I noticed with great interest and appreciation your chapter incorporating values in motivational interviewing in the latest edition of Motivational Interviewing. Values is often the missing link, in my view, in both clinical research and therapy. What, after all, motivates people to change? For me, as you point out, motivational interviewing has always been about flipping people to examine their behaviors in line with their values.

Stanton

Hi Stanton,

I think your website is one of the greats in the addiction field - stimulating and thought-provoking. Actually, your moral vision of addiction article is required reading in my introductory substance abuse course and was discussed in an earlier version of the MI values chapter before the editing process required some trimming down. I have used your question "why do the same people do so many things wrong?" as a launching point for classroom discussion. The longer I can keep students thinking about that question, the more they seem to have to re-examine the things they've come to believe based upon what they have been told by others or have seen on the TV. They have to think for themselves in order to answer the question without resorting to slogans and unexamined handed-down ideas. This is one of my primary interests in teaching – not to lead students to any one view of addiction, because I think all of the major perspectives on addiction are incomplete, but to help them to more critically think about the array of information available on substances and substance use and come to their own conclusions.

I also link to some of your other online articles on the MI website at http://www.motivationalinterview.org and require students in my classes to read other thought-provoking articles you have written.

My thoughts on values in counseling relate to helping people figure out what they really want and how they can get it or something close to it. It seems to me that when people know who they are and what they want, and have some opportunity to achieve it, many of the problems they experience go away on their own rather naturally. It just seems a lot easier to give up a habit that is getting in the way of something else that is more important to you than to give up a habit because it is bad for you or because it bothers other people. The focus becomes not "what do you need to quit or escape from" but "what do you want, what are you going toward." Counseling becomes a process for helping people become centered, clear, and empowered to live a life that is satisfying and of which they can be proud.

I have found that a lot of the time I previously spent with people figuring out what's wrong and how it got that way was inefficient, and that a better way for me to help toward change is to get excited about people freeing themselves from all sorts of chains and do my best to help make change a low-key, relatively non-threatening experience.

All the best,
Chris Wagner

Dear Chris:

I do think we are traveling much the same territory – I love your using my question, “Why do some people do so many things wrong?” In Diseasing of America (on page 135), it actually reads, “Why do some people – and their families and everyone they know – do so many things wrong,” which recites the foibles of Detroit Lions football player Reggie Rogers and his family. In an interview Rogers reviewed his disastrous previous year – including his brother’s death by drug overdose, his sister’s disappearance, his being charged with aggravated assault and begin sued by his agents. Less than three months after the first interview, Rogers was charged with killing three teenagers while driving drunk and recklessly.

Of course, when you think about that story (as you force your students to do), you immediately are forced to think about how some people, and their families and their social milieus, have bad values. Not that they can’t recover from that, but it indicates how important it is to inculcate values – like responsibility for your actions and concern for others – from the start. And behaviorists, disease proponents, and all politically correct people shy away from recognizing the role of values in much of what we identify as addictive and other dysfunctional behavior.

Of course, values are thus a key tool for changing behavior, since most people do somewhere subscribe to bedrock values, and some rather strongly, which their behavior belies. My favorite educational device is to talk about how my Uncle Ozzie quit smoking when a co-worker told him that he, a labor activist, was a sucker for the tobacco companies (that one’s on page 189 of Diseasing). I extend the story and then finally ask, “Why did Ozzie quit smoking permanently that day, based on a single chance remark by a co-worker?” I point out that if we could package that technique (of course, it requires people who are as focused on key values as my uncle), then we could become miracle workers as therapists.

Of course, I agree completely with your description of therapy – indeed, I have lately become aware that people are marketing something called “coaching” which follows what you and I practice. That is, it shifts from the past and trying to put labels on experience to the future and problem solving.

Chris, it’s great to make contact with you and to know my work resonates so well with your own take on motivational interviewing – which I practice and which I admire so much as it has been developed by Bill Miller and you and other of his colleagues.

Stanton Peele