This article was previously published on the Homelessness Resource Center website...
The Homelessness Resource Center (HRC) is funded by the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Homeless Programs Branch within the Division of Services and Systems Improvement, Center for Mental Health Services. HRC is an interactive community of providers, consumers, policymakers, researchers, and public agencies at federal, state, and local levels. HRC shares state-of-the art knowledge and promising practices to prevent and end homelessness through free training opportunities, webcasts, distance learning, on-line networking, and knowledge products.
“I do Motivational Interviewing on the fly. I talk to people on the streets,” explains Alan Pickett. He is a Mental Health Outreach Nurse at the Project Outreach Team (PORT) for Washtenaw County Community Mental Health in Ann Arbor, Michigan. PORT is an intensive community outreach team serving people who are homeless and who have mental illness.
“I believe that people who are trained in Motivational Interviewing have a different perspective on building relationships. Many people are trained to view clients in a paternalistic manner, like they are children. This attitude says that providers always know what is best for a client. This attitude makes us think that we must convince clients that we know what is best for them. In this view, success is measured by the provider’s actions, not the client’s.”
In the spirit of Motivational Interviewing, Alan does not define success this way. He believes his first task to is to make himself available to the client. He strives to be present and demonstrate that he is available as a supportive person. “I may not indulge a choice that is not healthy. But I am not going to stop listening to someone just because he or she is not making decisions that reflect healthy changes.”
Motivational Interviewing is a collaborative process involving two people with their own areas of expertise. The care provider uses skills to explore ambivalence and to elicit and strengthen “change talk” – client statements that express desire, ability, reasons, and a need for change. The client brings self-knowledge and life experiences to the relationship. A person knows whether or not he is ready to move in the direction of change. Together, the care provider and client ask questions, discuss issues, and share perspectives. It is not a one-way exchange of care provider to client, but a shared, two-way conversation.
To demonstrate the spirit of Motivational Interviewing, Alan shares the story of David.* David’s story illuminates the beauty of shared interests, a shared narrative, and the healing that can come from walking side by side…or in this case, examining lost treasures together.
David grew up in Ann Arbor, Michigan and suffered from the symptoms of profound anxiety and thought disorder. Using alcohol was his coping mechanism for many years. According to David, his “illness self” presented to others as a person who was both guarded and fearful. While it may not have been David’s true personality, it was how he interacted with others.
“Initially, I only had limited contact with David. When he was miserable and drunk he would come into our office. For months, I wanted him to see our psychiatrist. But he simply did not trust the system.”
Months passed. Alan would make appointments for David to see the psychiatrist. David would not show up, or he would arrive and express ambivalence and fear. He worried that he would be medicated and lose all of his rights. During this time, David lived in an abandoned building. He feared being found and arrested.
“One day, I happened to run into David at a construction site. He pulled some things out of his rucksack, including an antique pharmacy glass bottle from the 1800s,” explains Alan. Out of this small exchange, Alan learned that David had a strong interest in antiques. It was a genuine hobby.
“I was wowed by this. That very day, we went back to my office and spent an hour on E-bay surfing for antiques. Our interaction was not based on David’s pathology, or me having any power. It was based on David sharing and showing me something that he cared about. I was very pleased and I was deeply interested in his newly revealed strengths,” explains Alan.
For the next few weeks, David would come into Alan’s office with bags filled with his antique bottle collection. They were archaeological finds from local construction sites. One day when David arrived, the psychiatrist happened to be there with Alan.
“David showed us a glass bottle that had been made in Toldeo, Ohio in the 1800s. He knew that this particular glass came from just one manufacturer. This conversation evolved seamlessly into another about social security benefits. We learned that searching for glass helped David to cope with both anxiety and sleeplessness,” explains Alan.
Alan understood that his genuine interest in David’s hobby helped him to feel more comfortable. Slowly, David was able to share more than his hobby with Alan and the psychiatrist. He began to talk about his thoughts and feelings.
Eventually, David started on medications that helped him, secured social security benefits, and found housing. Today his quality of life is better. David has been housed for four years.
“David has continued to see our psychiatrist. He still brings us glass gifts from time to time. I believe that he became ready to explore the idea of changing within the context of the relationship with us. We recognized David as a person, supported his personal strengths, and accepted him without judgment, within his circumstances. This made all the difference,” offers Alan.
This is the spirit of Motivational Interviewing. For David and Alan, conversations about antique glass proved to be just a breath away from other conversations about benefits, mood, sleep, and thought patterns. Together, they uncovered hidden treasure in a human relationship. This discovery led to a transition toward a more secure, stable, and healthy life.
*Not his real name.
Photograph from www.antiquebottles.com/greensboro/