying but it’s better than it was, so I’ll take it.
The problem is that what I tend to settle for has things attached to it that I don’t particularly care for. In fact, some of the immediate rewards that bought me gratification (though fleeting), have some serious (even dire) consequences attached to them. In the case of my clients, it is prison.
The substance abuse work that I do is not prison ministry, per se. It is my job in a strictly secular setting. The ministry that I do at work many would say puts my job at risk on a daily basis. I am careful to only go as far as the values of my clients take me when it comes to the spiritual emphasis they put into their treatment. Even the 12-step element that is allowed is intended to address spirituality but anything specific to the Bible or any other religious doctrine. Notice that I italicized specific.
The other day there was discussion in my treatment therapy about the matter of extending the good news of recovery to family and friends at home; through both the spoken message and through behavioral change. (I wanted to say ‘gospel’ of recovery but the very word has a religious connotation.) A few of the guys had concerns that the message would not be favorably received. To what lengths should they go to continue to “preach” their message?
While these guys are new to recovery and are encouraged to do more walking the walk then talking the talk, I did talk to my group about a man that lived a long time ago that carried a message to his family friends about living a healthier life and that he was willing to share with them the tools he had to do just that. In fact, he even had the ability to extend healing to them to afford them a fresh start at a better life. The problem for the man was that his family and friends were more interested in debating his “credentials” than receive the gifts and the good news he had for them. They complained that he wasn’t anything special and criticized him with a “Who do you think you are?” attitude toward him. He was disappointed and discouraged by their attitude and left their town. He even told them flat out that the gift and the gift giver were apparently not welcome in his home town. He took his talents elsewhere.
My clients knowledgeable in Scripture knew exactly what I was referring to; that even Jesus did not waste the gift on those that didn’t want it because what they really rejected was him, the gift giver; not the gift. My less-than-believing clients seem to appreciate the message of the story, which I told them was from “the literature”. Most, if not all of them understand the literature that I am referring to is the Bible. Since I do not identify the Bible or identify specific characters, it flies. I have done the same with so many other stories: the paralytic at the pool of Bethesda, the Prodigal Son, David and Bathsheba, etc. I cloak the stories enough in ambiguity that it is safe, while driving a home a clear yet powerful message.
The following is my approach to Motivational Interviewing as a Christ-centered therapist committed to the call of God to deliver the gospel of recovery into God’s best God’s way.
Assessing and Challenging Ambivalence
William R. Miller’s initial description of Motivational Interviewing: “MI focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change.”
Motivational interviewing serves as a vehicle of unveiling revelation to help clients to see more clearly their ambivalence to change while focused on immediate gratification. However, once in the depth of the despair that comes with the lost freedoms of prison and separation from loved ones and the life they want deep down to experience—love, joy, peace, freedom—what develops is alarming discrepancy.
I want this and I want that, seemingly equally, but these motivations are in conflict; opposite from each other. I think I can have ‘this’ and ‘that’ but then come to find out that ‘that’ does not turn out well. ‘That’ had consequences attached to the rewards that far outweighed the benefit of those rewards.
Resistance to change diminishes when my clients make such discoveries and come to understand that what appeared and felt beneficial came with outcomes they hate. As they grow in awareness that fleeting gratification is connected to what they hate, then maybe they come to hate the behavior that on its surface appears and feels attractive. Maybe they come to hate the criminal life as they become resistant to it… for a change.
Roll with Resistance
Developing Motivational Interviewing skills reinforces my values and skills as a therapist to actively listen to my clients, to express empathy to them, and to reflect back to them what they said from their own mouths so that they can convince themselves that change is good; not because it’s treatment, but because it plainly makes the most sense to them, according to what they have communicated holds value for them.
Values and beliefs are an ongoing tug of war between intellect and emotion. Desire, motivation, and determination are emotions manipulated by the drive for contentment. The issue is the role intellect gets to play in the process of shaping values and beliefs in contrast to the role emotion plays.
There’s obviously a difference between what is good and feels good; what is right and what feels right; what is smart and what feels smart.
All I try to do is help my clients to see and agree with what they already knew intellectually to be good and right; but that they allow what they feel emotionally to cloud their own judgment in disagreement with what they trust intellectually. I help them to see for themselves that trusting in what they value emotionally betrays what they value intellectually.
Why keep doing the things I hate? What’s the sense in that?
Clients that believe Jesus Christ to be their Higher Power in their recovery have an obvious advantage as they are empowered—armed with the weapons, if you will—to break down the walls of resistance to change, along with the courage, energy and stamina for the journey of recovery. It’s a beautiful thing.
It is said that when the client is resistant the challenge is for the therapist to roll with that resistance in order to promote effective change. Since the “moment” in the case of Christ-centered therapy is intended to have a transformative effect, it can be measured against the shared value of common sense. This does not require agreement between client and therapist to determine what is sensible. Common sense, when it is arrived at in the session, is shared as both client and therapist have some “sense” about it and take on an agreeable proclivity for how they process and progress deeper into it.
One description for Motivational Interviewing that I have seen goes like this:
Motivational Interviewing is a collaborative, goal-oriented method of communication with particular attention to the language of change. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change.
I find working with my clients living in prison that they have been in intellectual agreement with what is typically considered to be common sense. To develop discrepancy between where the incarcerated client lives and where he would prefer to live you would think would be easy enough considering where he actually lives. Since many of these men have been in a pre-contemplative change stage, it’s not always as easy as it would appear. The reality has been that the emotional rush or high has run rough-shod over the men until they can for themselves draw on the connection between their circumstances and the behavior that brought them on.
To develop discrepancy is to help my client through his own sensibilities detect advancing disagreement between what he understands intellectually to be satisfying and the gratification he’s been is willing to settle for on an emotional level. Through active listening and reflecting back to my client from my intellectual understanding of what he has been telling me, it affords him the opportunity to explore his experiences from an intellectual base. As my client’s intellectual understanding of his experiences evolves, he emotes a sense for wanting something more substantive and sustainable from present and future experiences.
The description above suggests that Motivational Interviewing elicits and explores the person’s own arguments for change. The person’s own argument for change is what the person already knew intellectually to be true, honest and real. What is that if it is not common sense? It is exactly what that is! Common sense is derived from discrepancy between what the person wants in life and what he has in life. The discrepancy is that which is missing. Change is what he is willing to do and the lengths he is willing to go to get it.
Autonomy versus Authority
Since the ability and course for change lies within the person wanting and needing to change, therapists respect their role, not as the agent, or even the facilitator, of change since that burden lies with the client, but as a guide in the process. However, this is the area where autonomy and authority take on a collaborative role in the therapeutic Christ-centered relationship between client and Creator. The therapist has the opportunity to help promote the sensibility in advancing this relationship. It is in the relationship between client and Creator that clients can experience transformative change from what has broken down to what can be rebuilt and restored through the substantive and sustainable reality of redemptive healing.
This experience of collaborative relationship between the One that built it and the one that broke it appeals to the deepest sensibilities of the client in need of change. When the wires get crossed, why not call on the original mastermind that wired the thing in the first place? It only makes sense… the most sense; doesn’t it?
The Christ-centered therapist need not insist that there is a right way to change. Rather, the Christ-centered therapist guides the client to search himself to address his own belief system concerning the things he recognizes within himself to be honest and real concerning his spiritual relationship with God and how he views that relationship in the context of his life and how he chooses to live it.
Many would say that what I am suggesting here is not at all in keeping with the ardent principles and conviction of what MI is all about and intended to be when it comes to the presence of authority in the person of Jesus Christ. Many would say that Christ as a spiritual authority is judgmental and shame-based and will serve a counter-productive purpose to restorative change. I will not deny the presence of conviction. If we’re all being honest about what we do as clinicians, change does not really occur at all without a deep sense of conviction. Without conviction there does not exist the need nor the will for change into something different and better.
Autonomy still exists in the relationship between client and Creator since the relationship is in and of itself autonomous.
Empathy and Advocacy
What this article is not is Motivation Interviewing 101. If you are reading this, you likely are a clinician pretty well versed on this topic. So I wish to make a couple more key points and then you can proceed to use what you deem fit to use from this.
The last thing I want to discuss is the matter of empathy and advocacy for the client. After what I just said you might be thinking, “It doesn’t get any more rudimentary than this… Now he’s going to talk about empathy and being an advocate for my client?”
I am, but not in the way you might think. I will go into some depth with it from a Christ-centered perspective.
So then, since we have a great High Priest who has entered heaven, Jesus the Son of God, let us hold firmly to what we believe. This High Priest of ours understands our weaknesses, for he faced all of the same testings we do, yet he did not sin. So let us come boldly to the throne of our gracious God. There we will receive his mercy, and we will find grace to help us when we need it most. Hebrews 4:14-16 (NLT)
The principle central to MI is the expression of empathy. Every good counselor knows this, lives this, and is naturally empathetic (empathic?) with positive regard for their clients out of genuine compassion and concern for them and that they do well. But the relationship is professional; and while we may experience a Christ-centered love for our clients we do not have the immediate level of love and compassion for them like that of a loved one—a spouse, a child, a parent, a sibling, a close friend.
What we as therapists cannot offer our clients is the compassion, the love, and the mercy of a Savior. We will not impose our spiritual values on our clients. But even to the one who appears initially not to believe, I can ask, “If there was someone who loves you unconditionally, fully understands you, and would like to help… with the resources to help, would you like to meet him?” If clients want to here more about that, we as Christ-centered therapists can go with them as far as they want to go to know and receive from him.
Are we taking advantage of the vulnerability of clients that are hurting and susceptible to proselytize and impose Christ-centered values? I don’t see it that way. As therapists, if we’re honest, we are always taking advantage of the vulnerability of hurting clients to develop discrepancy between the source of their pain and the reward that comes through change to remedy the pain through best right living. It is in their vulnerability that their intellectual constitution can gain more of an equal footing with their emotional resistance to change that which perpetuates impulsive behavior that proves destructive.
Empathy versus Sympathy
We all know that empathy is the understanding that we generate for our clients’ problems, usually from imagining what it must be like to suffer through what they have suffered.
My clients live in prison. Most do not have healthy relationships with their fathers if they know their fathers at all. My clients have committed crimes against their communities and fellow human beings. Most have experienced gang-related behavior and the outcomes from gang activity; including violence on some level and the use of firearms, as well as injuries from firearms and various weapons. Right or wrong, the vast majority of my clients believe they are victims of injustice; born into a system of poverty and violence, having to fight for every advantage just to survive.
As their counselor, I cannot understand through my personal experience what they have experienced and how they have suffered. I can only imagine it, and in doing so can begin to understand their pain. It is difficult eliciting trust from them since I have not shared in their life experiences, intensifying the challenge to build relationship and establish healthy rapport.
For we do not have a high priest who cannot sympathize with our weaknesses, but One who has been tempted in all things as we are, yet without sin. Hebrews 4:15 (NASB)
Sympathy—from Latin sympathia, from Greek sympatheia, having common feelings, sympathetic, pathos feelings, emotion, experience—pathos means an element in experience or in artistic representation evoking pity or compassion
Sympathy—1 a: an affinity, association, or relationship between persons or things wherein whatever affects one similarly affects the other b: mutual or parallel susceptibility or a condition brought about by it c: unity or harmony in action or effect 2 a: inclination to think or feel alike: emotional or intellectual accord b: feeling of loyalty: tendency to favor or support 3 a: the act or capacity of entering into or sharing the feelings or interests of another b: the feeling or mental state brought about by such sensitivity
As defined by Merriam-Webster, Inc.
The Greek word for sympathy, sympathia, suggests that in Christ Jesus is an advocate for our clients who understands them, not because he imagines what they have experienced, but because he has shared in their experience. He has that in common with them. He knew the pain of being victimized by a system of poverty and injustice. He did not sin like they did, but he understood their desire and motivation to do wrong and commit harm. Jesus wrestled with human emotion and the temptation to react impulsively and selfishly. If that were not true, he would not truly have been tempted in his gut to sin and would not be able to sympathize, nor fully empathize with me or you or our clients.
The word sympathy is used in the case of Christ since he has shared in their suffering, affording him a sense of authenticity and integrity in relationship with our clients that even we cannot fully comprehend. We recognize this as clinicians when we have that authenticity and integrity in our own relationship with Christ that our clients cannot fully comprehend, and in many cases struggle to understand at all.
How did you get there? What does it really mean to actually have a relationship with a higher power that you call God, or Jesus Christ? What does that mean for you? Be willing to be transparent with the clients that want to know. You are not imposing your values on them or preaching. You are not in the role of converter. You are simply sharing enough of your story that your clients want to identify with. Sharing some of my story as it pertains to how I practically apply faith can have a revelating effect on my clients. It can open a window into what it means to have faith according to what I know, having experienced God (who I do not see) in my life.
Now faith is the substance of things hoped for, the evidence of things not seen. Hebrews 11:1 (NKJV)
My clients at the prison tend not to find God in prison. They are usually returning to God in prison. It seems that most of my clients report having a daily prayer life, at least in the morning and at bedtime. I am under conviction at times when the prayer life of my client leaves me feeling that mine is insufficient.
The point of all of this is to suggest that as clinicians we can encourage our clients through awareness that there is One who is deeply concerned about them who understands them even beyond our ability and willingness to understand them.
Reflections and Affirmations
The goal-driven strategy of Motivational Interviewing directs therapists to guide clients along the process of change, assisting their clients in moving from one stage of change to the next, always sensitive to their client’s readiness to change. To help clients stay on the path leading to change, counselors use reflections to help clients to see for themselves what they themselves are saying about their problem and what they are saying they need for their circumstances and relationships to improve. Reflective listening allows counselors to reflect back what clients are saying, punctuating from the client’s own words the necessary emphasis to help redirect focus as it appeals to the client’s intellectual comprehension of what makes the most sense to them.
What appeals to and makes the most sense for my believing clients is the change that reflects the relationship they want to restore in their relationship with God. I find that what works through reflective feedback to my clients is that which helps them to see the connection between living to honor their relationship with God and the restorative outcomes to circumstances and relationships. The proof of these positive outcomes—blessing—is the bed that truth lies in. They want what works. That’s it! So as they experience a certain consistency in experiencing God’s favor, the more they tend to move toward consistency concerning behavioral change, according to their new way of thinking. I suppose this is the essence of transformative change.
Don’t copy the behavior and customs of this world, but let God transform you into a new person by changing the way you think. Then you will learn to know God’s will for you, which is good and pleasing and perfect. Romans 12:2 (NLT)
As a therapist working with clients seeking to, in most cases, reconstruct the very nature of how they will live to remain free after their release from prison, it is incredibly rewarding to affirm progress for each step taken along the journey. As my clients respond to reflective feedback with insights from their deepest sensibilities, it is imperative that I affirm their motivation to achieve sustained freedom by their willingness to do whatever it takes in an action stage of change. As it becomes increasingly apparent that their value system is now being shaped by a God-directed moral compass (the sin nature, on the other hand, is self-directed and allows morality to be determined by self-centered values), it is my joy to reinforce such decision-making.
Again, to be clear, as therapist, I am not shaping anything; merely acting as a guide to help my clients to make sense of what they already know intellectually to be true and just and best. My goal in the MI process is to assist and guide my clients to experience improved quality of life because it was their own idea to take the initiative to move from where they are to where they want to be. As directed in willful relationship with God, they conclude for themselves that it is best for them to experience the best of what God wants and has for them, and he is giddy for the chance to shower them with it. As clients truly experience the rain of God’s love and mercy, finding rest in his peace, they want to stay there and soak themselves in it.
I have been asked, “What about clients that do not believe in Jesus Christ as the way to transformative change?”
I have clients that are Muslim; and still others who claim to be atheists that do not believe in God. No matter where my clients live spiritually, I am able to utilize the principles of Motivational Interviewing as I have laid out here to guide my clients to explore what they believe they need to accomplish as their self-motivated goal for change. My clients tend to know that I incorporate twelve-step principles to guide my life in recovery from entitlement, that left unattended results in problems for me. My clients tend to see me as a man of conviction as it relates to my outlook on circumstances in my life, and how I respond with a certain sensibility to my circumstances, especially when adversity poses meaningful risk to me and those influenced and affected by me.
I am able to have a rather comfortable rapport with my clients whose beliefs differ from mine. Utilizing the core principles of MI strategies promotes a healthy and productive therapeutic relationship. Should their be discussion turn to spiritual aspects of recovery, the emphasis is spiritual and on relationship with God (if he exists) and does not veer into religion. I seek to be informed by my clients as to what spiritual beliefs and influences affect them and their lifestyle choices. Should the discussion become more specific about personal beliefs, I emphasize with my clients what we agree on so as to abstain from self-righteous prejudice that would certainly infect and contaminate the client-counselor relationship. With the attention on agreement concerning spirituality, positive regard for one another is sustained while nurturing a well-natured therapeutic setting and mood.
MI strategies and principles take aim at intellectual sensibilities and common sense. Even discussions about literature that speaks to divine perspectives can be reasoned through intellectual sensibilities in such a way that need not offend clients and jeopardize rapport. I encourage you as a clinician that believes in God for redemptive transformative change in your own life, not to avoid or shy away from using Motivational Interviewing techniques to explore hopeful alternatives of a divinely spiritual nature with your clients.
For it is God who works in you both to will and to do for His good pleasure. Philippians 2:13 (NKJV)
This verse is usually interpreted as God benefiting from the work he has done in us. No doubt that God takes pleasure in our transformative change. But in God is already joy complete. The work God does in us as we let him is for our benefit; that we would experience the pleasure of God through his immeasurable favor.
When your clients experience revelation from God, it is profound. Do not be afraid to reflect back to them how spiritual revelation has helped you in the change process, affirming for them that change in relationship with God indeed works. Affirming for my clients the truth of their experience in Christ validates for them something they may have considered too mysterious to be taken seriously. That which is spiritual need not have a veil over it. If you know Scripture that gives teeth to what they may not be confident is from God, it can lend credibility to something experientially spiritual they may not have been previously familiar with.
It might run against the current of secular MI methodology to use it in this Christ-centered context, but for me with my clients it is really quite powerful.
After all, who is Apollos? Who is Paul? We are only God’s servants through whom you believed the Good News. Each of us did the work the Lord gave us. I planted the seed in your hearts, and Apollos watered it, but it was God who made it grow. It’s not important who does the planting, or who does the watering. What’s important is that God makes the seed grow. The one who plants and the one who waters work together with the same purpose. And both will be rewarded for their own hard work… But whoever is building on this foundation must be very careful. For no one can lay any foundation other than the one we already have—Jesus Christ. 1 Corinthians 3:5-8, 10-11 (NLT)