Just Three Things

I’ve often said that at its core ACT is about three things – relationship, relationship, relationship. Medication, recovery planning, psychosocial rehab all have to occur within the context of relationship.

In terms of the practical skills ACT clinicians need to do their work, I recommend three things – MI, MI, MI (you saw that coming now, didn’t you?) The skills of Motivational Interviewing – active listening, open-ended versus closed-ended questions, acknowledging ambivalence, using reflection, enhancing self-efficacy etc… – are absolute necessities for the day to day task of helping people effect change in their lives.

MI TitleMI is not a panacea. Even if you become most skilled at it you’ll still be working with clients who will continue to have profound struggles with addictions, with symptoms and with relationships. It’s like what Churchill said : “democracy is the worst form of government, except for all the others”. MI is better than bombarding with questions and much better than confrontations and ‘interventions’. Yes, there are times when I’ve laid it out in black and white to a patient – “Joe, you’re either agreeing to go into hospital or you’re not agreeing on going into hospital, but you ARE going into hospital.” But that kind of conversation should never be my ‘go to’ tool for anything.

How to acquire MI skills? Wish I could tell you it’s ‘quick and easy’ but it’s not. It’s worth investing time and energy learning them but it’s like exercise, I have to keep doing it and doing it and…

Miller, Rollnick and MoyerMiller and Rollnick’s Professional Training DVDs are an invaluable tool. Better than their book – is it ever as good reading an exchange between client and clinician versus watching and hearing? – these discs should be made available to all ACT clinicians.

If you’re an agency director buy your ACT team the set for $110 through the University of New Mexico. (Click to open the pdf order form) If you’re a team leader, program director or the like and have $110 left in your budget, buy the set. If you’re a front line clinician put it on your Xmas/ Hanukah/Kwanza/Winter Solstice wish list and casually leave this visible to your team leader come November. When you get the DVDs start watching them; watch with others, watch just 10 minutes then discuss some of the concepts; bring it to a team education session and talk about one thing. Slowly, slowly clinicians start to pick up some of the lingo, then become more aware, hearing that little voice in the back of their head asking “What I just said, was that a closed-ended question? How could I have made it into an open-ended question? How could I have put it as a reflection?”

On the DVD Theresa Moyers’ interview with ‘Jim’, demonstrating how to Roll with Resistance is masterful and it alone is worth the price of admission. Yes, the client may be an actor but Moyers is going in cold, no script, and her technical skills are so wonderful to watch. I’ve seen it at least a dozen times and still learn something new each time.

Try not to think of learning MI as an event; it’s a process, a long-term one that has to be returned to again and again.

I’ll be back with more on MI.

PS: I was saddened to get the recent email that ACTA will be shutting down. Thank you Cheri Sixbey and Alexandra Sixbey-Spring for keeping it going as long as you did.

To paraphrase Joni Mitchell, sometimes you don’t know what you’ve got till it’s gone.

Shalom Coodin

4 comments

  1. Thank you for these awesome posts, Shalom! I am an ACT clinician in San Diego, CA. I was wondering if you knew if there is a more recent series of videotapes for MI. I asked my team lead if I could buy these that you recommended from 1998 and she noted that a new version of the MI book has come out since then.

    1. Dan,
      Thanks for the feedback. As far as I know there still is only the one set of the video training set.
      I know Miller and Rollnick’s book is now in a 3rd edition. The publisher has some add-ons to the text on their website which might be of interest. As valuable as their book is, I think the DVD’s are a better tool for ACT clinicians, focussing on practical skills. The book has a fair amount of theory and evidence, more geared to academic needs. Busy ACT clinicians need the practical stuff.

      The DVDs come in the most boring case you can imagine – glitzy cover it ain’t. But the content is great.

      I fear a lot of agencies think of teaching MI as an event; send clinicians to a workshop or bring in someone to do a two day thing. These can be useful starting points but getting clinicians to incorporate MI is a marathon, not a sprint! If a team has someone who has an interest and becomes a lead in this area (maybe you on your team?!) that individual can be the driving force for coming back to developing MI skills over and over and over…

      I once heard a speaker at a big psychiatric conference giving an overview of MI. They started by saying “a lecture like this in front of a large audience – is NOT the way to learn MI”. I admired their honesty.

      Shalom

  2. Shalom,

    Thanks for the response. I will likely just buy the DVDs so I can have them to watch and learn from at home. Thanks for the recommendation. I very much appreciate the marathon/sprint analogy. I have been working for an ACT model for four years now and I feel I have barely scratched the surface of knowledge and skills I need to effectively help my client’s on the journey of recovery. I would like to keep a dialogue with you and others on this blog to share ideas and solutions.

    Dan

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