Notes on Motivational Interviewing CEU

On the invitation of the owner of Peace of Mind Counseling, a fellow student at FICAM, I went to the impeccably planned, informative, well attended and deliciously catered CEU session held at Casa Tequila Mexican Cuisine on June 20th. While there I networked with other mental health professionals and listened to Mary T. Curtis speak about Motivational Interviewing. While the communication principles found in her presentation was primarily for those in the field of mental health counselors, they are also applicable to a number of other formalized relationships. Translated to the discourse of effective management, for instance, it’s a form of interaction and communication effective in instilling a convivial relationship that encourages long-term partnership.
Mary first had us explore some of the intrinsic and extrinsic motivations for personal changes that we’d made in the past. By exploring the risks we perceived we were making by committing to change, examining the struggles that we had with it, and identifying the various resource used in order to get there she pointed out how it was the job of counselors to be know these tracks and patterns as they relate to change and be able to assist clients. Mary then outlined out the cycle of self-transformative change. The cycle – precontemplation, contemplation, preparation, action and maintenance – was not made from air but emerged from the research of Dr.’s Prochaska and DiClemente.
Based upon the research contained therein, Curtis presented five distinct communication principles to follow in order to master the art of motivational interviewing.

1. Express sympathy.
2. Support self-sufficiency.
3. Create discrepancy in expressed intentions and actions.
4. Avoid arguments.
5. Roll with resistance.

Each of the five principles could easily make up a long essay. Summarized into a few sentences, however, they could be expanded as follows. First, have all of your attention and capabilities be devoted to the person across from you in such a manner that it’s clear your intent to assist them. Relate to their struggle to get better, but do not feel bad for them over the poor decisions they’ve made. Create and maintain rapport or the rest isn’t possible. Secondly, encourage efforts through praise when appropriate and make sure to provide directions in the form of leading questions as much as possible. This oblique form of direction will assist the transformation of their thought processes. Thirdly, through the aforementioned questioning process, don’t just inquire on actions but underlying motivations. Doing so will lead to the most significant changes. Fourth, one of the reasons which arguments occur is from the breaking of affinity. If and when this occurs use linguistic Aikido so that their resistance transforms into transference. The fifth principle refers to the fact that until the new habits are incorporated into the daily life there will exist a split of sorts in the interviewee’s personality and the better angels of their nature should be appealed to. Using their own spoken phrases as much as possible to restate the goals they’ve already voiced and their own assessments is the optimal way to interview them.

As is clear from the above, motivational interviewing is not merely an other-directed practice but one that requires a great deal of self-confidence to be able to accomplish the above practices without coming off as wooden or scripted. Embodying qualities of empathy, compassion, collaboration, commitment, willingness and acceptance are also key MI components. One must do this as expressing too much upset or disappointment over a violation of a stated goal breaks rapport. Instead help them self-search as to the causes to their failure and imagine how they could go act next time if placed in a similar situation. One’s role in the motivational interviewing process is supposed to engender feelings of Autonomy, Collaboration and Evocation. Encouraging ACE to develop in them means that they will learn to better self-discipline.

It is our ability to propel and direct ourselves into the future that determines where we go in life. Since counselors and managers are navigating the future together on a bark of sorts with their clients or employees, those leading must use OARS as one of their strategies for direction. OARS is an guiding strategy for meetings between clients or employees that encourages the growth of skills rather mere directive comments which engenders agency dependency. OARS consists of Open-ended Questions, Affirmations, Reflections and Summaries. These are the linguistic forms used to encourage ACE. Some examples of these are as follows:

Open Ended Questions

“What do you think are the main goals that we need to accomplish today?”
“What are your motivations for the cessation of your habit of __________?”
“What is preventing you for accomplishing your goals right now?”
“How would you rate your level of withitness today? Is there something that you can do to quickly raise your state of presence?”


“You should be proud of the fact that just last week it took you ___ amount of time and that now you can do it in less.”

“It looks to me by the way you are holding yourself in that you’re in a good mood. Did the _____ thing I suggested to do when face with _____ help?”

“Based upon the story you shared with me I can really see your commitment to _____.”

“You are doing excellent work.”

“You ability to take directions has markedly increased!”


“Do you realize that your continuing to do _______ is in opposition to your statement that you want to stop?

“Do you realize that your continuing to do _______ is in opposition to the previous directions I gave you?

“Were you really doing your best on this project, or were you distracted by something?”

“When you saw that your abilities were not sufficient to complete the task, why didn’t you ask _______ or myself for assistance?”


“It seems to me from what you’re saying is that the reason you began doing _________, which you no longer want to do, is because of __________. If you were to stick with instead of shirking the protocols that I gave you, your repetition compulsion would no longer be a problem. What needs to happen to get you to do such?”

“In what you shared with me you presented a very good manner for dealing with ________ that we’ve never discussed before. I think that you’re able to approach those triggers with novel solutions really indicates how committed you are to making that change.”

“Now everyone, before we close this gathering let’s just run down the tasks. A is doing this, B is doing this, C is doing this, and I am doing this. Any questions, you know where I’ll be!”

“Today we covered a lot of ground and I’m certain that once you leave our shared space you will maintain the strength you’ve shown here.”


These, which when combined can be said to be the concretization of Desire, Ability, Reason, and Need for change will lead to that change when a plan is set in place. To learn more, you can also download the accompanying Powerpoint here.

What's in a Name?: Diagnosis, Attachment, Identification and the Limits of Personal Adaptation

Diagnosis is the name of the method with which applied humanist sciences use to locate the cause of illness and dis-ease. Not all formulae of diagnosis and nosology, however, are the same as each is based upon a number of individual, biological, social, etc. presuppositions. Positivistic practitioners such as psychiatrists would me more likely to use the Diagnostic and Statistical Manual of Mental Disorders while more dialectically oriented psychotherapist practitioners would likely use the Psychodynamic Diagnostic Manual. While sometimes the goals these two forms of therapeutic intervention have can be very similar, ie. the removal of behaviors that somehow inhibit the maximum functioning of the individual, the means with which they achieve such results can be quite different. The former focuses on the disbursement of prescription medications that is in humankind’s long history relatively new, while the latter seeks to process traumas and develop psychic resources to assist them live more powerfully in the present. The recognition of this divide is not new, but was recognized in a slightly different context long ago by German proto-psychologist Freidrich Nietzsche. He emphatically stated that the notion of Being propounded by the positivists was a fiction and that the true foundation of modern humanistic knowledge rested upon a philosophy of Becoming.

If thus far the point I’m making seems rather abstract, let me give some examples. In The Mindbody Prescription: Healing the Body, Healing the Pain by Dr. John Sarno the author, a renowned health-care practitioner and professor of medicine at NYU describes how many of the purported problems with back pain that people have emerge not from genetic abnormalities or physical traumas but are psychological in origin. Layman believe the doctors as they are invested with expert authority on the physical functioning of the body, even though they may be fully away of the mindbody connection. As Dr. Sarno has studied both subjects and practiced with thousands of patients, he is able to state without reservation that stress, psychic tension and emotional turmoil harden into the body via ischemia and Tension Mytosis Syndrome (TMS) and lead to the variety of illnesses various called slipped disks, joint pains, generalized back pain and other problems. The cure, according to Dr. Sarno, is first to repudiate the structural diagnosis provided by the doctors and then to begin a process of self-interrogation in order to find the emotional cause and means of moving the stuck mindbody energy. Such a therapeutic course is helpful to the body’s attempts at signaling the mind that something is wrong and need not be limited to physical considerations. Indeed, intra- and inter-personal problems as well can benefit from a similar process of diagnosis, de-attachment from prevalent (usually positivistic) prognostications and re-identification.

Let me give an example of this particular type of manifestation of the philosophy of Being based upon my personal experiences. A popular explanation within the Miami metropolitan region for certain types of behavior is “I’m Latin” or “I’m Ecuadorian, Venezuelan, Colombian, Cuban, etc.” Here we again see this essentialized notion of Being, in this case national or racial culture, being conceptualized as able to subvert and in fact control the free will of the individual. What such an explanatory feature to personal qualities does is essentially obfuscate the historical realities that conditioned the passing down of certain cultural mores, values, and beliefs and instead embeds it as an un-moving fixture within the personality. It is an exercise in circular reasoning: I am this way because I was born into this way of being. The fact that someone may not have been born in that country, that someone may have left a certain foreign milieu at a young age, that someone may upon sustained reflection actually have different values based upon their own experiences than that of the caretakers transmitting them, etc. are all suppressed. This suppression is then hidden from the conscious mind and when addressed by others can lead to conflict due to the conscious mind’s simultaneous need to protect it’s choices as well as it’s repressed recognition that all such justifications are fiction.

Finally, it is important to recognize that this method of self-diagnosis is not limited specifically to designations of national origin but also to general, personally descriptive terms such as victim, perpetrator or sinner as well as situation wherein instances of a certain type of behavior get generalized, ie a person is a depressive, an addict, an abuser, etc. The attributions of some of these terms can be empowering, but it always depends upon the context so it is important to recognize whether or not they actually functioning for that purpose. At most, a temporary attachment to them based upon the present circumstances is advisable for, as the above shows, the claiming of essential quality of Being has the effect of preventing adaptation to the exigencies of new situations which can cause inter- and intra-personal conflict. By facing the fiction of our Selves, embracing the past as something which we have more control than we would normally like to give it, re-forming ourselves based upon a deeper and more profound understanding of the human will and finally adjusting and adapting ourselves to our actual heart-felt wishes we are able to gain greater control over our lives.

Broward College Course Listings

For those interested in taking one of the upcoming POS 2112 – State and Local Government courses I’m teaching at Broward College, my Summer section is 482610 and my Fall sections are 498103, 498106, 498440, 498441.

Writing Therapy Exercise for Small Group

Trigger-Response Reflective Writing Prompt for Group


Print-out with Shakespearian and Petrarchan sonnets


5 minutes: Introducing myself and then meeting the group.
10 minutes: Explaining sonnet form, reading examples.
5 minutes: Discussing anxiety triggers for negative coping mechanisms and behaviors (maybe longer depending on how far along the group is in their understanding of these issues).
20ish minutes: Time allotted for group to write, I circulate and assist as required.
20 minutes: Group share of works produced and discussion.

Non-rhyme form of the sonnet:

First quatrain: Description of the anxiety trigger.
Second Quatrain: The previous response to it/why it’s specious.
Third Quatrain: The good response/why it’s beneficial.
Final Couplet: An empowering slogan.

Review of "Hold Me Tight: Seven Conversations for a Lifetime of Love

Dr. Sue Johnson’s book Hold Me Tight: Seven Conversations for a Lifetime of Love is a couples focused, practically-oriented example of emotionally focused therapy. The “emotional focus” stems from the fact that unlike other forms of couples therapy it does not view the romantic relationship as a form of rational calculus designed in order to achieve the greatest amount of happiness but the formation of dependency upon a partner to fulfill emotional needs. By working towards strengthening the bonds between partners that identify and transform the foundational moments that contribute to a loving adult relationship the couple is able to become more open and responsive to their each other’s needs. This focus is summarized by Dr. Johnson early on when she states that we need to “forget about learning how to argue better, analyzing your early childhood, making grand emotional gestures or experimenting with new sexual positions. Instead recognize and admit that you are emotionally attached to and dependent upon your partner in much the same way that a child is on a parent for nurturing, soothing and protection” (7).

One of the hallmarks of EFT, indeed all therapeutic interactions, is a willingness to commit to alteration of behavioral and conceptual habits. If one partner expresses an unwillingness to commit to them, or expresses such a desire but does not follow through, than EFT as well as any other form of connecting practices are impossible. Operating upon such a presumption, Johnson then outlines her theory of love, which is an inter-personal theory of romantic attachment. The cases studies which she uses to build up her definition of attachment is varied, but rather than this being a failure to operationalize her terminology I see this broad, positivistic term more reflective of the variety of human experiences. Attachment, like love, changes over time – a fact reflected by the increasing gray divorce rate – and also is understood differently by people based upon their upbringing and value system. That potential criticism dealt with, love is largely viewed within the framework of the classic romantic sense. Its attributes and operation are linked to physical attraction and basic human needs for security, safety, connection. With these we feel generally empowered, more confident, positive and peaceful. Lacking this sense of attachment not only damages our love life, but can have a huge impact on our health. Citing psychological research literature, she points out that hostile criticism from and conflict with loved ones increases our subjective self-doubts, creates a sense of helplessness, mars one’s self-image and leads to a tenfold likeliness for depression. When a relationship is good, however, loving contact and interaction with a partner acts as buffer against shock, pain and stress due to the hormones and chemicals released by this interaction.

Dr. Johnson follows this explanation of biochemical regulation related to attachment by illustrating how it is that couple can fall into a spiral of insecurity. When one partner becomes emotionally unavailable, unresponsive or even sadistic we feel that that once robust connection is at risk and this pushed the other partner into a primal panic. Whatever possibility at effective emerging from this dynamic is destroyed as a spiral of insecurity develops due to the lack of safety. Power struggles begin and making demands rather than requests is just one example of how once loving expressions become tainted, decreasingly responsive and alienating for both.

The seven conversations that follow all build upon the above theoretical framework and scaffolds on each other in a way that leads to a process of reconnection so as to create greater intimacy, security and compassion between the couple. By focusing on the emotions that are evoked in situation rather than the situation itself the negative habits of blame and the flight-or-fight response are circumvented and it becomes easier for new patterns of loving, connected action to emerge. While the book is directed to couples on the metaphorical rocks, the questions and experiential practices presented are good for any couple seeking to gain a better understanding of their partner and obtain a deeper their connection to them.

Kusang & Satsang the Body Electric: A Brief Investigation of Social Impact on Individual Happiness

After another wonderful weekend intensive class reviewing FICAM material on emotional intelligence and practicing therapeutic protocols I left feeling elated, electrified and exhausted at the same time. Seeing others make powerful shifts in their perception as a result of the work, feeling it myself and reviewing it all on a cognitive level I’d say it’s impossible not to be so touched! As I shared some of my experiences with friends and acquaintances, I heard the same response repeatedly: “I would love to be involved with something like that!”

As I thought more about these comments, being the hypermensiac that I am, a number of associations came to mind. For one, their stated desires reflected something that recent psychological research also attests to. People are able to achieve a happier, more fulfilling life by making less small talk about mundane things. Those that instead have substantive conversations about the issues of the day, deeply analyze their own or other’s motivations, problems and values all allow people to really examine our place in the world and give it meaning. This creation of significance on an individual and social basis not only gives meaning to our lives and world in some abstract manner, but provides a tangible manner in which individuals can engage to better themselves.

As the initial situation that obtained such responses from people expressing desire related specifically to my experience in an intentional community of people seeking similar abilities and knowledge this additionally made me think of the concepts of kusang and satsang found in Eastern philosophy that I was first introduced to while studying with Swami Shyam at the International Meditation Institute in Kullu, India. I highly recommend this article’s exegesis on the concepts from a Sikh perspective as it delineates the various manners by which doing so brings about personal and social unhappiness and goes into more depth than I will here. In brief, kusang (false association) is the categorization of attributes that indicate a fixation upon and devotion to small talk and the social values implicit within it. It’s opposite, satang (truth-filled company), was of course what my weekend at FICAM was all about.

The general tendency of American settlement patterns to develop Bourgeois Utopias that inculcates social isolation and class-based segregation has also assisted in it’s turn away from once vibrant religious communities. This has had numerous effects on the so called “Habits of the Heart” and not for the better. Whatever one’s position on organized religion, it has generally fulfilled the inherent need for individuals to unite into a group for identification with others based upon the discussions and dissemination of literary material that addresses to some degree the everyday experiences which cause people anxiety, desire, fear and hope.

How then to develop this if you can’t be involved like I am in FICAM? Simple! Extend and enact your will to achieve greater happiness and feeling of being present in the world through action. Make an effort to speak with others about the issues that concern you, form conversational groups or book clubs that will allow you to tap into this source of personal fulfillment. Secondly, try to avoid conversations or cultural products that don’t evoke spiritually or intellectually ennobling features. After all, you can’t touch garlic without getting its stink upon you for a period of time afterwards and by focusing on the ennobling you take it into you almost as if by osmosis.

Review of "Trances People Live: Healing Approaches in Quantum Psychology"

According to Dr. Stephen Wolinsky’s book Trances People Live, you are in a trance right now. How do I know this? Because your attention is focused on the text as you are reading this. You are internalizing the symbols of these words and converting them to sound in order to understand what I am trying to convey. For the most part you are likely wholly unconcerned with the ambient sounds or space around you, and while this “absorption of knowledge” trance could be broken by, say, a loud sound it would not necessarily make you trance free, but instead send you into a “be on the alert” trance. While this example makes trances appear innocuous, at a more fundamental level they play a powerful role in our daily lives and are primary determinants as to whether or not we experience the sensory world in a present or hallucinatory manner.

Trance states are the patterns of thinking which hold us together in the present moment. They are not necessarily singular and topical, as in the above illustration, but are also amalgamations of strongly held values clustered under the general header of Deep Trance Phenomenon. These are the associations and responses that we literally embody, that is to say somatically, on a daily basis which we consider to be “us”. At one level “I” am the experience of these various clusters in a world that subverts, is neutral to and assists the manifestation of said trances. From another vantage point, the “I” is a completely fictional construct able to be manipulated to a new form by our will if we so desire. The problem is, however, that quite often our responses to large or small traumatic events are so ingrained or occur within conscious evaluation that we forget the resources we once knew and become stuck in patterns that inhibit our maximal agency. Put another way, our psychosomatic symptoms are caused by the non-utilization of unconscious resources. When something is overwhelming us, affecting us in a way that is purportedly beyond our control it is because we are preventing our deeper knowledge of the self from surfacing and steering our consciousness.

Using hypnosis to interrupt, shift or alter these Deep Trance Phenomenon allows the practitioner to both access these resources and circumvent the content issues that in other forms of talk therapy. This form of de-symptomization is called brief therapy and was pioneered by, amongst others, Milton Erickson who Wolinsky openly models himself upon and theoretically adapts. Avoiding the stories that are falsely perceived as causative of the symptoms may seem counter-intuitive, but upon a closer examination it becomes more apparent why this is preferable at times.

Instead of spending an extended period of time locating traumatic moments the precede and inform that maladaptive psychosomatic symptoms which first brought the client there, as Wolinsky demonstrates that such a narrative is only related to the patient’s present circumstances as firmly as they desire it to be, it’s better to simply shake up those help the patient realize their authorship and control of the situation through various practices of creating context. Once we have come to recognize that we are more than or larger than the source of distress with which we most often identify our entire experience of life shifts. This is not to say that such derivational searches into one’s past are wholly specious – just that we should not fetishize the Freudian talk-therapy model that would have us spend countless hours rehashing details of traumatic events that we’d like to move beyond. Additionally worth mentioning is how Wolinsky repeatedly states that if regression work is done it’s of the utmost importance to have the client acknowledge that the response to a traumatic situation was the best possible choice at the time. But now that time has passed and conditions are no longer the same, he argues, it’s imperative to shift it to a state of greater presence so that a more appropriate perspective can be embodied.

Dr. Wolinsky then proceeds to delineate the qualities of various trance states that cause detrimental effects on the psyche. Based upon the entrenched patterns of the states he places them within an oppositional dichotomy so that therapists can process them via negation. Doing this helps patients realize their control over their internal dialogue and psychosomatic symptoms. As the list is not long I will include it here so that the reader can get a hint at some of the specific Deep Trance Phenomenon that lead to unnecessary anxiety and stress: The opposite of age regression is a pseudo-orientation in time; the opposite of hypermnesia is amnesia; the opposite of sensory distorition is analgesia; the opposite of over-identification is dissociation or hypnotic dreaming; the opposite of positive hallucination is negative hallucinations. Unfortunately the descriptions of these are and I doubt anyone will be able to read it and not be able to recall their having been trapped by one of these perspectives. Another aspects of this section that I found personally moving was reading Dr. Wolinsky’s narrative of how he had come to embody the state of hypermnesia as I had similar early life conditions which lead me to the same vigilant trance state.

This particular book has been one of my favorites amongst the assigned FICAM reading and I look forward to reading more of Dr. Wolinsky’s work. Not only is his exegesis of concepts clear and the contextualization of his use of them insightful, but the processes he outlines for working with patients based upon his experience makes the knowledge the book provides eminently operable.