In our last list of ways that we do more to end chronic homelessness, we concluded with #24: motivational interviewing and how it helps us seek lasting solutions to homelessness one person at a time.
But how? you may be asking yourself. How exactly does motivational interviewing end homelessness?
Great question. When using motivational interviewing, also called motivational enhancement therapy, a case manager, doctor, or clinician first identifies a client’s “stage of change.” These stages are: pre-contemplation, contemplation, determination/planning, action, maintenance, and relapse. Dr. Morse, our psychiatric resident from George Washington Hospital, is a specialist in this technique and has been helping all of refine our skills.
That’s cool, you think. What next?
Then, we match our approach and tone to bolster motivation for behavioral change according to the client’s stage of change. For example, someone who is abusing alcohol and is in the contemplation stage has some awareness of both the costs and benefits of using alcohol — it makes them feel better and makes living on the street easier, but it’s expensive and if they’re not drinking, they feel terrible.
When we sit down to talk to this person, we work to get them to recognize the additional costs of drinking in hopes of tipping the balance toward wanting change.
Oh, I get it. So what happens after they start to want change?
After the contemplation stage is the determination/planning stage. We’d then work with our client to make a plan of action that they can get behind. For example, one of the first steps may be, “Tomorrow at 7am, I will go to DC’s APRA center and complete an intake for a 30-day detox and treatment program.”
By getting a client to want change for him or herself and to help come up with next steps and goals, the chances of him or her meeting those goals increases.
One of the powerful insights from motivational interviewing is that the intervention must be matched to the stage of change. Pushing someone to go to treatment when he or she is still in the contemplation stage and doesn’t see all the benefits of going to treatment may evoke a defensive behavior, which then actually moves the patient further away from change rather than closer.
At GMC, we meet each person where he or she is and guide them toward housing and stability by using motivational interviewing. Then, we are able to truly create lasting solutions to homelessness one person at a time.
(Thanks to Dr. Michael Morse for his insights, helping us learn more about motivational interviewing, and for providing examples of how motivational interviewing is used to create change.)
