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August 2016

Lifestyle, Sick-care; MI training; Acceptance


It’s nearly 40 years since I graduated from my psychiatry specialty training in Boston and then entered private practice. Hard to believe. I am a physician, psychiatrist and addiction treatment specialist. Over the years, I have been focused on illness, disease, pathology and sick-care. There is still much to do to improve health care for all. However over the past few years, I have added a focus to my attention: the need to move from a sick-care and health-care system to one of health, wellness and well-being.
That’s why a few years ago, I became a co-founder of the Institute for Wellness Education (IWE) whose mission is “to help drive cultural transformation so that health and wellness become the norm for individuals, communities, and the nation.”
People’s difficulty changing lifestyle and behavior increases costs and fuels a sick-care system.
  • Chronic disease treatment accounts for over 75% of national healthcare expenditures.
  • Half of adults do not receive recommended preventive care and screening tests (guidelines for age and sex).
  • On average, 50% of people with chronic diseases do not comply with their treatment plan.
  • Productivity losses (personal & family health problems) cost U.S. employers, on average, $225.8 billion/year.
  • Individual lifestyle determines 50% of health status and 60-75% of health costs.
Living a life of health and wellness doesn’t just feel good; it does good for everyone associated with you at home, work and play. We all know the old saying of “an ounce of prevention is worth a pound of cure.” As much as we know this, millions still struggle to change habits and embrace lifestyle change. It is going to take a cultural transformation, not just a few new nutritional, exercise and stop-smoking programs.
Change is hard as evidenced by these estimated statistics.
  • 33% of patients don’t fill prescriptions given to them by their doctors
(Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The Incidence and Determinants of Primary Nonadherence With Prescribed Medication in Primary Care: A Cohort Study. Ann Intern Med. 2014;160:441-450. doi:10.7326/M13-1705.)
  • 50% of people drop out of therapy after the initial session
(Premature discontinuation in adult psychotherapy: A meta-analysis. Swift, Joshua K.; Greenberg, Roger P. Journal of Consulting and Clinical Psychology, Vol 80(4), Aug 2012, 547-559.)
  • 92% of people set New Year’s resolutions and don’t keep them
(University of Scranton. Journal of Clinical Psychology, December 27, 2015.)
  • 50% of dieters lose weight only to gain back what they’ve lost, plus more
(Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005 Jul;82(1 Suppl):222S-225S.)
  • 50-75% of people with diabetes don’t adhere to their prescribed regimen of care
(García-Pérez L-E, Álvarez M, Dilla T, Gil-Guillén V, Orozco-Beltrán D. Adherence to Therapies in Patients with Type 2 Diabetes. Diabetes Therapy. 2013;4(2):175-194.
Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012 May;29(5):682-9.)
  • 50-90% of people relapse after a period of recovery following treatment for a substance use disorder
(Moos RH, Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction (Abingdon, England). 2006;101(2):212-222.)
Change doesn’t have to be out of reach for anyone. Where’s the problem? It is that most people who want to change don’t know how. Or, initially they aren’t even considering making changes, but may be forced into it by external factors.
One of the most common barriers to change is ambivalence. It’s “yes, but” thinking:
  • “I’d like to get exercise, but I get home from work late and then have to take care of my kids.”
  • “I’d like to cut back on my drinking, but it’s what I do when I hang out with my friends.”
  • “My doctor told me I have to lose weight, but they don’t understand that everyone in my family is big-boned.”
Motivational Interviewing is an evidence-based approach helping people get beyond “yes, but.” It helps people change behavior…for good…on their own terms and in their own way, the only way change will really “fit” and “stick.”

skills & sharing solutions

In my 14 years of writing  Tips and  Topics, I have often shared solutions to improve knowledge (SAVVY) and SKILLS. This month I am excited about new learning opportunities, which will improve your knowledge and skills in Motivational Interviewing (MI). I know many of you have had trainings on MI and you may think you have it down.
Too often it all makes sense in the workshop, but…… translating that workshop knowledge into real practice change in your counseling or therapy sessions can be a whole new ballgame.
Take a look at a brand new learning opportunity on Motivational Interviewing from IWE.
At IWE, we’re putting convenient, evidence-based online training into the hands of people across the nation. Our courses give people (whether professionals in healthcare or other industries, or everyday people trying to do better at home, work, or in the community) the science-based tools to make change happen that fits each individual and change that sticks.
Here’s my invitation: Consider boosting your staff’s skills and effectiveness by enrolling them in a new motivational interviewing course the IWE team and I have created. Perhaps you know someone interested in helping people change?
  • At home as a parent or family member
  • At school as a teacher, guidance counselor or principal
  • In the community as a concerned citizen or wellness coach
  • At work as a human resource person, team leader or co-worker
This MI course was designed to make sense to ALL, not simply healthcare professionals.
It offers the critical elements that make training in MI a success:
1. Convenient scheduling:
The online course can be accessed 24/7 from any computer, laptop, table, or phone; and students have up to 12 months to finish the course.
2. Effective learning format:
The course features a rich variety of learning activities: interactive practice, video demonstrations, concise and practical explanations, illustrations, and live teleconferences for skill building.
3. Rigorous training:
The course is designed to promote extensive deliberate practice because it’s the kind of practice that leads to real mastery.
4. Affordable:
Students get the benefit of a rigorous, interactive course with live feedback…. without having to take time off from work or travel for a workshop “blitz” often leaving students with lots of great ideas but not enough practice.
Surf the website link to learn more about the course. Be sure to scroll to the end of the web page to see some attractive special discount, sign-up deadlines you won’t want to miss.
Take a look at Train for Change, Inc.’s approach to skill retention and organizational change.
Train for Change (T4C), Inc., is a sister company of The Change Companies. T4C offers training solutions, which build on and go beyond skills training for individuals to promote real changes in organizations and leaders. More on this approach here:  T4C’s Comprehensive Approach
At T4C, there are:
  • Onsite training and e-Learning modules.
  • Strategies that promote systems change – like Change Agent and Supervisor Training.
  • An array of training and implementation strategies for ASAM Criteria and Motivational Interviewing.
You can see more detail at:   T4C’s Array of Training Opportunities
Both T4C and IWE use knowledge from adult learning principles; organizational development; and systems and culture change to create effective and efficient learning opportunities.


Recently, I was delivering a Motivational Interviewing (MI) training. I was discussing people ambivalent about stopping smoking. Here’s what I said: I would always first recommend someone stop smoking. However, if in our continued conversation, it became clear the individual was ambivalent about ceasing, I’d say they should continue to smoke if they want.
A workshop participant challenged me with this question: “ Isn’t that just being manipulative and using reverse psychology?” I acknowledged it can sound that way, however intent is everything. My approach with a client is from a place of acceptance of their autonomy to make decisions about his/her own life and health. And anyway, I am truly powerless over making him/her change.
“Acceptance” is such an easy word to throw around. In the current edition of Motivational Interviewing (pages 16- 19, 2013) however, Miller and Rollnick break “acceptance” down into four parts – easy to list, but not so easy to actually live/practice in our work with people:     
  • Absolute Worth – full respect for whom the person is as a unique individual.
  • Accurate Empathy – “ability to understand another’s frame of reference…and that it is worthwhile to do so.”
  • Autonomy Support – “honoring and respecting each person’s…right and capacity for self-direction.”
  • Affirmation – “to seek and acknowledge the person’s strengths and efforts.”
Acceptance is part of the true spirit of MI. There is a new e-Learning module from Train for Change out to guide you in understanding all about the Spirit of MI.  Here’s the link:  The Spirit of MI training  It’s the middle course in the top row of learning opportunities.
A few years ago at a workshop, another participant shared phrasing his supervisor had taught him, and which I said I would “steal” and teach myself:
“How is what I am doing with this client at this time, helping them to help themselves?”
In other words: our work with people is not about our brilliant insights and confrontations of clients’ knowledge deficits and thinking errors. It is not about teaching them what is wrong with them; and then having them do what we think they should do and be.
What is it about? It’s about partnering with them in a self-change process within an atmosphere of acceptance, compassion and discovery. That takes a lot of SOUL.
Miller, William R; Rollnick, Stephen (2013): “Motivational Interviewing – Helping People Change” Third Edition, New York, NY. Guilford Press.
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