- Hey, everybody.
Here I am at the National Alliance to End Homelessness
Ending Family Homelessness Conference.
I always have trouble saying that every year,
but it's a great conference.
And I'm here with Ken, Ken Kraybill
who we first met at 100,000 Homes leadership.
They brought us in to help advise, and it was the first
time that I heard of this thing
called motivational interviewing.
Would you tell me about that?
- Sure.
Really, motivational interviewing is just a matter of having
a helpful conversation with somebody.
We talk with people all the time, and we have conversations.
But oftentimes we find ourselves in situations,
especially when somebody brings to us a concern or problem.
We have this impulse to want to help them, of course.
And the first impulse for many of us is
to just give them good advice, right.
It turns out I've discovered, and probably most people know,
that advice is not something that people are real fond of.
Even when they ask for it, in fact.
So this is true of when we do more clinical work
with people who are struggling with substance use,
with other kinds of behavioral health issues
and behavioral issues in general.
We see people.
We think, wow, if only you would just turn this direction
and go that way or make that choice,
things would be so much better.
And then we try it, and what happens is what?
People generally say, no, that's okay.
I'll keep going this way.
- Right.
- Or they go the opposite way to what we want
them to do, so motivational interviewing is something
that grew out of the substance use field.
But it's really a way of talking with people in a way
that helps to enhance their own motivation to change
as opposed to our motivation to get them to change,
so I often think of it as the idea of trying
to help people talk themselves into changing
as opposed to me talking you or someone into changing.
- Right.
- So that's the essence of it, but it takes some skill.
- Right.
- It takes some learning.
It takes a mindset.
It makes, it requires another way of thinking
when you're in a conversation with somebody.
- Basically, you know, for us in homeless services,
I'm sure it's many different vocations, sectors can relate.
You know, where you have a client care provider relationship
that, you know, you go in and you're meeting them,
and you're, you know, basically you have a goal
of trying to direct 'em in a way that will help them.
- Yep.
- But often, they don't want to do that,
and, you know, in our way of meeting them
and interviewing them, and I know I'm guilty.
Sometimes it's just like you're hitting this wall.
- Yeah.
- I have a homeless vet that I've been working with
for several years that he's been in the hospital
twice this month.
He blew a .41, alcohol.
He almost died.
- Yeah.
- And I still can't, you know what I mean?
So how could I?
What would be your basic 101 of how to interact
with him that might be able to motivate him to change?
- Sure.
So what you want to do is just say, stop it.
Don't do that anymore.
- Right, right, you're killing yourself.
We love you.
Don't do it.
- And well, after you've tried that.
- Right, we're past that about 20,000 times.
- Then, we go to plan B.
- Right.
- Yeah, you know, it turns out that you would think
that if somebody suffered lots and lots of consequences
for their behavior, they would naturally just turn around
and say, this is crazy.
I'm moving on.
That's not how human beings seem to work.
We just dig ourselves deeper and deeper into a hole.
You know, whether you call it hitting bottom
or whatever it is, but something has to shift,
and it doesn't take just negative consequences
usually for people to shift.
It takes something else, and we could call it motivation.
We can call it being ready, willing, and able.
But there's something that has to shift,
a tipping point basically where somebody says, oh.
Yeah, maybe I should try something different.
And in motivational interviewing, the language we use
is we try to have a conversation that draws out
from the person what their own needs and desires are,
what kind of life they really want to have,
how that's dissonant from the life they're living.
Not to guilt trip them.
- Right, right.
- But just to help them, to shine a light on it.
And say, so help me understand.
You want to live.
You want to be friends.
You want to do this.
You're blowing a .41?
- Yeah.
- You should be dead.
But you know, the question would be if I were
to encounter that person, would be, you know,
first to show some empathy.
- Right.
- Wow, wow.
And probably just to be very, simply begin to explore.
So tell me what went on before--
- Right.
- You found yourself imbibing like that,
and tell me how this fits with everything else?
I mean, I'm being very general right now.
- Right.
- What you do is you start from the general,
and you start having a more concrete conversation all along.
And eventually, a conversation might lead to saying things
like, so tell me what are the good things about what's
happening in your life right now,
including the alcohol consumption.
- Right.
- You know, what are the good things about that for you
because I, the premise is, people engage in behavior
because they're trying to meet a need even if that attempt
to meet the need is totally screwing up their lives.
People still, I believe, are trying to meet a need.
So to try to understand what is the need maybe there?
Is it loneliness?
Is it anxiety that you're self-medicating?
Is it just you want to obliterate yourself?
Pain, it can be anything.
And we can't name that for people.
They need to name it for themselves.
- And the alcohol or drugs itself also has a lot of power.
- Yeah.
And we can't argue with the fact that heroine,
methamphetamine, alcohol, whatever it is,
it works for awhile.
- Yeah.
I was there.
- Yeah.
- I was the worst of the worst.
- I mean, yeah.
- How would I learn, say if I'm out there,
and I'm viewing this, and I want to learn how to,
I'm giving you a perfect segue here.
(laughs)
So how would I learn about motivational interviewing?
- Gosh, well, there are a number of ways to do that.
Motivational interviewing has come to be known
as an evidence-based practice, meaning that it's been
tried and tested with a variety of populations
well beyond the people who use alcohol and drugs.
And so for people who want to control or manage
various behaviors, chronic illness, lose weight,
eat better, exercise more, and beyond.
You can read about it.
You can do that.
You can, I mean, but if you want to help other people
change, reading about it isn't sufficient usually.
'Cause you have to change your own behavior
in how you interact, and so almost always it requires
some combination of reading, perhaps going to a workshop
or two, maybe take an online course.
People learn in lots of different ways,
and they learn over time, but I happen to work
for an organization that--
- It took you a while to get there, but we did it.
We finally got there.
- I'm a little slow.
(laughs)
I'm a little slow because, you know.
But the reality is that, I mean, there are a variety
of places people can turn.
So T3 is a training institute.
- Right.
- Think, teach, transform is the three Ts,
but we have begun to kind of specialize our focus
on people working with low income, underserved,
vulnerable homeless populations and help equip people
who are working in the field of all disciplines
to have a helpful conversation with people
that goes well beyond advice giving,
which typically doesn't work.
And so what it means is helping people learn to think
reflectively, to think in an evocative way,
to pull out from the person what they already know,
to operate in a collaborative way,
so we're together in this search.
- Right.
- We're not pitted against each other.
We dance.
We don't wrestle.
You know, some of the language we use.
But it's also a very compassionate way of being
with somebody because you're actually respectful
of where they're at and understanding,
helping them understand where they're at
because only then, I think, does it become possible
for people to examine where they want to go.
- Well, it's spot on.
I've actually taken the course on motivational interviewing.
I just get emotionally attached sometimes,
like with my current homeless friend that I'm trying to--
- Sure.
- But it's very professional, online, yes,
I'm gonna do the pitch.
Go to ThinkT3.com.
There's a free course on homelessness in America,
stuff I didn't even know.
It's amazing.
It's free.
But the courses on case management, motivational
interviewing are very cost effective, especially
in today's landscape of zero funding or funding
going away and disappearing.
But we need to get better.
We need to improve, and education is a big part of it.
So I do.
I'm gonna come right out and say I do endorse Think T3.
I love what they're doing.
So please visit the site, and say hello to Ken.
'Cause I'm gonna put his Twitter handle here
so that you can all say hello to him on Twitter.
- Awesome.
Thanks.
(laughs)