Cassi Vieten: So, Dr. Miller is somebody who I’ve referred to in my work for quite a long time. Some of you who know me know that I had a background in studying addictions and Dr. William Miller is an Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico and he has for quite a while been Co-Director of UNM’s Center on Alcoholism, Substance Abuse and Other Addictions, and he’s really a pioneer in the field of addictions in a couple of different areas. One is Motivational Interviewing which is a promising, somewhat new treatment for addictions; it’s not – I guess at this point it debuted at some point in the eighties, but it’s really picked up speed recently and is a kind of fascinating way not just to look at substance addictions but to look at the ways people change in general. And when you’re looking at how people change and you’re hoping to stimulate a change and you’ve got someone, if you’re a clinician or even just a friend of someone who’s looking for a change and they’re sitting with you saying, “You know, I really want to change but I can’t seem to make it happen…,” the premise of Motivational Interviewing is that motivation doesn’t come from what you think you should do; it comes from actually what you’re passionate about and committed to. And so –
William Miller: Hello, Cassi.
CV: Hi, is this Dr. Miller?
CV: Hi, there! Well, I was just introducing you and just talking about, a little bit about my understanding of Motivational Interviewing and I’m going to ask you a little bit more about that but, welcome. […] So I really appreciate you coming on the call and was just introducing you as Professor of Psychology and Psychiatry at University of New Mexico and longtime co-director of the Center on Alcoholism, Substance Abuse and Addictions there, and someone who’s really been a pioneer in the field of addictions and substance abuse and really how people change; I mean, it’s not just limited to substance addictions and alcoholism although you’ve got a very long background in that whole arena, but more recently you’ve broadened your work to looking at how people change. And so I was just starting to talk about Motivational Interviewing and just for the information and the folks on the call: Dr. Miller’s published over forty books and four hundred articles and chapters; he’s been PI, a Principal Investigator on numerous research grants and contracts; he’s been a consultant for the U.S. Senate, the World Health Organization, the National Academy of Sciences and the National Institutes of Health, and he’s really been a pioneer in particularly a few different area in addictions. One is in the development of Motivational Interviewing which I was just starting to introduce before you came on the line, and the other has been in the integration of spirituality and psychology. And so Dr. Miller, I just wanted to first welcome you and maybe ask you to tell us a little bit about the underlying premise of Motivational Interviewing because I was saying to the folks who were listening that although it’s been studied most often in substance addictions, I think it really has profound implications for anyone who’s trying to make a change in their lives.
WM: Well, I’ve been astonished at the extent to which it has disseminated. It really is for the situation in which a person needs to make a significant life change and is ambivalent about doing so, and people get stuck in feeling two ways about something. They like drinking, they know it’s causing them trouble; they know they need to exercise more, they also don’t like exercising so get stuck in the place of wanting and not wanting something. And Motivational Interviewing really has been about helping people to move off of that stuck place and go ahead and make the kind of change that they need and want to make.
CV: And how do you think Motivational Interviewing works? You know, what – how is it shifting someone’s motivation, I guess, toward the outcome that they’re hoping for as opposed to the resistance to it?
WM: Yeah, it’s not installing anything. An awful lot of therapies are about trying to install something that the person is imagined to lack. So you lack knowledge, I will educate you; you lack skills, I’ll teach you those skills; you lack insight, I’ll give it to you. We really start from the premise that the person already has what is needed in terms of motivation, that the reasons for change, their intrinsic motivation for change is already there and so rather than trying to install motivation, we’re actually calling it forth. And, where people get stuck is that they have conflicting motivations, and in a way we help people keep pursuing the motivations for change and find a way out of the woods and onto the kind of life change that they need to make.
CV: So, in a way would you say it helps people align with sort of their higher purpose for themselves or their long term goals as opposed to maybe their shorter term goals?
WM: That’s often the process of taking a look at this particular life change in relation to what your values are, what you want for yourself in life, what you want the meaning of your life to be, and that often helps to tip the balance and move the person along. In a way, it’s I guess part of a broader process that Hobart Mowrer wrote about long ago of trying to bring your actions into accord with your values so that you have integrity in your life and are living in accord with the things that you aspire to be and do.
CV: Can you give us an example of how you’ve seen this work for someone, maybe a client or a story that you’ve heard from a clinician who applied this process?
WM: Well, I’ve seen many examples of that, of course. In my own work, I am remembering a fellow who came in because his wife threatened to leave and take the children if he didn’t do something about his drinking. And he had not really thought at all about trying to stop drinking or even having a problem with drinking. And I did an evaluation with him, gave him some information back about what we had learned and then we just talked about what it is that he was thinking about his drinking and some of the surprises that had arisen in the evaluation. It ultimately came down to he loved his family and didn’t want to lose his family, didn’t want the divorce, didn’t want to live apart from the kids and that was for him an overriding reason to make a change in his drinking, which he did. I made a mistake in that interview and when I got to the end of it, I summarized for him what all his reasons were that he had given me for making a change and then I asked, “So what you’re considering is stopping drinking. Is that what you want to do?” And he said, “No,” which surprised me a bit and I said, “No?” And he said, “No, it’s not what I want to do; it’s what I’m going to do,” -
WM: - which for me really clarified the difference between what we wish or would like or might prefer and what we do that is because it’s the right thing to do. And in fact, it’s fairly common to do something that you don’t want to do because it’s the right thing to do.
CV: Yeah. You know, I’ve been so fascinated by many studies now that have shown that even one session of Motivational Interviewing, when added to someone’s sort of normal course of treatment increases the success rate tremendously. And, it’s so interesting to think that even just one session of clarification and having someone honestly inquire into your deepest motivations and bring those to the surface and somehow sort of allow you to align with them – I have to say it’s almost like a mystery that one session could make such a difference.
WM: Well, it certainly surprised me and in fact this line of work began when what we thought of as a control group was working. So we had a fairly brief condition that I initially regarded to be a no-treatment control, and people in that group continued to do just as well as those that we were giving more extensive treatments to. And then we discovered that the level of empathy of the counselor was a very powerful predictor of drinking outcome so we did twelve-month later number of drinks per week, a very specific behavioral outcome from how well the therapist had shown accurate empathy. That is, how well they were listening to and understanding what it was the client was saying. And it for me emphasized the importance of exploring the person’s own meaning and the person’s own processing and motivation and understanding, and it’s very powerful. I was certainly surprised by the fact that we were, in our early studies, finding response to just a session or two of this which I had initially thought of as just a preparation for treatment. But people were changing in response to just this motivational interview far more than I had anticipated, and now that’s fairly well replicated that it happens. And it’s intriguing that even a little bit of this seems to help, so a nice thing for practitioners in learning it is that they pretty early begin to see different results even though they’re not particularly good at Motivational Interviewing yet. Even moving in that direction a little just seems to have enough power to it that you can see a difference in the way people respond.
CV: I think this is so true and this really relates to some of what we wrote about it our book, Living Deeply: The Art and Science of Transformation, in which we quoted some of your work. You know, sometimes it seems to be even the smallest, simplest changes can make all the difference and a few of the, I think we called them attitudes, that you could bring to the table when you were trying to transform your own life or sitting with someone that you’re trying to help them transform their lives, is this sense of deep listening, of curiosity, of inquiry, and in some ways those are skills that we seem to have lost in our culture, even among helping professionals. And like you said earlier, so much of what we think will help people is, “Let me deliver knowledge to you that you apparently lack. Let me deliver a way of looking at things that you don’t seem to be able to manifest.” We think that we are supposed to bring this to people when one of the acronyms that I always remember from Motivational Interviewing is the acronym OARS, like the oars of a boat. And OARS stands for Open-ended questions, Affirmations, Reflections and Summaries, and it’s really a nice template for the process of inquiry, curiosity and deep listening. And sometimes it seems like that process can be more transformational than trying to deliver something to someone.
WM: It is certainly a different model from, “I have what you need.” The model is, “You have what you need and together we’ll find it.” One of the surprises for me also has been that this is feasible in relatively short spans of time. So one of the places where there’s a lot of application of Motivational Interviewing now is in health care where very often they’re not long, certainly not 50-minute psychotherapy sessions available and something more like five or ten minutes really to have a conversation like this. And sometimes physicians say, “Well, I don’t have time to do this,” but it looks actually like you don’t have time not to do this if you don’t have very long because this is more likely to produce a significant change in a short period of time than wagging your finger or telling people what they should do or giving them advice and suggestions.
CV: Yeah, in a sense it’s a more efficient use of the time. I’m wondering if you’ve ever reflected on how people could apply these principles to themselves in their own everyday lives. So using the examples that you used earlier, “You know, gosh, I really want to exercise more,” “Boy, I wish I could be more this way or less that way…” Is there a way to apply the principles of Motivational Interviewing to yourself in your own life to kind of keep your highest purpose and motivation kindled?
WM: You know, I really don’t know. Everything we’ve done so far has been in the context of conversation, has been interpersonal interaction, and in a way, I think motivation often arises out of that conversation or interpersonal interaction. But I’ve been thinking about – is there some way that you could do this on your own? And it would probably be through some sort of journaling process, and I would probably point people toward reflecting on and writing down why they would want to make the change that they’re considering, what would be the good things about that; thinking about and writing down how they would go about it if they decided to in order to be successful because nobody knows more about you than you do. So if you were going to really do this, if you made, if you decided, if you were going to really do it, how would you do it so that it would work? I would encourage people to reflect on and write down specific reasons for making the change; maybe those are things that aren’t so good about how things are now, maybe those are advantages of making the change. But what are the three best reasons for actually doing this? And another question we often ask is, “How important is it to you to make this change?” Sometimes we use the specific scale from zero to ten, and zero is “not in the least important” and ten is “the most important thing in my life.” Where are you on that scale right now? How important is it to you to stop smoking or whatever it is that you’re considering? And, why are you there? Why that number and not zero? There’s something there that is saying, “Well, it’s at least six important,” or whatever the number is. And in the process of doing that, people sometimes find they get clearer about their level of commitment to do that.
CV: Hmmm. And it’s so easy to forget, I think, when you get in the heat of the moment and are being tempted by -
WM: Uh huh. And it really is about making a decision, it really is about making up your mind and committing to do it and I think that’s the thing that gets people stuck when they’re ambivalent. They may want to make the change but wanting the change isn’t doing it and they may be able to make the change. If they say, “Well, I could cut down my drinking,” but to say that you could or you can is not again saying that you’re going to do it. You can list reasons for it but doing so is not itself a decision to do it. And you can even say, “I’ve got to do this, I have to lose weight,” but that is not saying I’m going to do it.
WM: So there is a final step that I know happens in interaction, in conversation and it may be possible to do in a kind of written format; we just don’t know yet. But that last step has to do with really getting to yes, getting to saying this is what I’m going to do, not just what I want to do, but what I’m going to do.
CV: Hmmm. So, I’d love to shift the conversation now to some research that you’ve done over the past I think now maybe 15 years on what you called in your book Quantum Change. And in some ways, we’re talking about a similar thing, how do people change their lives but this kind of Quantum Change is a little bit different than the kind of change that we’re talking about here. Can you explain what is Quantum Change the way you look at it?
WM: Well, the easiest image in our society to get the idea of this is Ebenezer Scrooge, someone who had an experience in a span of minutes or hours that changes them permanently. And not just changing a behavior but really changes who they are and how they experience themselves and how they think about themselves. And these experiences do crop up in fiction but they crop up even more often in biography and autobiography. Because they’re reasonably common experiences, certainly in the lives of people who wind up writing an autobiography, where there’s a critical moment or experience in life that was really a turning point. And those moments tend to be highly memorable; people often have very vivid memories of exactly what happened and of the day and the time and what the weather was and what was happening around them even though it may have been twenty years ago. They know that something out of the ordinary is happening to them at that particular moment. And they also know that they’ve gone through a one-way door, which is an interesting difference to me working in the addiction field because so many people struggle with being afraid they’re going to fall back to how they were before. Folks that have these experiences by and large know that they’ve passed through a door and there’s no going back, and they’re not even concerned about going back. There’s a sense of really forward momentum. These are often very spiritual experiences also, not always, but people commonly find themselves in the presence of an “Other” for which they may have no language but an “Other” much greater than themselves and experience the nature of that “Other” in a very consistent way.
CV: Hmmm. And what are some of the common elements of that experience of what you’re calling the “Other?”
WM: Well, the thing, and it was striking to me, and we did 55 of these interviews – this study is the most fun I ever had in 35 years of research – we simply asked through a newspaper story for people who had had an experience like this to come in and talk to us. We didn’t pay them anything, and the phone rang and rang and rang. And we wound up getting, I think, 89 calls and 55 of these folks came in and did a three-hour interview with us. And all we had to do was say, “Tell us what happened,” and it would come tumbling out. But when the folks who did have the experience of being in the presence of a transcendent “Other,” which is more than half of the folks, described that experience as one of profound acceptance and love. That in that moment, they felt themselves totally, profoundly, unspeakably loved and accepted in a way that was very hard to put into words.
All of these folks struggled to put into words what the experience was, and they would reach for metaphors or some way to try to explain it. But they were all talking about the same thing which was striking to me. This was not an Other that they were frightened of or even intimidated by, certainly impressed and awed by, but they felt very safe and they carried with them into their future lives a really profound sense of safety. Not that they would be immune from anything bad ever to happen to them, because that isn’t the case, but a deep, profound sense of being safe in an ultimate way.
CV: You know, we have done a similar study that led to our book, Living Deeply, and this interview is part of a Living Deeply teleseminar channel where we’re sort of exploring different aspects of the results that we came to in our study. And it’s really interesting what you’re saying because many of our participants talked about an experience of oneness or a lack of separation.
CV: And it’s slightly different than kind of encountering an “Other;” it was a little bit more like, “I was absolutely certain that I was not separate from anything.” And still the same kinds of feelings of safety, held-ness, acceptance, I really am essentially okay and sort of unshakable certainty around that. But it’s interesting the slight variation between sort of the idea of being in the presence of a benevolent “Other” and a sense of oneness.
WM: I think it’s the same experience and people struggle to find language for it. And a sense of unity and oneness was very common in the people that we talked to. And some of them didn’t experience that as an “Other” entity, and many of them did. So I think it’s the same experience; it’s just that we struggle to put it into language with these little brains that we have.
CV: Right, how to story it, how to make it, yeah, it’s kind of an ineffable experience. So, what do you think as a researcher who’s been in the field for a long time, especially in the field of addictions, do you think that something is happening in people’s brains during these experiences? I mean, it’s so hard to account for the absolute change in perspective that is, as I think you say in your book, “dramatic, profound, long lasting,” and as you say, it’s sort of irreversible in a way; once you’ve seen it, you can’t un-see it.
WM: Uh huh. Well, of course something’s happening in the brain. I mean, we don’t have experience without, in this life at least, without the brain being involved in it. And I expect if you were fortunate enough to have people hooked up to imaging devices at the moment one of these things happened, you could identify areas of the brain that are lighting up. In the current scientific ethos, people use that to explain away a phenomenon, “Oh, it’s just something in the brain happening,” but that doesn’t explain it away to me any more than finding out what part of my brain lights up if I eat a piece of apple pie proves that there’s no such thing as apple pie. It’s just what is it in us that responds to this, and I think we’re wired to respond to that reality as well as to the physical sensory realities that are around us. So of course the brain is involved in it. And I think there’s already good progress made in understanding what’s happening in the brain during meditation, for example, and other kind of altered states, and that’s not at all surprising that there would be circuitry in our brain that is prepared to respond in this way. That’s part of who we are.
CV: And did you find that most people, you know, did people struggle with integrating experiences like this, or were there things that helped people to facilitate the integration of an experience like this into sort of a long term beneficial change in their lives?
WM: Well, we went back and found people ten years later, so we found 41 of 55 people ten years after we had talked to them initially, and integration is exactly what had happened. I mean, there was no one that had fallen back to a previous way of being or was even concerned about that, and their sense was of being on a journey and of things sort of falling into place; some of them had had additional noetic experiences of this kind over time. But it looks like integration, at least in the folks that were talking to us, happened fairly naturally; that it wasn’t something they were struggling to do or wrestling with. It was like a veil being taken off of your eyes and you could see more clearly and are now learning about the world that you can see. But it wasn’t something that seemed difficult or hard or frustrating for them to integrate. They didn’t talk to people about it. In many cases, we were the only people they had told about the experience or one of a very small set of people they had talked to. And these experiences often sound quite crazy; if you read them to a psychiatrist out of context, the person may say, “This person should be hospitalized, right now.” And so there’s a little bit of reservation to share what’s an out of the ordinary experience and yet these are relatively common experiences. We didn’t have trouble finding people who had had them. And, if you go into an Alcoholics Anonymous meeting, you will, you find people who have had this kind of experience. That was also the seminal experience of Bill W., the founder of Alcoholics Anonymous.
CV: Yes, and I think I remember reading a recent poll that said something like 65 or 70 percent of people reported having had a religious or spiritual experience that changed their life.
WM: Yeah, that’s out of Gallup. It’s certainly over half. You don’t know exactly what people mean by that, but it’s not uncommon. And whenever I give a talk about this, people come up from the audience afterwards and say, “I’ve had an experience like this, and let me tell you about it.”
CV: I wonder if, you know, in some ways the way that you looked at it and in some ways the way we looked at it was sort of studying a phenomenon, a natural phenomenon that happens, and I think in, out in the world in some ways it happens through grace or it happens unexpectedly or it’s not necessarily something that’s been prepared for or even sought out. And I know a lot of people are very interested in making these kinds of big fundamental changes in their own lives but also changing the consciousness of people around them, or you know in some ways you’d want to intentionally cultivate that kind of change, particularly the really beneficial kinds of change that make people more open and loving and that feeling of safety and more altruistic and kinder people. Did you learn anything about, when you did this research, that might provide some clues to sort of cultivating that kind of change, either in yourself or in other people?
WM: Well, I think there is a paradox there. These were by and large, as you found also, uninvited, unexpected experiences, so they didn’t happen at moments that people were trying to have a big change. They don’t seem to come in that way. My publisher wanted me to have a final chapter on “How You Too Can Have a Quantum Change” -
CV: Right (laughter) -
WM: I said I simply don’t know; it’s a mystery, profoundly benevolent experiences. Maslow wrote about them, I mean they’re all over literature. But is it something that you can even trigger and kindle? I’m not sure and I’m not sure I would want to do that. They’re such enormous experiences that I’m not sure I would even want to have the hubris to be producing these things in people. So -
CV: Right, right.
WM: But if there was anything common to people who were experiencing these, because we did look at what people were doing just before and at the time that they had the experience, in terms of doing something, it was praying. And often, they were folks also who were sort of at the end of their rope, or at a bottom in the way, and the prayer they were offering was often the first in a long time. That was certainly the story of Bill W. who founded Alcoholics Anonymous, that he got to an absolute desperation point and said basically, “God, if you’re out there, this would be a good time.”
WM: And at that moment, had his white light experience. So, if there’s anything that we do, I mean the only thing that I can point to is that kind of opening prayer and probably meditation.
CV: Well, this is the point in the call that we typically open it up for folks who are on the call to ask questions and I think we’ve got another something like 15 of 18 minutes to do that. Angela, do you want to coordinate that?
IONS: Yes, I will put it into Q & A mode which still leaves all of your phones muted; you’ll hear a recording that says, “Press 6 to unmute your phone.” You actually have to press *6 to unmute your phone. Then just please say your name, where you’re calling from and what your question is. So I’m going to change the mode now, and you should hear that – all right, we didn’t hear the recording; let’s try it again. [Recording: All callers are muted and may unmute themselves by pressing 6.”] There you go. So you should have all heard that and just press *6, say your name and what your question is. So, who would like to ask the first question? All right. (pause) There you are, okay; it accidentally muted all of us too. There, I just unmuted us; okay, who would like to ask the first question?
Q: Hi, it’s Filip in Salmo.
IONS: Hi Filip.
Q: Hi. I have a question in regards to brain injury.
IONS: Thanks Philippe, we can hear you. Go ahead.
Q: Oh, great. I have a question in regards to this similar experience in regards to trauma or brain injury and a concussion type of situation. Have you run across anything like this in regards to brain injury?
WM: Well, there are some mystical life experiences that occur with temporal lobe abnormalities certainly. The only incidence of that in the 55 people that we talked to was a gymnast who was demonstrating a complex trick and actually broke his neck on the edge of the trampoline, and that was the moment at which he had this experience. Now, I don’t think he was brain-injured; he actually severed his spine quite high and has been paralyzed ever since. But it was at that moment that this experience came to him. So the only association I have to what you’re talking about is mystical life experiences that people report with temporal lobe stimulation or seizures sometimes.
CV: And Philippe, I imagine you’ve seen the video that’s been propagated through the internet recently of the woman who had the stroke and had an experience of the left side of her brain being shut off while the right side was still active and conscious and describing in detail the unitive experience she had when that happened. Have you seen that?
Q: No, I haven’t.
CV: Oh, yeah, you’ve got to look that up. Look at, I think it was at a conference called TED, and I’m not sure what it stands for, but if you go to Youtube or Google, look up “stroke insight TED conference,” T-E-D. Have you seen that, Dr. Miller?
WM: I have. It was fascinating, yes.
CV: Yeah, very interesting. So I would recommend everyone take a look at that if you’re interested in these kinds of experiences.
Q: Hello? Hello?
CV: Yes, we can hear you.
Q: Hi, it’s Regina in Sonoma, and I understand that people have life-changing experiences through almost tragic means, but why can’t we have them without having a tragedy?
WM: Well, actually about half of our people did. While there were quite a few people kind of at bottom or at desperation or at the end of their rope, there were almost about half for whom nothing in particular was going on. They were just walking across their living room. Like Scrooge, they were just on the way home, and if you had stopped Scrooge on the way home and asked if him if was miserable and wanted some psychotherapy, he would have blown you off, you know. One woman was cleaning the toilet; another woman was sitting on the toilet when it happened and couldn’t identify anything out of the ordinary. So these things also come to people just in the course of their everyday life and not just in the midst of desperation. It’s about 50-50.
Q: That’s fantastic news.
CV: And Regina, I’d echo that with our study. We interviewed, or actually we surveyed about a thousand people, about ninety-five percent of whom who said that they had had an experience like this, and again, it was about half that happened during an experience of crisis or suffering or loss or grief, illness, and then another maybe thirty percent talked about having it happen during an experience of awe or wonder or reverence, maybe encountering a sunset or one of the donors for the project actually had an experience while standing on the Big Sur coastline. So catalysts in nature, catalysts of great beauty, the birth of a child, sex, psychedelics – so there were all kinds of different, and like Bill is saying, we also had people who just had sort of the very everyday moment that really wasn’t anything going on. I think there’s a great, I’m trying to remember what tradition it comes from, maybe it’s a Tibetan tradition where there’s a wonderful story of a woman who became enlightened carrying a jar of water across the kitchen and it shattered on the floor and in that moment, she felt awakened by the shattering of the jug. So I think it’s true that it can happen in experiences of deep grief and loss and suffering and disorientation as well as profound experiences of awe and beauty as well as in ordinary, everyday activities.
Q: Okay, thank you.
Q: This is Ben in [?] – hello?
CV: Hi Ben.
Q: Hi. Dr. Miller, I just wanted to say that this presentation and Cassie, your going back and forth to me brought out so much stuff that I’d been working with in my entire life, and what you’re calling Motivational Interviewing to me is what I started using back in the seventies – what I call Conflict Dissolution. And I did a lot of work with various organizations in conflictual situations. And my stance was definitely everybody had already the way to solve the problem and they were the only ones that could do it from their insides, and I just created safe space for that to happen. So when I had two conflictual situations, I would interview extensively the two, not really paying any attention to the content, but really where they were coming from and who they were in the conceptual context framing that they set up, that then created their perceptual reality and created differences. And I was very successful in that process.
CV: Thanks, Ben.
WM: This has been the experience that this is quite useful in conflict resolution. And this is not new or original or unique; I’ve just tried to express it in a way that people can understand it and learn it, and it’s doable.
Q: Yeah, and what I did for myself was the other question that came up. I’ve written numerous papers with different parts of myself that I have a sense of self when I’m in my intuitive and I have a sense of myself when I’m in my reasoning and I have dialogs back and forth which have helped me, then, my experiencing and my knowing, to develop different framing and different languages for each of those two sets. And I’ve also presented at a [?] and an AHP conference when it first started on “Aha” experiences. And my idea was that there’d be some common ground between them and epiphanies. Instead of that, I found that the experiencing process itself was all indigenous to wherever the person was and whatever happened and really didn’t have any common ground. So to me, what you’re working on, if we could get languaging and framing that subjectively each individual could determine different parts of themselves, basically the intuitive and the reasoning part I think, and then they could start working on it without having all of the huge, kind of big shift things and gradually change it, actually on a daily basis.
CV: Great. Thank you, Ben.
WM: I’ve certainly come to a kind of profound respect and confidence in the people who do this and the resources of people to find of a good resolution.
Q: Thank you.
CV: Any other questions out there? Well, Bill, I’ll ask you one more question. You know, you said this is the most fun that you had in your career, and I just wondered what was fun for you, what was the most interesting part of it?
WM: It was just such a privilege to hear these stories; I mean, in a way these are people who kind of glow anyhow and they’re folks that were a privilege to be around. But to listen to the depths of these experiences and to hear the similarities across the stories and get a glimpse of what had been shown to these folks because there definitely was a noetic quality to this as well, it was just uplifting. I thought I was done when I wrote the chapter on what I thought might be going on and then realized that there was yet another chapter in the similarities of what had been shown to people and what they had come away with; despite their enormous differences in social class, background, occupation, education, gender and age and all the rest of it, there were some messages that were coming through, and it was if there were some messages trying to get through to humankind and these folks happened to be the recipients of those. Now I’ve, that’s like my experience in doing psychotherapy more generally; it’s simply a privilege to get to know so many people in the course of your lifetime at such a depth level. But that was a really intense experience for me in this study, and I just felt privileged to be there.
CV: Beautiful. Are there any other questions, because if not, I think that’s a great place to wrap up. Any last questions?
Q: This is Nancy in […] Washington. Hello?
CV: Hi Nancy.
Q: Hi. Dr. Miller, I have, you talked about your work with Alcoholics Anonymous. Have you looked at the other twelve-step programs and found similar results, Overeaters Anonymous or Narcotics Anonymous or even in the Al-Anon family of programs and services? How broad within the twelve-step treatment approach do you find this?
WM: There’s a lot less known about the other twelve-step programs. Most of the good work that’s been done has been done with Alcoholics Anonymous. And there’s a lot of crossover, too, as you may know; I mean, people with other drug problems may still go to AA because they find the experience is what they’re looking for there. So scientifically, at least, we just know a whole lot more about what’s going on in AA, and there’s not as much knowledge out there. We did do a study with Al-Anon as one of the conditions, and this was a study in which we were trying to help people who were desperate relatives of a family member who had alcohol or drug problems. And every treatment center gets these calls, from a mother or a spouse or a child or a brother or a sister who says, “What can I do?” And one of the things that we encourage them to do sometimes is to attend Al-Anon, so we were interested in what would happen with various kinds of advice that were given to people. And what we found with the Al-Anon condition in that study was that not very many people got into treatment, not very many of the drinkers or drug users got into treatment but that’s not really a goal in Al-Anon. The goal is for the person, him- or herself, to find some peace and centeredness, and that happened. So in all three of the kinds of help that we offered to people, there were huge improvements in the family member, the significant other, him- or herself, in terms of less depression, less anger, less angst, fewer physical symptoms; they were just a lot better getting really any kind of help and support, and the big differences were in whether their loved got into treatment or not.
Q: So were you using Motivational Interviewing techniques in working with that population?
WM: Well, we were studying three things. We were studying Al-Anon as facilitation as one condition, Johnson Institute intervention as another and that also was not terribly successful, and then a method called Community Reinforcement and Family Training Approach in which, rather opposite from what Al-Anon communicates, we’ve said, “You’re a very important person in this individual’s life and you have a lot of influence, and let’s talk about how you could use that influence to move the person in the right direction and get into treatment.” And in that condition, we were successful in getting two-thirds of people into treatment within a relatively short period of time, compared to ten percent in the Al-Anon condition.
Q: Could you give me a way to access that study? The name of it or –
WM: If you Google Robert J. Meyers, you’ll find his website; he’s probably also on Amazon, you can find him. He’s published a couple books on this; there’s one for professionals and there’s one for families called Get Your Loved One Sober that puts into very accessible language.
Q: Great. Thank you very much.
Q: Hi, it’s Filip in Salmo again. I had a question about the OARS thing you mentioned. Could you say what each of the letters meant again?
WM: Sure. I mean, there’s a, that piece of Motivational Interviewing is basically right out of Carl Rogers. Eighty percent of Motivational Interviewing is good, client-centered counseling. So, it’s asking open questions, and we actually ask particular kinds of open questions; rather than firing a lot of short-answer questions at a person, we invite them to explore a bit. So that’s the “O,” Open questions. “A” is Affirming, genuine affirmation of the person and what they’re doing to move in the right direction. Reflection, the one that is probably the most common, is just good quality reflective listening exactly as Rogers described it; and then Summaries, that pull together of the person’s own meaning. So in essence, we’re listening for people to tell us their reasons, their motivations for change; then we reflect those back to the person; then we put them together like a bouquet of flowers in the summary and periodically show the bouquet to the person also. It’s a way of getting unstuck from ambivalence which is a place where you can stay for a very long time.
CV: Wonderful. And there’s also a lot on the web and I believe, Dr. Miller, you’ve got one or more books on Motivational Interviewing out there. So you can look up on the web William R. Miller and Motivational Interviewing and you’ll come upon quite a bit of information about it.
WM: Yeah, the best website is motivationalinterview.org which is operated by the network of trainers. We’ve got more than a thousand trainers around the world now.
Q: Can you suggest a particular book? This is Sarah from Boston.
WM: Well, it depends. The original book, Motivational Interviewing, was written for people treating addictions. When we came to the second edition, it had spread to so many different areas that it’s fundamentally about change, but that’s still written with a kind of psychotherapist-counselor audience. And more recently, Steve Rollnick and I and Chris Butler have published a book on Motivational Interviewing in Health Care, so if your setting is more, briefer contacts with people, I think there’s a nice clear exposition of MI and how that would be done in a health care setting. And then Hal Arkowitz has one recently on uses of Motivational Interviewing with psychological problems, kind of the rest of the DSM besides the addictive behaviors.
Q: Well, actually, I’m interested in it personally. I’m not a therapist; I’m a scientist.
WM: Oh, okay. Well, we haven’t, I’ve not written a self-help book on Motivational Interviewing –
CV: There’s your next project –
WM: Yeah, well –
Q: Well, I’m a meditator and somebody who does a lot of contemplation, so I’m very interested in this process but, and in these questions.
WM: Well, I’ve started working with a group called the Change Companies on putting this into a journal-like format that people can use, and we’re probably a year away from having that well done. But that is kind of the next step that I’m moving toward that has come up on this call. In fact, is there a way that this is accessible without my going and finding a professional therapist? I don’t know the answer but we’re going to give it a try.
CV: Yeah, and it’s interesting because it may be something that can be explored by yourself or with the kinds of journaling techniques that Ben was talking about earlier where you’re talking to different sort of stakeholders within your own personality. And then it may be that there’s some sort of peer-partner approach because it, also having that bouquet of flower mirrored back to you, to have someone across from you, specifically aligning with your positive motivational impulses, and kind of putting them together and presenting them back to you may be sort of one of the magical elements of this intervention. So, I’ll really look forward to seeing what you come out with around that. And, you know, my other wrap up for this phone call is just to say that I think both of the areas that we explored in more depth today, the Motivational Interviewing and the ways that people change in these sort of continually realigning with your priorities and your purpose and clarifying those and remembering what they are, and combined with these experiences where you can dip into sort of a deeper, unitive sense of consciousness, maybe into a sacred dimension; and I love the way, Bill, you put the, maybe the message that’s coming to humanity through these portals of experience that are in fact, quite common. And I think in the Living Deeply book and in our own thinking about how people transform their lives, it really is a dialectic between this continual integrative work and clarifying motivations and purpose and values and then those experiences of grace where you really get to have a big glimpse that can change you in an irreversible way. So, I thank you for being here, Bill.
WM: A real pleasure.
CV: And typically what happens now is that people are invited to stay on the line to have a community discussion for about another half hour, and you’re welcome to stay for that and you don’t need to, either. And I want to thank everyone who came on the call, and Angela, do you have any other housekeeping?
IONS: No, that’s it. Thank you both for a wonderful interview!