Motivational Interviewing and Quantum Change, with William R. Miller

Motivational Interviewing and Quantum Change, with William R. Miller

well good evening thank you for joining
us for what I anticipate will be a very
inspiring lecture by dr. William Miller
who I think brought with him to our
lovely city the weather from the
southwest it’s got a beautiful summer
evening finally I’m Tina’s up Nikki I’m
deputy Dean for the curriculum and also
a faculty member here at the School of
Social Service administration I welcome
you on behalf of Dean Neal Gutterman who
sends his regrets as he’s currently out
of the country I think he’s in Uganda
right now I know he joins me in thanking
you for your attendance today I’d
especially like to welcome SSA students
alumni faculty lectures staff field
instructors and all of our colleagues
from the field of Social Work in
tonight’s lecture you’ll hear from our
distinguished speaker about the
potential for personal transformation we
also want to acknowledge your collective
work counseling clients supervising
students directing programs and
advocating for improved social welfare
policies your efforts have the potential
to change some of our most intractable
problems of our day this evenings
lecture is made possible by the Ruth
Knee fund for spirituality in social
work named in honor of ssa graduate Ruth
Ireland nee it provides an opportunity
to explore the diverse ways spiritual
and religious traditions are experienced
in clinical social work practice Ruth
was a pioneer in social work in
community mental health in the United
States joining the Public Health Service
as one of its first psychiatric social
workers a founding member of the
National Association of Social Workers
she chaired the Committee on the study
of competence which was instrumental in
setting standards for Social Work
practice over a period of 30 years Ruth
nee developed social work roles within
public health and military health care
programs and advanced innovations and
improvements in mental health services
at the federal level she also served as
one of ss A’s luminary valen
Cheers sponsoring Washington week the
student Career Services program designed
for to help SSA students learn about
career options in Social Policy and
government among her many
accomplishments and honor in 2001 she
was given the Edith Abbott award
honoring lifetime achievement it is a
privilege for us to honor Ruth’s legacy
through this biannual lecture on behalf
of the school I would like to thank the
sponsors who helped make tonight and
tomorrow’s advanced motivational
interviewing workshop possible the
Center for Health Administration studies
particularly Jean marsh Colleen Grogan
and harold pollack the center for
interdisciplinary inquiry and innovation
and sexual and reproductive health or
ci3 most especially Amy Whittaker and
Melissa Gilliam and Heartland Alliance
particularly Karen Bhatia Joan Leto and
Reverend Sid mone I’d also like to
acknowledge the tremendous assistance of
SSA alum Scott Peterson who proposed the
idea of offering an advanced
motivational interviewing workshop which
he will co-lead tomorrow with dr. Miller
a brief housekeeping item please return
your evaluation at the conclusion of
tonight’s event at the registration
table if you are receiving CEUs for your
attendants please remember to sign out
and pick up your certificate before
leaving now I’d like to introduce my
esteemed colleague and central figure
and arranging dr. Miller’s visit to SSA
professor Summerson car
[Applause]
in 1959 CP snow famously identified two
cultures that of science and that of the
humanities he charged that these
cultures have become so bounded so
circumscribed in their intellectual
concerns so Orthodox and their
epistemological commitments and methods
of engagement that even his most learned
colleagues could not find a way to
communicate across them gone were the
days of scholars like William James who
began his career at Harvard as an
anatomist and physiologist and spent the
next 40 years teaching and writing
fluidly between physiology philosophy
and psychology wielding tremendous
influence in the US and Europe in part
because of the beauty and accessibility
of his writing yet even James and the
opening lines of his University of
Edinburgh lectures that were later to
become the varieties of religious
experience admits some trepidation and
approaching the question of mystical
experience by way of psychology and
neurology not only because the science
of the day failed to consider religious
experience a properly scientific subject
but also because there were those who
wanted to protect the realm of the
sublime from systematic inquiry if the
results of James efforts are now widely
appreciated of still the subject of
hearty critique consider that James work
is now far more likely to be taught in
an English department alongside his
brothers novels than in a Department of
Psychology or a School of Social Work of
course this is now also the case with
the work of Sigmund Freud arguably one
of the very few things that Freud’s and
James work has in common is that it’s
considered insufficiently scientific to
be seriously engaged by many academics
like psychologists and clinical social
work scholars today yes indeed there are
still two cultures but William R Miller
is an intrepid traveler between them he
is also a gifted translator whose work
who works between the well-fortified
borders of scientist
and humanistic inquiry and do and in
doing so offers us new ideas about how
we might enrich intellectual life and
especially our our understandings of the
processes of human change as one of the
world’s most cited scientists author of
40 books over 40 books and 400 articles
many of which are devoted to the
development testing and dissemination of
behavioral treatments for addiction
William Miller has also written
extensively about integrating
spirituality into treatment
judeo-christian perspectives on
psychology and positive faith or living
as if he has also followed James and his
interest in mystical experience devoting
particular attention to what he calls
quantum change it is not just across his
voluminous writings but also within his
best-known work on motivational
interviewing that one finds a happy
marriage of humanistic and scientific
thinking bill has devoted himself to
specify and evaluating techniques of
therapeutic engagement with a close eye
on fidelity and the measurement of M
eyes effects at the very same time that
he is proper that there is a spirit to
mi which unites its veterans
practitioners and speaks to M eyes ever
spent expanding client population in MI
we find an evidence-based practice which
is endowed not only with a set of highly
specifiable skills for producing change
but also with the quasi-mystical
proposition that radical change can and
sometimes does emerge out of the most
mysterious reaches of human experience
and interaction we are lucky today to
hear his first public talk between his
very well-known work on MI and his
lesser-known work on quantum change
lesser known perhaps precisely because
the boundaries of what counts in the
study of human experience are drawn to
strictly by many of us in the scholarly
community so it’s with great
anticipation and without further ado
that I introduced dr. William R Miller
who will speak to us today about
motivational interviewing and quantum
change reflections on human potential
[Applause]
thank you it’s a pleasure to be back in
Chicago especially with weather like
this I’m going to be talking about two
lines of research one of one that’s
going on for almost 40 years at this
point and another that maybe is 15 years
old and and I hope to do that in an hour
so that’s about a minute a year I’ll be
moving over a lot of terrain but those
two lines of research have to do with
motivational interviewing and with and
with quantum change that initially I
thought did not have much in common but
I’m beginning to think that they do so
first I tell you the story about
motivational interviewing that did not
start from a theory did not was not
pre-planned but just sort of emerged
over time and in a theoretical and
accidental kind of way and wound up
taking over my life I guess a beginning
was in Milwaukee where I was on
internship at the Veterans Hospital
there and I was invited to spend the
summer on an alcoholism unit and the
director of the unit said what do you
know about alcoholism
I said nothing really well what did they
tell you in graduate school well I
actually don’t remember it coming up he
said well then you better come and spend
the summer with us because this is the
second most common diagnosis you will
see throughout your lifetime and so I
did spend the summer there and it opened
up my one of my primary areas of love
and interest in clinical work and since
I didn’t know anything about alcoholism
I simply put on my best Carl Rogers half
happily I’d been trained in Rogers as
well as cognitive behavioral therapy and
just listened to the patients and asked
them to tell me how they come to be
where they were and what their thoughts
were about their future and what they
cared about and I just listened with the
best reflective listening that I could
to muster and the patients seem to
really enjoy it and I really enjoyed it
I learned a tremendous amount from them
and then I began reading literature on
alcoholism which I’ve not read before
and it said alcoholics are pathological
liars have immense levels of immature
defenses and denial they’re out of touch
with reality very difficult to
communicate with and I thought gee those
aren’t people I was talking to maybe
they’re different in Milwaukee but it
was a beginning hint that there was
something in the addiction field that
needed a bit of attention well I I was
inspired to do my dissertation on
treatment of alcohol problems and in a
subsequent study one of the puzzles was
why did the control group get better hmm
in this particular study we compared two
different conditions both of which were
cognitive behavioral basically one of
them was a counseled and delivered
behavior therapy for about 10 weeks and
one of them we which was our no
treatment control we sent people home
with a self-help book that described the
same kinds of methods and said you know
read the book work with this and see how
you can do with these things and we’ll
see you in 10 weeks and see how you’re
doing and both both groups kept a weekly
record to elaborately diary of their
drinking that that book eventually
became what is now called controlling
your drinking it’s still in print after
all this time well what we found was
that the two groups did not differ at
all in their outcomes the yellow group
is the decline in drinks per week in
people who are seeing a counsellor looks
good you’d be happy with those outcomes
and the red line is people working on
their own with a self-help book and they
look like they’re doing just as well as
people who were being seen by a
counsellor and that wasn’t the way it
was supposed to be according to my
training according to my training the
more time you spend with a therapist the
better you get but these people have the
gall to go home and
and read a book and get better um so I I
moved to Albuquerque and thought the
finding would go away I repeated the
study with those two groups in it and
replicated the finding in 1978 in 1979
in 1980 talk about being in denial yes
and I finally decided that there may be
these phenomenon here that needs to be
understood so what was going on how come
people were getting better in this kind
of self-directed condition well maybe it
was just an artifact of time maybe once
people walk through the door of the
clinic they’re better
I mean they’ve made the decision to come
to a clinic and you can stand on your
head or do anything and they’re gonna
get better after that so that’s an
impossibility we also ask people in
these groups of what what really helped
you and they said keeping those records
really helped me a lot that when I wrote
down every drink like it told us before
I had the drink I’d get out my card and
say mm maybe I’ve had enough and so that
made me really aware so we thought maybe
it’s a reactive effect of
self-monitoring and so we designed the
study to control for those things and in
this particular study we had the first
the two usual conditions of seeing a
counselor for 10 weeks going home with a
self-help book going onto a waiting list
and keeping a diary or going onto a
waiting list and not keeping a diary
well what we found was that the yellow
group again improved rather well their
red group working on their own with the
self-help book started off worse and
wound up better relative to the
counselor group and statistically they
were pretty similar to each other at 15
month follow-up they’re just you know
just the same again so we have just as
much improvement in the self-help group
as in the counseling group as we’d found
in 4 previous randomized clinical trials
on the Green Line the waiting list group
didn’t change at all and then when we
treated them with or without the diary
by the way then it didn’t matter if they
the diary actually people keeping a
diary the drinking went up a little bit
but combining the control groups they
didn’t change at all then we treat they
came in and saw counselor and they’re
drinking went down and looked just about
as good as the other groups although it
splashes back a little bit so so it
wasn’t just the passage of time and it
wasn’t just keeping diary records it was
something else well although that
finding was surprising to me they’re now
dozens of trials showing that even a
relatively brief intervention with
people who are drinking too much
contribute change and in another paper
they wrote there certain characteristics
of interventions that seemed to work
well in helping to trigger that change
in a single conversation again that was
different from my training it shouldn’t
be that you can have a single
conversation with somebody that’s been
practicing a pathological behavior for
15 years and they turn the corner and
yet there was over and over in the
literature and I began to think about
that control group because actually if
you do follow people over time once
they’ve identified themselves as having
a problem they do tend to decrease and
in problem behavior and yet these folks
didn’t change at all they’re absolutely
flat and it occurred to me they did what
we told them to do they waited they were
politely waiting for us to give them
permission to change we and what are you
saying to someone when you put them on a
waiting list you’re not expected to get
better until we can treat you and then
we can so go ahead and drink and and
then we’ll treat you and then you’ll get
better and so a very obedient patients
did what we what we suggested that they
ought to do and it kind of got my
attention in terms of how much influence
we can have just by almost our
subconscious communications with with
patients I also began to notice that
therapists have very different outcomes
and in every study in addiction
treatment where that’s been studied it’s
true different therapists doing
same treatment with the same manual with
the same supervision process with the
same content allegedly have very
different outcomes and we were seeing
the same thing in the study we did quite
a while ago as you can see we had nine
counselors and three supervisors
including myself and we watched those
counselors working through will be a
one-way mirrors that’s so long ago this
was couldn’t afford video equipment at
that time and among the things that we
had in our laps as we were observing was
the accurate empathy scale developed by
trucks and Kharkov called Rogers
students and colleagues how well is this
counselor listening to the patient
interested in what they have to say
understanding it and reflecting it back
well so most of you I’m assume have had
some training and in client centered
counseling and know the skill I’m
talking about now they’re doing behavior
therapy and we were looking at that too
but we were looking at how well are they
listening really listening to the
patient and reflecting back meaning and
so we randomly assigned patients to the
therapist so there was no systematic
bias there and we all rated these
therapists on the level of empathy and
our our ratings had very high agreement
0.89 among the three of us with
independent ratings well you see nine
yellow bars and those are the nine
therapists and their success rates and
working with patients and they’re lined
up from 1 to 9 1 being the most empathic
therapists we all agreed that was the
most empathic therapists that we saw out
of nine and if the other end number nine
was the least empathic therapists two of
us rated that person nine and the other
rated that person eight out of nine so
we had very high agreement and you can
see that the outcomes are rather
different and it’s they’re not randomly
distributed here
therapists with high levels of empathy
have a hundred and seventy-five percent
positive outcomes and drops down to 25%
in the with therapists who had the
lowest level of empathy who went to
medical school by the way
now over on the right-hand side of the
graph you see a red bar that is the
success rate of people working on their
own with a self-help manual because we
sent people home with a book also and
60% of them hit this criterion for a
good outcome if you average all the
therapists together their average
outcome is 61 percent so therapists and
manual self-help manuals are no
different from each other and yet you
only have to look at the graph to know
that therapists are different from
self-help manuals there are five of them
where they have a better success rate
than just going home with with the
self-help manual and there are actually
three therapists where the client would
have been better off going home with a
good book than working with this
counselor and this is not unusual
finding an addiction treatment they’re
often a small number of therapists with
particularly poor outcomes hanging out
down at the bottom there well that’s
pretty interesting and and not only do
we know their differences among
therapists but we can account for them
by empathy that a high level of
skillfulness in what Carl Rogers taught
as accurate empathy makes you a better
behavior therapist hmm it’s kind of
intriguing
in fact the correlations were pretty
high if you know about correlations we
were able to predict the number of
drinks per week the clients were having
six months later with a correlation of
0.8 – you square your accounting for
two-thirds of the clients drinking by
how well the counselor listened at a
year correlation is still 0.7 one two
years later the correlation is still
0.51 accounting for a quarter of the
variance in outcome which is huge in
psychology based on how well this
behavior therapist was listening to
their client and reflecting meaning back
to them we’re not the only ones to find
it in the study published the next year
Steve Valle reported these relapse rates
so up in this graph is not good all
right
relapse rates for clients assign
randomly to counselors in an alcoholism
treatment program and the red bars are
counselors who were low in in client
centered skills the yellow bars are
clients who had kind of medium
client-centered skills and the green
bars are the the therapists therapists
counselors who had the highest level of
client centered skills and you can see
that there the relapse ratio is anywhere
from two to one to four to one different
depending on what counsel you got if you
got an empathic counselor you’re much
better off if you get a very low empathy
counselor well with that I went off to
Norway on my first sabbatical and they I
worked at an alcoholism hospital and
they gave me a corner office that had
been the barber shop so they ran they
ran the barber out of there and I got
this beautiful office on a lake and a
fjord sitting there you know looking out
into the Norwegian forest and I was
hired to the lecture on the cognitive
behavioral treatment of addictions which
I did and the director of the clinic
also said would you be willing to meet
with our psychologists most of them are
pretty green most of them are just out
of training and they’re working with
kind of tough clients and just you know
have a conversation maybe every week or
so and see what comes of it I said sure
I can do that and so we began meeting
and what they wanted to do was to
roleplay the clients they were seeing in
English of course because my Norwegian
wasn’t very good at that point still
isn’t and so they would roleplay in
English the patient’s they were
struggling with the most and essentially
say oh okay smart guy show us what you
would do with this and and I would do my
best to show what I’ve been doing in
Milwaukee and and since and they would
stop me often now the way European
psychologists are trained is very
analytic not psychoanalytic but but
analytic thinking very reflective kind
of introspective and they would stop and
say what are you thinking at this point
you you asked the client a question now
you could have asked a lot of questions
why did you ask that particular question
or you’ve reflected what the client said
but the client said a lot of things how
did you decide how did you know to
reflect that particular thing of all the
things that the client had said and when
I was being trained in client standard
therapy nobody told me which things to
reflect you know but somebody had taught
me and my clients had taught me which
things to reflect and so I began to
verbalize some decision rules that I was
using implicitly that I was not
conscious of and that we’re
embarrassingly different from the
lectures I was giving in the next room
and I wrote them down in what Carl
Rogers called a discussion paper just to
kind of send around to some colleagues
and say what do you think about this and
the the basic concepts in it were it it
should be the person rather than the
clinician who makes the arguments for
change and what you want to do is you
VOC the person’s own concerns and their
own motivations for change they don’t
care why you think they should change
but hearing why they might want to
change is important listen empathically
use those client centered empathic
skills to really hear what the person
saying if you meet resistance don’t push
back against it don’t confront it you
know don’t oppose it we said then rolled
with resistance just kind of go with
with the flow reflected you know nothing
complex nurture hope and optimism
because if you convince somebody they
have a serious problem but there’s
nothing they can do about it you haven’t
done them any favours no
so also nurture optimism that change is
possible and I was thinking of this as
kind of priming the pump as getting
people ready for treatment you know and
so that was the paper that I that I
wrote up and distributed the colleagues
one of whom to my surprise said I want
to publish it in behavioral
psychotherapy and he was the editor of
it I just made it out
I mean the only numbers are the page
numbers I mean I don’t I don’t have any
data at all for this
he said just let me publish it I think
it’s a good paper so I said okay and and
cut it in half he said which editor is
always saying and I did and he published
it and I figured that’s the last that I
would hear of it yeah but I didn’t go
home and began thinking of we turned
this into an intervention for people
with drinking problems what might that
look like
and having worked with severely
dependent people I thought and I’d like
to go further upstream I’d like to find
people before they get so severely
impaired and do something with them and
maybe this is something that would work
there and so we designed something
called the drinkers checkup and the
drinkers checkup was essentially a very
low threshold enrollment then we put a
notice in the newspaper that said if if
you if you’ve ever wondered whether
alcohol is harming you in any way we
have a free checkup that you can come in
for it’s not treatment it’s not this is
not part of a treatment program you’ll
get health information back and what you
do with that information is up to you
well we got a lot of calls and most of
these people had never been near a
treatment center but every last one of
them had a drinking problem every last
one of them and there were serious
reasons for concern we did a thorough
assessment looking in particular for
things that would be early signs of
alcohol impairment and then we saw them
one time and gave them feedback about
what we found in a motivational
interviewing style and gave them a
treatment referral list here are all the
places you can go for treatment and I
figured people would go for treatment
the outcome was almost nobody went for
treatment but they had the gall to
change their drinking on their own
without additional permission or
treatment and they’re drinking declined
just as much as in the graphs that I
showed you earlier following us a single
checkup intervention so while I was
thinking this would push people through
the door to treatment I guess we forgot
to tell them that and and they just went
ahead and changed you know
well then we began decided to compare
counselling styles and so we compared
two different ways of giving that
feedback one of them was feedback in a
kind of confrontive directive style so
if you tell the person well you’re
drinking more than ninety percent of the
population and the person said what that
can’t be I mean everybody no drinks that
much that can’t be right
you might say well now how can you sit
there and tell me that when you and I
sat here and constructed your drinking
and here are the drinking norms for the
culture and then we take a look it’s
right there in front of you which was
sort of common addiction counseling
procedure at that point or in a more
motivational interviewing Rogerian style
well I don’t think it’s that bad so this
really surprises you it’s not what you
expected a reflection well without any
further treatment the red group is the
confrontive condition and they they’re
drinking decreases some the yellow group
is the group also getting feedback
randomly assigned in a motivational
eating style and you see it’s a steeper
decline both of them maintain pretty
well over time and again the waiting
lists control was very polite and waited
for us and then we did the checkup and
then they’re drinking went down but
again with some splash back I’ve seen
this now in several studies that if you
make people wait for treatment it
doesn’t seem to work as well as if you
treat them when the window of
opportunity is open we found the same
thing in a training study – by the way a
training of motivational interviewing
study that when we trained people
immediately when they asked for it they
showed a nice improvement it didn’t
maintain as well if we made them wait
for training later on so waiting lists
are not necessarily a good thing in fact
they may be print issues
now besides the counselors doing what I
told them to do because the same
counselors did both conditions so I had
to train them up so they could walk into
the room open an envelope and it says
confront and you can do that or it says
reflecting you can do that but I knew
from watching that some of them were
pretty good at one style and not the
other style so I said well what did they
actually do not what did what I just
tell them to do but what did they
actually do and there we found that one
counseling behavior predicted client
outcomes it was confront the more the
counselor confronted the more the
clients drank and it was 0.59
correlation pretty strong
we also found by the way that the more
resistance behaviors we saw from the
client the worse their outcome was as
well but those resistance behaviors were
under the control of the therapist so a
few counsel in a confrontive way that
that evokes a lot of resistance you have
bad outcomes basically that was what we
were seeing in this particular study we
also took a look at to what extent did
we get change talk that is the client
arguing for change giving us their
motivations for change and in in the
more directive condition we get half as
much change talk as in the more empathic
condition where we’re listening so if
you listen well the patient’s they say
more things about why they want to get
better and we looked at resistance and
we got half as much resistance in the
empathic condition and it is we know
from subsequent research the ratio
between change talk and resistance or
counter change talk that predicts
behavior change so you’ve gone about a
three to one ratio in the empathic
condition whereas in the directive side
you’ve got ambivalent clients equal
amounts of pro and con and it is an
experimental product of the way in which
they were counseled
so here we got pieces of a puzzle we
have brief conversations brief
interventions that make a difference it
definitely matters what the counselor
does so after after studying this for so
long I’m very aware when I walk in a
room I need to pay attention to what I’m
doing because what I say matters I can’t
just sit here in chat you know because
what I say matters that empathy predicts
client change replicated numerous times
that confrontation undermines change
people are less likely to change if you
confront them than if you leave them
alone and given a brief intervention
clients went ahead and changed on their
own without further intervention
interesting so then I went off on
another sabbatical this time to
Australia and in the office next to mine
was this South African Bushman who was
at the time living in in Cardiff Wales
but working in Australia says a man of
the world and his name was Steve rolnick
and he said to me Miller you you think I
wrote that article on motivational
interviewing
I said you read it Wow I’m impressed
that somebody’s read it and he said well
read it no I’m teaching motivational
interviewing all up and down the UK it
has become a preferred treatment for
addiction and I don’t even know if I’m
doing it right
they’re just this one crummy little
article and you got to write you got to
write more about this so I said well
show me what you do and and the way he
practiced had exactly the same heart and
exactly the same dance and exactly the
same rhythm and working with patients I
said yes that’s it let’s write a book
together and so we did and the first
edition of motivational interviewing
came out in 1991 focused on addictions
by the time our second edition rolled
around it had already spread into so
many other areas of health care and
social services that it wasn’t about
addictions anymore and the third edition
just in 2013 again quite a different
book from the from the previous two so
where are we now well the my books have
been translated into at least 22
languages there are more than 200
randomized clinical trials of
motivational interviewing including 10
multi-site trials there more than 15
hundred publications directly about
motivational interviewing and something
like 40,000 that in some way reference
motivational interviewing across a lot
of problem areas there’s evidence of
this helping so it’s now being used in
healthcare mental health addictions
correctional settings
more recently schools dentistry I can’t
keep track of the places this stuff
keeps popping up and says there’s
something in common across these kinds
of behavioral challenges that people
bring and ambivalence which is kind of
the heart of what you’re working with
and motivational living is just human
nature many it is who we are and the
particular problem area it isn’t so
specific as the phenomenon of
ambivalence you I want to I don’t want
to at the same time and how you work
with that there are more than 3,000
trainers working in at least 47
languages that we know about and whole
states and whole nations are
implementing motivational interviewing
in a correctional system or in a mental
health system or whatever so I’m just
astonished I mean this started with an
article that I hadn’t even planned to
publish
it has just taken off like a rocket this
is Google Scholar articles by year and
so you can see the plot starts off with
nothing and slowly picks up and it
follows the the dissemination of
innovations curve heading for 40,000
articles now in 2013 so what is it well
it’s a collaborative conversation style
for strengthening a person’s own
motivation for and commitment to change
that’s the way we describe it now in the
third edition that’s what we call the
elevator definition if you’re getting in
an elevator and someone says what’s
motivational interviewing and you’re
getting off on the second floor that’s
what you think yeah practitioners want
to know what why would I bother to learn
this right how would how is this useful
to me and there we say well it’s a
person-centered counseling style for
addressing the common problem of
ambivalence about change do you ever
have patients who are looking for change
and yet seem to be ambivalent or
reluctant about it you know if so is the
tool that might be useful to you and
Steve and I began teaching motivational
interviewing and about 1995 we began
writing about the underlying spirit of
motivational interviewing for a
particular reason we saw people using
the techniques that we taught them and
we were dismayed now it just it didn’t
feel right it didn’t look right then
seemed to work using the techniques
without what we now call the spirit just
was missing something really important
and what we said is we’re obviously
missing something in our training
there’s something that we’re not
covering because people are going away
and trying techniques but they don’t get
what we’re trying to teach them and so
we began to write about the spirit of
motivational interviewing that now has
these components to it
collaboration it’s a partnership it’s
not I’m an expert I’m gonna fix you I’m
a teacher I’m going to teach you these
things I’m a doctor I’m gonna repair you
I mean it’s it’s two people having a
conversation companions on the journey
each with expertise you have
professional expertise your client has
expertise nobody knows more about your
client than the client does and if what
you want is a behavior change to happen
in their life you’ve got to have they’re
at
protists involved it’s got to be a
collaborative partnership kind of
approach acceptance fairly profoundly
like Carl Rogers was talking about so a
non-judgmental approach a respect for
what the person believes and an interest
in what they have to tell you and a
belief that they have wisdom in them and
want to be well Eve occasion
instead of installing things that are
missing that was kind of my training and
behavior therapy what clients are
missing a skill and what you have to do
is install that skill and then they’ll
be better or clients are missing insight
you’ve got to install the insight and
then they’ll be better or they’re they
have irrational thinking what you have
to do is install rational thinking and
then they’ll be better so all of it is
kind of I have what you need and I’m
gonna give it to you
motivational interviewing says you have
what you need and together we’re gonna
find it you already have what you need
together we’re gonna find it and it’s
calling forth from the person their own
wisdom their own resources their own
ideas their own motivations for change
and then finally we added compassion the
the primary reason for the conversation
is the other person’s welfare because
you can do the other three things and
sell used cars those are those are all
interpersonal influence techniques that
once learn can be used in a whole
variety of contexts we’re saying here
the purpose is is solely the other
person’s best interest we talk now about
four fundamental processes this is a
whole new way of talking about in
teaching motivational interviewing first
engaging so often ignored you begin by
collecting facts you-know-whats intake
intake collecting a whole lot of
information
you know Roger said that’s not good to
the client they already know all that
stuff engaging so you have a working
relationship and that can be done fairly
rapidly we’re not talking about 20
sessions of engagement you see it happen
in minutes within an mi session focusing
getting clear where we’re going what are
the goals of our work together then you
the thing that is most unique I think to
motivational interviewing calling forth
the person’s own ideas and motivations
for change and then developing a plan
once the person is to the point of being
willing to move forward so far
summarizing a amazingly large database
am i training we know yields and my
consistent changes in practice and I’ll
talk a little maybe well certainly talk
about that tomorrow some that we’re
learning better and better how to teach
people to do this and we’ve tried a
variety of different training strategies
so we can increase mi consistent
practice mi consistent practice yields
more change talk and less resistance
during treatment sessions those things
predict behavior change outcomes and
that seems to be true across quite a few
different problem areas so this is not
just something for addictions as I said
it’s being used in many different areas
average effect sizes small to medium
with a lot of variability so counselors
seem to vary a lot in how well they do
this and what outcomes they get you see
variability across studies also some
studies find an effect others don’t in a
multi-site trial with all the therapist
trained together and my works at some
sites and not others so there’s
something that we’re missing that’s
important that varies across delivery
I think we’re getting hold of some of it
that accounts for some of this
variability what seems the matter a
therapeutic relationship and my spirit
and empathy we know are related to
better outcomes not just in motivational
interviewing and behavior therapy as
well the evoking of client change talk
matters we can predict from client
change talk during a session how likely
changes to happen from what the clients
saying during the session and what the
clients saying during the session is a
function of mi consistent practice also
decreasing client resistance is
associated with change and that’s
something that you see with a
motivational interviewing session as
well person may walk in very highly
resistant but it just kind of goes down
over the course of the session
you’re not response
for the level of anger and resistance
the client walks through the door with
but after that it’s up to you and then
the counselor refraining from counter
therapeutic behaviors so maybe some of
what we teach people is just not to do
the wrong stuff don’t get in their face
don’t scream at him you don’t do that
with most things in the DSM you know but
somehow an addiction treatment that was
good for him you know it’s not don’t try
to persuade don’t give uninvited advice
those things all kind of increase the
pushback and resistance and some perhaps
if we can just stop people from doing
those kinds of things you get better
outcomes and by the way these things all
matter and counseling more generally not
just in motivational interviewing so in
a way we’re getting at what get called
common factors or general factors or
nonspecific factors in counseling that
matter
besides the content of the therapist
manual we also in the third edition
they’ve said this is not just about
behavior change it’s not just about
stopping bad habits and not just about
dealing with problems motivationally
being can be used in a much broader way
that involves human potential and
thereby it connects it back to the roots
of motivational interviewing which is a
humanistic counseling approach the work
of Carl Rogers and and Abraham Maslow
and Viktor Frankl and others that were
important in the human potential
movement well how could my be used in
developing human potential I mean first
of all I’m removing obstacles growth so
I I was worried the client standard
folks would would hate me because we’re
sort of directional with em i but in
both the UK and the US as I went to and
talk to the client centered communities
well no of course I mean if person is
drinking and that’s getting in the way
of their personal growth of course you
would remove that obstacle there’s no
that’s not a problem you know we got
over that long ago exploring personal
values what do you care about in life
what matters to you
reducing self ideal discrepancy miss
Rogers thought this was a source of
pathology that that the more your ideal
self and your actual self are different
the more unhappy and pathological you’re
going to be and of course you can do
that by changing your goals or you can
do that by changing your behavior and
maybe some of both by you you see now a
lot of emphasis in third-generation
behavior therapies on acceptance
accepting things you can’t change
familiar in 12-step community as well
Hobart Mao or a learning theorist wrote
about integrity therapy living in a way
that has integrity with your core values
what do you care most about and in what
way is your life reflecting that or not
reflecting that mmm I think emma has
tremendous potential there there’s an
article and spiritual bypass of people
trying to avoid dealing with emotional
pain by talking about spiritual issues
and this comes from spiritual directors
they say there’s something else going on
here and the person doesn’t want to deal
with it
so again helping people get around
obstacles to their growth coming to
peace with life transitions acceptance
of one’s limitations and ageing
acceptance of dying process both in the
person who’s dying and then the people
around them there’s a relatively recent
study on evoking death talk having
people talk about the dying process
while it’s happening as a therapeutic
process and the next step in life’s
journey whether its moral growth
thinking about Kohlberg model
what’s if you would if you were to take
the next step in moral development what
would that look like in compassion is
described by the Dalai Lama and Karen
Armstrong in developing your faith your
spirituality is described by James
Fowler in awareness is described by the
Buddha in consciousness you know so
there are these kind of maps for human
growth and none of us are at the end of
those you know so what’s the next step
for me in my spiritual journey and how
might I take that and why do I want to
take that
so we’re thinking more about how am I
can be used in other ways
now the shift gears here I’m gonna talk
about another line of research that
seemed to me unrelated I was interested
in rapid changes that people experienced
in a matter of hours that seemed to be
permanent our our model for these in
fiction is Ebenezer Scrooge or It’s a
Wonderful Life the Jimmy Stewart
character there where both of them have
a really out of the ordinary experience
that changes them we presume permanently
and suddenly and dramatically different
in personality and I’ve loved those
stories that a Christmas Carol just has
so much in it it’s beautiful but does
that happen in real life
well it turns up in biography all the
time spiritual leaders very often in
spiritual leaders there’s been a turning
moment a moment of Epiphany or something
that happened that was just a change the
direction of their life and it’s there
very frequently all the way back to
Moses and the Buddha and also social
reformers including Jane Addams you find
in in their biographies these moments of
change where something happened
mysterious in a way often and they
really move ahead in a whole different
direction
bill W founder of Alcoholics Anonymous
had a white light experience that for
him was the turning point and the end of
his drinking
suddenly the end of his drinking well if
they happen and and my question going
into this study was do these things
really happen I mean is this something
that actually occurs in the everyday
life but if they do why haven’t we been
interested in those in psychology there
wasn’t even a term for it and the last
psychologist they could find it wrote
about it was William James in varieties
of religious experience in 19 – a long
time ago now if the illusions write
about it James Lauder has a book about
transforming moments
but not not in mainstream behavioral
health it’s just sort of dismissed as a
kind of strange phenomenon when my
behavioral colleagues did publish a case
report of a sudden dramatic
transformation and and called it an
exorcism you know it’s like I don’t know
how it happened but here’s the report at
least he was honest enough to report it
you know well James said there are two
kinds of change there’s the type one
change that most of us have most of the
time little gradual steps small steps in
the direction of a longer-term change
two steps forward one step back I mean
you all know the variety call that the
educational variety of change successive
approximations to something you’re
trying to do it’s gradual it can take
longer than you want and you be
frustrated with how long it’s taking to
change it’s what we see in addiction
treatment most of the time and type to
change he said these things happen
discreetly suddenly and they’re enduring
changes they’re permanent I mean when
these things happen people are changed
in a permanent kind of way and it’s sort
of like shooting Rapids that you just
kind of suddenly are in a very different
place than you were to begin with and he
gives multiple examples of those in his
book Maslow talked about peak
experiences of picking up on this to
some extent that he said are very
memorable
they usually have a people remember them
very clearly even a long time later they
have a discrete beginning there’s they
kind of knew when something strange was
happening to them often profoundly
emotional they seem to come out of
nowhere he said like Scrooge had you
stopped Scrooge on the way home and said
would you like some psychotherapy he
would have said at best
no thank you yeah and these folks have
little or no sense of doing it
themselves that this is not something I
achieve this is not something I was
doing this happened to me it came from
outside me in some sense and they’re
profoundly benevolent said Maslow as
well and he thought at first they only
happened to people toward the end of
life and when they’re very mature but
then he began
meet young people that had just the same
experience and revised his theory about
them well I got interested in how could
you study this phenomenon if it exists
and we solicited storytellers through
the Albuquerque Journal through their
local newspaper and just kind of
described a peak experience and some of
the things that James had talked about
and the story said if you’ve had an
experience like this dr. Miller would
like to talk to you we get eighty-seven
telephone calls in a week it was 89 I’m
sorry we said we would like to come in
for two to three hours and we’re not
going to pay you anything
we didn’t want people making up stories
for pay you know and ultimately 55
people came in donated their time and
completed a rather long assessment
process that was both qualitative and
quantitative and on average it had been
11 years since their experience so
sometime at past some of them were very
recent some of them are quite remote
average was 11 years ago and most of
them had told nobody about it or very
very few people they had talked to one
or two people who told them they were
crazy and they decided it was better not
to talk about it
and when they saw this described in the
paper they said that’s what happened to
me
you mean this happens to other people
too that’s amazing you know and they
wanted to meet the other people this
thing happened to know well as we
studied their stories their fifty-five
transcript which I talked off to the
oregon coast and sat and just absorb
them and read them and tried to
understand what what do these things
have to tell me it seemed like there
were two kinds there were people oh I
had a kind of insight now it wasn’t well
I’ll come back and tell you more about
that and there are people who seem to
have a mystical experience like like
Bill W did
so the insightful type of quantum change
happens suddenly people say it was not
like I decided something it was not like
I came to a conclusion this was shown to
me so I was meaning of the word noetic
this was knowledge given to me came from
outside it was an abrupt
shift in the way they understood
themselves or the world a reality and
the second they saw it they knew it to
be true it had that power of
persuasiveness about it okay so let me
read you one of these stories of the
insightful type that we call taking the
a a train this is that this is a person
who had been in Alcoholics Anonymous for
13 years was sponsoring other people and
trying to help them get sober and was
having some difficulty with sponsors and
sponsors and not quite knowing what to
do and heard about this guy that taught
the big book and thought well maybe I’ll
go talk to him and just see if I can
learn something that would be useful to
me in my sponsoring and these are these
are persons actual works he called me
back and said if you’d like me to take
you through the first part of the book
maybe what I can teach you in a few
hours could help this person that you’re
working with and you can pass it on it
ended up being five hours it seemed like
twenty minutes to me he was so precise
intense and exact and answering all my
questions and I was full of questions I
was supposed to leave the next day on a
plane but within that five hours of
going over the big book on experience
just a complete transformation of my
understanding not only of the AAA
program but my view of the world my
whole outlook on life I wasn’t drinking
coffee that day but I felt highly
energized in fact I just felt like if I
drank coffee I’d blow off the face of
the earth no I was already real hyped
energy wise there was this adrenaline of
my mind embracing and consuming the
material that I’d been hungry hungry for
for such a long time I was crying for
joy I really wanted to know this stuff
it was just like I knew it when I heard
it I recognized it it was really
exhilarating extremely cheerfully happy
that I’d finally found what I’ve been
looking for I went away in kind of a
stupor for the rest of that day I
proceeded to study the big book more
learn more and be more effective as a
recovering alcoholic in fact I became a
recovering alcoholic whereas before I
was sober but I had these emotional ups
and downs roller coasters angry that
was out of control and just a whole lot
of sick behavior now I was completely
blown out of the water I saw there was
absolutely nothing but do him ahead for
me if I didn’t do certain things that
provided certainty in hope I’d gone to
this guy feeling like I had all these
years of sobriety and I had all this
experience and I’d work with all these
people and my little life was just great
I didn’t think I needed anything to
happen I wasn’t going to I wasn’t going
because I was distraught or anything
I wish of looking for some good ideas to
help the people I was sponsoring its
Scrooge going home not looking for
anything in particular
that’s really all I expected I went
there to look for solutions for other
people and what I found was a solution
for myself I was devastated but it was a
joyful kind of devastation because I saw
the solution in the same moment that I
saw the problem in all my years of
searching for solutions I studied lots
of different faiths and religions
philosophies of the world dabbled in the
occult I realized that this was a
central truth that pulled together all
the truths of all the great religions to
philosophers you know there’s so many
denominations around and millions of
people saying our way is the only way
now I have that sense of unity above it
all and what the world is really about
that made it even more powerful than me
because I knew that this thread ran
through everything else that was a value
in a matter of hours this happened to
her well that’s insightful it’s not
mystical exactly I mean it has a lot of
emotion energy with it but not quite
mystical James did a beautiful job of
describing mystical experience mystical
experiences have been actually studied
by psychologists and are well understood
at least in terms of what they look like
yeah if you have a mystical experience
you have a hard time talking about you
can’t quite put it into words it just
doesn’t seem to translate very well into
words there is often that quality of
being shown something suddenly receiving
knowledge no their transient they don’t
last long mystical experiences have a
kind of beginning in a fading period but
they don’t last for
long time person is passive they don’t
feel like they’re doing it it’s being
like something being downloaded or
happening to me that’s not my doing a
sense of transcendence of material
reality person knows this is not
ordinary experience that’s happening to
them it’s very distinctive this theme of
unity of being of connectedness with all
creation or all humanity is a very
common realization familiar in Buddhism
of course a sense of awe being impressed
you know like whoa what am I in the
presence of here Wow and again
profoundly positive rather like what
Maslow was talking about
well the Epiphany type of quantum change
has those characteristics now not all
mystical experiences change people for
good in fact most do not mystical
experiences are much more common than
quantum change and not all quantum
change has a mystical component so
they’re not the same thing but these
mystical experiences had an immediate
profound transforming effect and people
knew at the time that they had gone
through a one-way door and there was no
going back so different from the
experience of people that we treat in
addiction who with white knuckles are
trying not to relapse not to fall back
to old habits again Bill W knew he was
done he was finished drinking and we saw
that over and over and over again as as
soon as it happened I knew there was no
going back down I was before
here’s one of the most interesting
experiences to me because it’s from a
friend of mine and he and I used to
exchange cassette tapes rather than
writing letters to each other
and he was driving through the desert of
Oregon coming back from doing a concert
in musician and was driving across the
desert and making a tape to me when one
of these things happened to him and he
kept the tape running and literally
speaks into the tape the immediate
experience which is transcribed here
this is just the briefest description of
it all of a sudden out of nowhere this
wave of spiritual electricity washed
over me my body in the car and the
landscape and everything started turning
into smaller and smaller and smaller
pieces and everything started
disappearing including myself I didn’t
know if I was having a heart attack or
what was happening during those moments
everything including myself and the car
and the landscape just turned into
little dots of light fortunately he
pulled off the road a visual metaphor
that captures something of what it
looked like and felt like is the
transporter in Star Trek where the
person being beamed up has turned into
little dots of light and go somewhere or
nowhere it was awesome and it was
terrifying and it was peaceful I pulled
the car off of what was left of the
highway and what happened in the next
few minutes changed my life it was the
annihilation of the self which I had
never heard about or read about but now
was experiencing what I felt was the
actual experience not the thought not a
discussion about but the actual
experience of being one with everything
else and with God I felt myself dissolve
into it and it dissolved into me it was
into quite a bit of detail about the
year about the experience that is not a
normal experience I read those to a
psychiatrist and they say this person
needs to be in the hospital right now
and yet these are some of the healthiest
people I’ve ever met but the experience
is estranged and if you can imagine if
you begin describing this to your friend
then really okay and another of my
favorite stories called something like a
storm if the fellow was admitted to
alcoholism treatment unit against his
will he had one of the interventions
where this family gathered around and
they had a car with the motor running
outside and okay alright I’ll go a
month-long program when t eight-day
program and he’s been there a week and
he saw what was happening to people in
the later weeks which included
exploration of their childhood abuse
which I’m not sure is a good idea but it
was at least happening in this program
and he had been abused as a child and
was terrified of that being opened up
and didn’t know what to do didn’t know
how to handle it and so it’s Saturday
quiet in the program nothing happens
till Monday Saturday afternoon facing
the beginning of this survivors week the
next Monday I went to my room to read
one of the books they gave us I’m lying
in my bed thinking about this and
feeling very uncomfortable because I
don’t want to face it I’d seen a little
of the guided imagery stuff I thought
maybe I could just pretend to take a
little bit of God and put it within me
because that first week when I was
looking inside all I could find inside
myself which is blackness and coldness
let’s try this I thought see what
happens I set my book aside I was alone
in the room and it closed my eyes and I
just thought well if God is real how do
I picture God the thing that came to
mind was just whiteness a silvery
whiteness everywhere all around me
everywhere so in my mind I reached out I
actually did reach out my hand and tried
to touch it just to take a little piece
of it inside me and when I touched it in
my imagination and I turned my hand
there was something in my hand it was
like a blue-white star
and light was just shining out of it and
raised in all directions I took this
little point of God this infinitesimally
tiny part of God and I put it to my
chest as soon as they put it into my
chest something took over my body it was
physical I felt like something was
blowing up inside me I could feel my
skin bulging outward I started to gasp
for breath I felt an ecstasy that was
the only way I can describe it is that
it was like a sexual climax but there
was nothing physical about it it was
better than a sexual climax infinitely
better he was essentially a spiritual
climax and I was gasping for breath and
then I was grabbing the bed this thing
had ahold of me I mean something
literally took over my body it was very
physical I was not in control
something was doing this to me and I
don’t know how long it lasted but
probably about 10 seconds it seems like
a long time then it left me I just wept
I was stunned I thought what the hell
was that I mean it was real this wasn’t
just something in my imagination
something literally grabbed me something
touched me at first I was just saying
thank you thank you my god thank you and
the very next thought was why me why me
which was such a common theme among
quantum changers why was I so lucky and
then the next one was what do you want
from me
I would just absolutely the loss for why
it was so intense I was looking for some
little thing to help me feel better
about the next week
this was incredible powerful
overwhelming and I was just holding my
chest I could feel warmth like a glowing
inside me I could feel warmth and life
inside me it was like there was light
inside me where there had been only
darkness before I lay there for about 10
minutes
just absolutely stunned and then I said
I’ve got to record this and I grabbed
this notebook
which he carried in with him and wrote
it down what happened it was very hard
to find words for it a mystical quantum
change experience that changed him for
good
well what was going on before these
things we were interested in that you
know for about half of the people they
were in some kind of crisis or trauma
they were at hitting a bottom they were
at the end of the rope and the rope
broke you know it was it was in severe
pain one man was a gymnast and he was
demonstrating a trick and he fell and
broke his neck and became paralyzed for
the rest of his life and it was at that
moment that his quantum change happened
for which he was tremendously grateful
so sometimes there was trauma and great
conflict there was often a history of
childhood trauma there was sometimes a
feeling of being trapped like I can’t
get out I don’t I don’t know where to go
with my life I’m stuck I’m it’s hopeless
was sometimes aimless wandering I don’t
know where I’m going I’m lost in life
but and also for almost half the people
it was just ordinary life nothing out of
the ordinary was happening it was
Scrooge going home from work you know it
was it was walking across the living
room past the fireplace it was cleaning
the toilet was sitting on the toilet you
know and these were literally the
situations in which these things happen
to people and nothing that suggested
something was going to happen out of the
ordinary so it’s not just trauma where
these things happen as well and a third
of the time people were praying was the
most common behavior and often they were
praying for the first time in a very
long time that was Bill WS experience he
was really in a traumatic hitting bottom
situation and said ok God if you’re
there this would be a good time you know
that kind of prayer what changed what
people told us when we asked that is
everything changed we had him unpack a
little bit but but that was the common
response everything in my life changed
emotions were lifted tremendous fear or
depression or anger about the past just
suddenly lifted some people were
released from destructive patterns
including addictions relationships
deepened became fewer these folks
couldn’t tolerate superficial friendship
any longer but they had a few very deep
friends spirituality they were kind of
blossoming spiritually if you think of
it in Mass those terms of
self-actualization it’s like they got a
fast forward in that process their sense
of self changed their trust of the
future these these people felt
profoundly safe and some of them were
going into very risky volunteer
situations and felt profoundly safe in
doing so and values changed we had
people give us a description of their
values with a card sort that Milton
wrote Kiki originally developed what
were your values before this experience
and what were your values after this
experience and there they are for the
men before the experience wealth
adventure achievement pleasure being
respected family fun self-esteem and so
forth afterwards spirituality personal
peace family is still there God’s will
honesty these are except for family
things that were at the bottom of the
list before the last has become first
and the first has become last what about
the woman’s woman’s highest values
before family independence career
fitting in attractiveness afterwards
growth self-esteem spirituality
happiness generosity and family still
there but further down the tree
interestingly and I realized that these
people started from sexual stereotypes
and after their experience looked much
more like each other that their high
priority values were very much the same
for men and women after their experience
what we did attend your follow up can we
find these people 10 years later
and we found 41 of them out of the 55
that 41 were clearly quantum changers so
we as we looked at the stories there
were some that I don’t know about that
one but of the 41 that we’re clearly
quantum changers that there were six we
didn’t find three had died and two we
found and they declined to be
interviewed and we don’t know why we
couldn’t pursue them further but 30
people 73 percent did complete an
interview again at 10 years and what we
found was this now 20 years since their
experience they still remember it
vividly as they did before as if it had
happened recently of sensory memories of
it nobody described having gone back to
their previous self what they described
instead was a persistence and and a
growth or an extension of the change
that began with their quantum change
experience some of them had more quantum
change experiences over the subsequent
years and very low distress very low
psychological symptoms very low
disturbance these were not people who
would be coming in for therapy as I said
they were some of the healthy people I
ever met in fact they seemed to kind of
glow which was interesting yeah their
top values were the same as they had
been 10 years before and their pre
quantum change values were still absent
God’s will was an interesting item if it
was present which was true for that for
one third of people it was the highest
value of all of them otherwise it was
absent well I felt like I had to write a
chapter on what happened what’s going on
and my co-author and I proposed actually
five different possible ways of
explaining this one of them is people
reach a breaking point something has to
give
I mean they cannot continue the way they
had before there just needs to be a
reorganization of some kind
Jim Jim loader writes about this in the
transforming moment that that
personality almost decompensates and re
assembles in a different way well that
seems to fit some of our cases
others there was no apparent conflict at
the time well maybe unconsciously they
had a deep discrepancy of some kind and
it just kind of came roaring to the
surface in this they were in some kind
of conflict they weren’t aware of but it
got repaired but of course that would be
hard to demonstrate I’ll skip over a
loader’s quote here maybe it’s personal
maturation maybe maybe this is as Maslow
said this is something that’s meant to
happen to all of us it doesn’t but but
maybe it’s sort of a next step in human
evolution maybe it’s a kind of maturing
that happens to some of us Richard
Rory’s book falling upward describes the
tasks of the second half of life and
what he talks about are very much the
very things that quantum changers are
telling us about maybe it’s something
peculiar about this person usually the
first thing that psychologist says well
their problem obviously psychotic or
we’ve got a personality disorder or
something you know but I sure didn’t see
it you know I mean certainly not
afterwards some of what they were
suffering with before their experience
would probably meet DSM criteria but
there just wasn’t a consistent disorder
there and then a fifth thing is these
people hadn’t encountered with the
ultimate with with God or a higher power
or ultimate reality or whoever you think
about this and it was a genuine
encounter with that and and many folks
experienced it exactly that way I
thought I was done on the Oregon coast
and I was packing up and then then it
hit me that there was actually one more
chapter to write and what struck me was
that the things that had been revealed
to people in their noetic moments we’re
very similar even though these people
were about as different from each other
as you can imagine socioeconomically
gender-wise age wise personality why is
all over the place and yet the thing
that they saw that they knew to be true
in the moment came up again and again
and again
and so I said let suppose these are
messages trying to get through to
humankind and these people happen to be
the recipients of them what are those
messages first one certainly is that
change is possible deep change is
possible tomorrow it doesn’t have to be
the same as yesterday people have a
tremendous potential for major change
they knew it because it happened to them
there are different ways of knowing
truth in rationality is a piece of of
knowing truth science is a piece of
knowing truth but there are other ways
of discovering truth as well beyond the
senses and when you see truth you should
not be imposing it on other people that
wouldn’t kind of surprised me because
these people were not out evangelizing
me they were not out trying to convince
other people of what they had seen if
someone talked to them about their
experience they were happy to share it
but they weren’t out trying to persuade
people because they knew it to be true
they didn’t need to persuade anybody
else they knew it to be true I’m not God
well that’s a good one yeah that I’m not
the center of the universe I’m you know
and and I need to get over I me my mind
this all this kind of self-centered
stuff is not the way we’re supposed to
be material reality is only a small part
of everything that is possessions but
not possess us be careful about what you
own because it will own you and use your
time taking care of it and protecting it
and trying to keep it from being stolen
and you know all those kinds of things
everyone who encountered in other and
some of them gave it the name God some
of them had known it they had no
religious background and no name for it
but they felt themselves in the presence
of some awesome in the old real sense of
that word some awesome presence and
every person no matter their religious
background described that other in the
same way as profoundly loving profoundly
accepting they experienced in that
acceptance to their very depth being
loved completely as they are every
person that’s the nature of the other
that they encounter and it was it was so
profound they had trouble putting into
words it was an overwhelming experience
and that love is what we’re meant to be
when you meet shortcomings whether
they’re your own or other people’s the
way to meet them is with forgiveness and
compassion and acceptance not judgment
and punishment and such all of us are
profoundly linked we are all part of the
same reality and all of life is a gift
an opportunity so those are things that
these people suddenly saw well is there
any connection between these two lines
of research because to me they started
from different places and and yet in
some way that I have a little hard time
verbalizing they feel like they’re
flowing together or they’re the same
River in a way so let me just speculate
a little bit about that and here’s a
case example I think is helpful
David Premack described this and I think
it was autobiographical a man had gone
to pick up his children at the library
thunderstorm breeding him as he arrived
there and as he waited with his engine
running he searched his pockets and
there was a familiar problem those
cigarettes not in the glove compartment
not on deceit not in his pockets nowhere
in the car so we pulled away from the
curb quickly to go buy a pack of
cigarettes at the corner store and he
never smoked again what happened
fully dependent smoker what caused him
to quit glancing back to the library
caught a glimpse of his children
stepping out into the rain but he
continued around the corner certain he
could find a parking space rushing by
the cigarettes and be back before the
children got seriously wet and he said
dear heaven I’m a father who leave his
children standing in the
to chase a drug no that was it that was
it now it’s a behavior smoking that
that’s a kind of dramatic example the
kind of thing we see in motivational
interviewing he wasn’t he wasn’t getting
behavior therapy for his smoking I mean
nothing like that happened it was a
moment of insight in a way or shame or
however you want to describe it the
behavior of smoking was inconsistent
with something that was much more
important to him
what was that underlying event a
decision well kind of he decided not to
smoke a shift in perception yeah smoking
at a whole new meaning for him all of a
sudden people talk about the difference
between being a smoker who has quit and
being a nonsmoker bladder is a different
kind of identity certainly an emotional
impact to it increased readiness to take
a look at change yep that’s going on
ambivalence getting resolved yep what
smoker isn’t ambivalent about smoking
you know but here suddenly it shifts
some right about the Baumeister writes
about the crystallization of discontent
that this was or the last straw that
that caused the balance to tip the best
thing I can find that makes sense of
this to me as Milton wrote each’s theory
of personality that there are various
levels to our experience at the most
peripheral there are behaviors or
feelings or thoughts in the moment and
beneath those are a set of things we
believe about the world and beneath
those he said are attitudes that we have
about who we are and what the world is
like and beneath those values
instrumental values about how to do
things and beneath those terminal values
the things that you want to accomplish
in your life instrumental the way you do
it terminal what you actually want and
care about and desire in your life and
then there’s a sort of mysterious self
in the middle
he said when something that’s more
peripheral comes in the conflict with
something deeper change happens if it’s
a behavior that comes into conflict with
something dear which is what happened in
the Premack example the behavior loses
but if you get conflict at the deepest
level it can spread out through the
entire system when I read that I thought
this is in a way this is what we’re
seeing in quantum change and if it is
some sort of underlying change that
triggers an underlying shift that
triggers change it’s not just that we’re
selectively reinforcing change talk in
motivational interviewing we know that
matters but there’s something much more
important going on that we don’t
understand as well so far so what do
they have in common well they’re both
pretty brief without a whole lot of
outside influence they’re both
relatively discrete and happen fairly
suddenly when we’re talking about
relatively brief conversations often
producing an enduring change producing
change that seems to last pretty well
over time maybe these are the ends of a
continuum
maybe there’s behavior change over here
and then this sort of sweeping
personality change over here and
everything in between
just like roaches model a benevolent
presence well that’s what we try to be
as motivational interviewers someone who
is doing what Rogers talked about was
shows positive regard for the person who
cares about and listen as to what they
have to say who was genuine and present
with them and that kind of presence
people experience in their quantum
changes and said it changed them an
acceptance was a key piece of it the
experience of discrepancy something’s
not right here sort of appears on both
sides
and there’s no coercion people in
quantum change have a clear sense of a
choice they go with it or not in fact we
had one person who told us a story and
decided not to go with it and was
telling us how much he regretted that
ten years later but not a sense of being
forced it’s still a sense of being
they’re out of their own choice so they
feel alike to me I don’t know if they
feel alike to you but it feels like it’s
the same kind of thing happening just at
a much more profound level in quantum
change the editor wanted me to write one
more chapter for this book which is how
you two can have a quantum change I said
I don’t know it doesn’t feel to me like
like it’s doesn’t happen in therapy you
know I mean you dream about this happen
in therapy but it’s not something that
we know how to do and I’m not sure we
ought to know how to do it you know
maybe it is a divine encounter I don’t
know but I don’t know how to write that
chapter and so I didn’t and I think in
spite of all we’ve learned and been
inspired by in this we still are just
starting to understand that depth of
human potential for change we just have
a glimmer of it just an idea of how much
is possible for ourselves and for the
clients we work with thanks very much
[Applause]
I think we have about seven minutes for
questions that we have microphones if
you’d like to raise your hand well I
mean so what muscle beacon others have
written about deep change and kind of
superficial change and I think you can
imagine changing any of those levels in
row pitches model mostly what I do is
behavior changing mostly I’m working
with people about drinking and smoking
and things like that these things I mean
our profound sweeping reorganizations
within the person I don’t have to do
that do you know how to change an
attitude well actually we have a little
more wisdom about that there were no how
to change beliefs well yeah we do know
something about things that change
beliefs and and so the behavioral the
behavioral science helps us that they
kind of outer rings but there’s this
wonderful interesting inner ring that
that we haven’t even looked at for a
century you know and I mean my question
going into it was does that really
happen to real people and I have no
question at this point that is a real
phenomenon I mean it is there I don’t
pretend to understand it I’m inspired by
it I feel in a way like this is the most
important work I’ve done in my career
even though it’s almost nobody’s heard
about it but there’s something about it
that just strikes me as boy that matters
thank you you know it does seem to
dovetail very strongly with the idea
that you know the change is coming from
within the person you’re dealing with
and this is just the far end of a
continuum of possibility that may be
there you know there are lesser examples
just a lesser degree and everybody’s
work with with anybody yeah well you can
imagine experiences that change of value
that person has which is then going to
affect some beliefs and attitudes and
behaviors and feelings and so forth and
and Roky said the deeper in the level
that changes the more it emanates out
through the rest of the system very like
Paul Vaughn selects writing about levels
of change relationship between
psychedelic drugs and quantum change you
get mystical experiences but not quantum
change I find so there there are there
are definitely studies with with
psychedelic induced mystical experience
and they’re just like what James
described but I’m not aware of situation
there may be something I’m not aware of
situations where that produced a
permanent sudden change in personality
then do it over time
there probably are something yeah how
are you to understand or wrap your head
around quantum change if you don’t if
one doesn’t believe in God or you know
options you know you can pick one of
those and it doesn’t I mean you don’t
have to use the concept of God to
describe whatever reality the person’s
experiencing but it is something outside
material reality that they’re
experiencing but I mean I have
colleagues in neuroscience who say oh
this is a brain fart this is that this
is some epileptic phenomenon or
something like that that’s going on so
you can always explain it away
when you hear so many of these stories
and the content of them is so consistent
mean to me it was very moving and very
persuasive but I’m also a person of
faith so it so to me it makes perfect
sense to say this personally had a
contact with whatever that thing is that
some of us call God and it changed him
for good
perfectly comfortable with it mystical
experiences are more common but again I
don’t know if quantum changes are more
common among meditators I I can’t think
of any of the people that we interviewed
who talked about being regular
meditators or had any sense that
something they did produce this and I
kind of think if you if you practice
religion or meditation so that you can
have one of these it’s unlikely to
happen
that’s extrinsic religion you know so so
there are lots of I mean paradoxes a lot
of truth is about paradox is there any
evidence that motivational interviewing
is more effective when practiced or
administered by authority figures
teachers parents judges and the like no
I mean doctors have good results with it
nurses have good results with it
counselors have had good results with it
I mean your salary doesn’t seem to drive
efficacy with with motivational
interviewing it kind of makes sense that
if you have both high prestige and am I
going for you you get a bigger effect
but I don’t I couldn’t think of any
evidence for them it sort of quick two
quick questions one is was there any
particular age range at
which you found that people most
commonly had a mr. mix mystical type of
quantum change I think the youngest was
like six Wow yeah and quite a profound
one and and well up into my senior range
and also so there was not a particular
age at which it seemed to happen and
after that happened if you knowing that
you stuck with the people did they have
did they kind of struggle with that or
kind of have to you know kind of work to
keep it up after they keep up the
changes or was it something that they
experienced as just it easy to maintain
those yeah I’d say more the latter I
mean so there wasn’t any sense of I
might lose it I need to do this to keep
it and I mean that urgency just was not
there and people approached him more
with gratitude and experienced the
continued movement like following a
river in a way and being in the river
but not having to make the river or push
it in some way thank you for being here
yeah thank you I have recently read a
book called my stroke of insight of a
neuroscientist who had a stroke at the
age of 37 and she talks a lot about the
differences in the right and left
hemispheres of the brain and we’re so
left brain oriented in our society and
for her when that was taken out the
right brain which was the sense of unity
with the universe and the peace and the
acceptance and she couldn’t think
literally the way before initially but
she had this just overwhelming come this
sense for her it was this quantum change
that happened through that even though
it was 8 years to come back from the
stroke but I’m wondering if there’s
anything do you think that there’s
anything in these specific instances
that you’ve been researching of people
who maybe their right brain
they you know like opened up to where
their right brain now they’re
functioning more out of that hemisphere
and this different sense of their values
and all a just there was so much
similarity from what I was remembering
from the book and what you are saying oh
I don’t know I mean I would love what if
we could find somebody who’s just about
to have one of these and put him in a
scanner you know but that’s very hard to
do so you have to keep a lot of people
in scanners for a real long time so I
don’t know if and I’m I’m more a whole
brain thinking kind of person anyhow but
but it does experiences that happen with
stimulation of the right brain in some
ways resemble these things and it I mean
as a person of faith it makes sense to
me that we’re wired to be able to do
this you know that that would that would
be a natural part of how we’re wired you
couldn’t use the very same data to
explain it away and say it’s just the
brain malfunctioning or doing something
strange you mentioned that people quit
talking about these experiences after a
few people didn’t want to listen to them
or thought they were crazy and that they
were delighted to talk about it oh yes
did you facilitator was there any
interactive conversations among them no
I didn’t have permission to introduce
them to each other I mean it we thought
about having a party you know and I’m
kind of sorry we didn’t but we didn’t so
we did not introduce them to each other
but if you do a study like that have a
party yeah
well I want to thank you all
you