Resisting Recovery? Find Motivation through Therapy

By Leslie Davis

Entering a drug or alcohol treatment center can be intimidating. The only experience that most have had with treatment centers is what they have seen in movies or on TV, which likely showed a patient being scolded, yelled at, or thrown out of treatment for relapsing into substance abuse.

If you are considering entering a drug or alcohol treatment center, be assured that this is not the experience you will have at most facilities. Treatment centers have changed their mindsets about what is effective when it comes to treating patients, and now take a more patient-centered approach using motivational interviewing.

What Is Motivational Interviewing?

Motivational interviewing was born out of the idea that confrontational interactions with patients in rehab were ineffective and caused people to stop treatment before they got anything worthwhile out if it. Therapists and other staff at treatment centers use motivational interviewing to work with patients to enhance their motivation to continue treatment.

“Folks who come to a treatment center that uses motivational therapy are more likely to engage in treatment, stay longer, and have more days that are clean and sober,” said Julie Miller, MC, LPC, LISAC, a therapist at Sierra Tucson, a drug and alcohol treatment center in Arizona that has successfully put motivational interviewing into practice.

Most people enter treatment with ambivalence about whether they even have a problem and what they want to do about it. Through motivational interviewing, patients can learn to resolve their ambivalence about wanting to go through treatment so that they can move forward and do the necessary work to achieve and maintain sobriety.

There may also be a certain amount of resistance by people entering a drug or alcohol treatment center. People may be unsure about if they have a substance abuse problem and resist treatment or discussions about it.

“Using motivational therapy, we help patients look at their own goals, where they want to be in their life, and how their behavior interferes with them achieving their goals,” Miller said.

Basic Principles of Motivational Interviewing

When patients experience a lack of motivation or resistance to treatment, it is often because the therapist is using strategies that are not appropriate for where the client is. Motivational interviewing allows a therapist to be more in tune to where you are in treatment and when you are ready to move on.

There are five basic principles of motivational interviewing that therapists follow to ensure patients are getting their needs met:

1. Expressing accurate empathy. This means seeing everything through the eyes of the patient so that you feel understood. In that way, you are more likely to be open about your experiences and share them with your treating therapist. Your therapists and other staff at a drug and alcohol treatment center will ask open-ended questions to try and understand exactly where you are coming from.

2. Developing discrepancy. This will examine the differences between where you are and where you want to be. It is your task as the patient to articulate any ambivalence you are feeling about treatment, and it is the therapist’s task to raise any discrepancies and help you explore the discrepancies between your goals and your behaviors.

3. Avoiding arguments. Because motivational interviewing is about finding out what the patient needs, your mental health professional should be clarifying with you what you mean instead of aggressively confronting you about your feelings or statements. Your therapist should not sound authoritative, do most of the talking, or be demanding or coercive. Instead, you should find a therapist who actively listens, is supportive, maintains engagement with you and expects you to succeed.

4. Rolling with resistance. If you are resisting moving forward or uncomfortable at any stage of treatment, your therapist should slow down and back up to a place where you feel comfortable. Therapists should meet you where you are and be aware of your readiness to change, and not jump ahead of you in the treatment process.

5. Supporting self-efficacy. This means you, and not the therapist, are the expert on your life. While your therapist will help you develop answers about your goals, they will not pressure you to move forward if you aren’t ready for the next step. “We are really just there to help people move forward,” Miller said.

A therapist who can effectively help you achieve lasting sobriety will use those techniques. If you find you are not getting anything out of sessions with a therapist, or feel like your therapist is not really listening to you and helping to guide you forward, you may want to consider finding a therapist who will.

Use at Residential Treatment Centers

Drug and alcohol treatment centers are shifting to the use of motivational interviewing to more effectively help patients recover from their addictions. For the patient, it can help them find their own motivation for recovery so they can move forward in the direction that they want to go. “It’s a style and a mindset that meets them where they are,” Miller said.

At Sierra Tucson, the use of motivational interviewing will often be obvious to you at your initial meeting with a professional at the treatment center. “It’s a quick way to establish rapport,” Miller said. “Motivational interviewing is used immediately, and throughout treatment.”

Though other treatments are used to address each patient’s underlying substance abuse issues, motivational interviewing helps patients move through their treatment with minimal resistance.

Motivational interviewing can be used to help patients rapidly engage in their treatment. At Sierra Tucson, your first session with a therapist will often focus on engagement and motivation rather than filling out paperwork so that you can experience a more enlightening and sustaining recovery.

“We rarely kick people out of treatment for ‘acting out’ behavior,” Miller said. “We work with people to enhance their motivation to recover.”


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