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 we've got a beautiful summer evening finally I'm Tina 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 Neil Gman who send 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 lecturers 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 evening's lecture is made possible by the Ruth KNE fund for spirituality and Social Work named in honor of SSA graduate Ruth Ireland NE 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 and Community me 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 NE 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 ssa's luminary volunteers 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 in 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 interview interviewing Workshop possible the Center for Health Administration studies particularly Jean Marsh Colleen Grogan and Harold Pollock the center for interdisciplinary inquiry and innovation in sexual and reproductive health or ci3 most especially Amy Whitaker and Melissa Gilliam and Hartland Alliance particularly Karen batia Joan liato and Reverend sidon I'd also like to ackn knowledge 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 cus for your attendance please remember to sign out and pick up your certificate before leaving now I'd like to introduce my esteemed colleague and central figure in arrang ing Dr Miller's visit to SSA Professor summerson [Applause] Carr in 1959 CP snow famously identified two cultures that of Science and that of the humanities he charged that these cultures had 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 in the opening lines of his University of Edinburgh lectures that were later to become the varieties of religious experience admits some trepidation in 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's 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 brother's 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 Sigman Freud arguably one of the very few things that Freud and James work has in common is that it's considered insufficiently scientific to be seriously engaged by many academic Psy 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 uh fortified borders of scientific and humanistic inquiry and do and in doing so offers us new ideas about how we might enrich intellectual life and especially our the our understandings of the processes of human change as one of the world's most cited scientists author of 40 books uh 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 in 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 specifying and evaluating techniques of therapeutic engagement with a close eye on Fidelity and the measurement of mi's effects at the very same time that he is uh profer that there is a spirit to Mi which unites its veterans practitioners uh and speaks to mi's ever expand expanding client population in mi we find an Evidence B 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 too strictly by many of us in the scholarly community so it's with great anticipation and without further Ado that I introduce Dr William R Miller who will speak to us today about motivational interview and Quantum change Reflections on human potential thank you it's a pleasure to be back in Chicago uh especially with weather like this I'm going to be talking about two lines of research one that one that's gone 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 uh and I'll be moving over a lot of terrain but those two lines of research have to do with motivational interviewing and with uh 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 uh that did not start from a theory did not was not pre-planned uh but just sort of emerged over time in an an a theoretical uh and accidental kind of way and wound up taking over my life yeah I guess a beginning was in Milwaukee where I was on internship at the Veterans Hospital there uh 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 what did they tell you in graduate school I said 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 uh 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 uh and since I didn't know anything about alcoholism I simply put on my best Carl Rogers hat happily I'd been trained in Rogers as well as cognitive behavioral therapy uh 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 muster and the patients seemed to really enjoy it and I really enjoyed it I learned a tremendous amount uh from them then I began Reading literature on alcoholism which i' had 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 uh and I thought gee those aren't the people I was talking to maybe they're different in Milwaukee I don't but it was a beginning hint that there was something in the addiction field that needed a bit of attention well I I I was inspired to uh 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 in this particular study uh we compared two different conditions both of which were cognitive behavioral basically one of them was a counsil who 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 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 a weekly record a weekly Diary of their drinking uh that that book eventually became what what is now called uh 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 uh yellow group is the decline in drinks per week in people who are seeing a counselor 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 are being seen by a counselor 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 you know but these people have the gall to go home and and and read a book and get better you 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 maybe there a phenomenon here that needs to be understood so what was going on how come people were getting better in this kind of self-directed uh 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 going to get better after that so that's an possibility we also asked people in these groups what what really helped you and they said keeping those records really helped me a lot that when I wrote down every drink like you told us uh before I had the drink I'd get out my card and say maybe I've had enough and uh 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 uh 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 the red group working on their own with the self-held book started off worse and wound up better uh relative to the uh counselor group and statistically they were pretty similar to each other at 15-month followup they're just you know just the same again so we have just as much improvement in the self-help group as in the counselor group as we'd found in four previous randomized clinical trials on the Green line the waiting list group uh didn't change at all and then when we treated them with or without the diary by the way it didn't it didn't matter if they kept the diary actually people keeping a diary the drinking went up a little bit you uh but combining the control groups they didn't change at all then we treat they came in and saw a counselor and their drinking went down uh and looked just about as good as the other groups although it splashes back a little bit so so it wasn't just a passage of time and it wasn't just keeping diary records it was something else well although that finding was surprising to me there are now dozens of Trials showing that even a relatively brief intervention with people who are drinking too much can trigger a change uh and in another paper that I wrote there are certain characteristics of interventions that seemed to work well uh in helping to trigger that change and 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 it was over and over in the literature and I began to thinking about that control group because actually if if you do follow people over time once they've identified themselves as having a problem they do tend to decrease in 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 uh what we suggested that they ought to do and it kind of got my attention in terms of terms of how much influence we can have just by almost our subconscious Communications with with patients 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 uh different therapists doing the 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 is as you can see we had nine counselors and three supervisors including myself and we watched those counselors working through via oneway mirrors that's how long ago this was um 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 TR and corov call Rogers students and colleagues how well is this coun are 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 I've had some training in 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 uh 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 089 among the three of us with independent ratings well you see nine yellow bars and those are the nine therapists and their success rates in working with patients and they're lined up from 1 to nine one being the most impct empathic therapist we all agreed that was the most empathic therapist that we saw out of nine and at the other end number nine was the least empathic therapist 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 175% 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 the 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 come is 61% so therapists and manuals 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 uh 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 kind of intriguing in fact the correlations were pretty high you know about correlations we were able to predict the number number of drinks per week that clients were having 6 months later with a correlation of 082 you square it you're accounting for 23ds of the client's drinking by how well the counselor listened at a year correlation is still 71 two years later the correlation is still 0.51 accounting for a quarter of the variance in outcomes 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 a study published the next year Steve Valley reported these relapse rates so up in this graph is not good all right relapse rates for clients assigned 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 re bars are the the therapists uh therapists counselors who had the highest level of client centered skills and you can see that the the relapse ratio is anywhere from 2:1 to 4:1 different depending on what council you got if you got an empathic counselor you're much better off than if you get a very low empathy counselor well with that I went off to Norway on my first sabatical and they I I worked at ISM 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 uh I got this beautiful office on a lake in a fjord sitting there uh you know looking out into the uh the Norwegian Forest and I was hired to 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 psychologist most of them are pretty green most of them are just out of training uh 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 uh in English of course because my Norwegian wasn't very good at that point still isn't uh and so they would roleplay in English the patients they were struggling with the most and essentially say Okay smart guy show us what you would do with this and and I would 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 uh kind of introspective and they would stop and say what are you thinking at this point now 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 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 Center 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 you know 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 him 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 you know 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 evoke 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's saying if you meet resistance don't push back against it don't confront it you know don't oppose it we we said then roll with resistance just kind of go with the with the flow reflect it 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 favors you know so also nurture optimism that change is possible and I was thinking of this as kind of priming the pump as as getting people ready for treatment you and so that was the paper that I that I wrote up and distributed to colleagues one of whom to my surprise said I want to publish it in behavioral psychotherapy and he was the editor of it I said I I just made it up you know 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 editors always say and I did and he published it and I figured that's the last that I would hear of it yeah but I did go home and began thinking now if we turn this into an intervention for people with drinking problems what might that look like and having worked with severely dependent uh 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 Drinker checkup and the Drinker checkup was essentially a very low threshold enrollment thing we put a 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 uh but every last one of them had a drinking problem every last one of them had there were serious reasons for concern we did a thorough assessment looking in particular for things that would be early kinds of alcohol impairment uh and then we saw them one time and gave them feedback about what we found in a motivational interviewing style um 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 goall to change their drinking on their own without additional permission or treatment and their drinking declined just as much as in the graphs that I I showed you earlier following 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 counseling 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 90% of the population and the person said well that that can't be I mean everybody I know 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 I might take a look it's right there in front of you which was sort of common Addiction Counseling procedure at that point or he in more motivational interviewing Ruan style well I don't think it's that bad so this really surprises you it's not what you expected a reflection all right well without any further treatment uh the red group is the confrontive condition and they their drinking decreases some the yellow group is the group also getting feedback randomly assigned in a motivationally being style and you see it's a steeper decline uh both of them maintain pretty well over time and again the waiting list control was very polite and waited for us and then we did the checkup and then their drinking went down but again with some splashback 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 too by the way a a training of motivational interviewing uh study that when we train people immediately when they asked for it they showed nice Improvement 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 pricious 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 reflect and 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 did 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 a 0. 59 correlation pretty strong we also found by the way that the more resistance behaviors we saw from the client the worst their outcome was as well but those resistance behaviors were under the control of the therapist so if you 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 uh to what extent did we get change talk that is the client arguing for change giving us the 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 to patients 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 or counter change talk that predicts Behavior change so you you've got about a 3:1 ratio in the empathic condition whereas on the directive side you've got ambivalent clients equal amounts of pro and con basically 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 and 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 sabatical this time to Australia and in the office next to mine was this South African Bushman uh who was at the time living in uh in card of Wales but working in Australia say it's a man of the world and his name was Steve rolick and he said to me Miller you you the guy 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 motiv 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 there's just this one crummy little article and you you got to write you got to write more about this you 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 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 uh from the previous two so where are we now well the Mi books have been translated into at least 22 languages there are more than 200 randomized clinical trials of motivational interviewing including 10 multi-side trials there more than 1500 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 Health Care Mental Health addictions Correctional settings more recently schools Dentistry I 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 in motivational living is just human nature I mean it it is who we are uh 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 uh 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 uh so I'm just astonished I mean this started with an article that I hadn't even planned to publish uh and 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 uh dissemination of Innovations curve heading for 40,000 articles now in 2013 so what is it well it 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 uh that's what we call the elevator definition if you're getting in an elevator and someone says what's motivationally interviewing and you're getting off on the second floor that's what you say 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 uh if so it 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 uh it it just it didn't feel right it didn't look right didn't seem 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 going to fix you I'm a teacher I'm going to teach you these things I'm a doctor I'm going to 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 and if what you want is a behavior change to happen in their life you got to have their expertise involved it's got to be a collaborative partnership kind of approach acceptance uh fairly profoundly like Carl Rogers was talking about so a non-judgmental approach uh a respect for what the person uh 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 evocation instead of installing things that are missing that was kind of my training in behavior therapy what clients are missing a skill and what you have to do is install that skill and then they'll be better you know or or clients are missing Insight you got to install the insight and then they'll be better or they they have irrational thinking and 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 going to give it to you motivational lving says you have what you need and together we're going to find it you already have what you need and together we're going to 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 that 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 uh that once learned can be used in a whole variety of contexts we're saying here the purpose is is solely the other person's best interest right we talked now about four fundamental processes this is a whole new way of talking about teaching motivational interviewing first engaging so often ignored you begin by collecting facts you what's intake intake collecting a whole lot of information you know Roger said that's no good to the client they already know all that stuff you know yeah 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 evoking 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 forward so far summarizing a amazingly large uh database Mi training we know yields miic 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 Amic consistent practice mic consistent practice yields more change talk and less resistance during treatment sessions those things predict Behavior change outcomes uh 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 size is 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 cross studies also some studies find in effect others don't in a multi-site trial with all the therapists 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 to matter therapeutic relationship and my spirit and empathy we know are related to better outcomes not just in motivational interviewing in 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 client's saying during the session and what the client's saying during the session is a function of am I consistent practice also decreasing client resistance is associated with change and that's something that you see with a motivational ining session as well person may walk in very highly resistant but it just kind of goes down over the course course of the session you're not responsible for the level of anger and resistance the client walks through the door with but after that it's up to you yeah and then the counselor refraining from counter therapeutic Behavior 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 them 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 uhuh it's not don't try to persuade don't give uninvited advice those things all kind of increase the push back and and resistance and perhaps if you can just stop people from doing those kinds of things to get better outcomes and by the way these things all matter in 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 non-specific factors in counseling that matter besides the content of the therapist manual all right we also Al in the Third Edition of said this is not just about Behavior change it's not just about stopping bad habits and not just about dealing with problems uh motivational living can be used in a much broader way that involves human potential and thereby it connects it back to the roots of motivational interv which is a humanistic counseling approach the work of Carl Rogers and and Abraham mlo and Victor Frankl and others who were important in the human potential movement well how could Mi be used in developing human potential I mean first of all I'm removing obstacles to growth so I I was worried the client centered folks would would hate me because we're sort of directional with Mi but in both the UK and the us as I went to and talk to the client centered communities they said well no of course I mean if person's drinking and that's getting in the way of their personal growth of course you would remove that obstacle no that's not a problem you know we got over that long ago so yeah exploring personal values what do you care about in life what matters to you reducing self-ideal discrepancy this 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 Mau 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 I think Mi has tremendous potential there there's an article on spiritual bypass of people trying to avoid dealing with emotional Pain by talking about spiritual issues and this comes from spiritual directors 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 aging 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 uh as a therapeutic process and the next step in life's journey whether it's moral growth thinking about Goldberg's model what's if you would if you were to take the next step in moral development what would that look like in compassion as described by the Dal 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 to shift gears here I'm going to talk about another line of research that seemed to me unrelated I was interested in rapid changes that people experience in a matter of hours that seem to be permanent our our model for these in fiction is ebene or Scrooge or It's a Wonderful Life the the Jimmy Stewart character there where both of them have a really outof thee ordinary experience you know that changes them we presume permanently and suddenly and dramatically I mean different in personality and I've I've loved those stories I 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 or something that happened that was just change the direction of their life and it it's there very frequently all the way back to Moses and the the Buddha and also social reformers including Jane Adams you find in in their biographies these moments of 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 is this something that actually occurs in 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 I could find who wrote about it was William James in varieties of religious experience in 192 long time ago now theologians write about it James loer has a book about transforming moments but not not in mainstream Behavioral Health just sort of dismissed as a kind of strange phenomenon U one of 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 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 uh steps in the direction of a a longer term change two steps forward one step back I mean you all know the the variety call that the educational variety of change success of approximations to something you're trying to do it's gradual it can take longer than you want you can be frustrated with how long it's taking to change it's what we see in addiction treatment most of the time and type two change he said these things happen discreetly uh suddenly and they're enduring changes they're permanent uh 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 maslo talked about Peak experiences kind of picking up on this to some extent that that he said are very memorable they usually have a people remember very clearly even a long time later they have a discreet beginning there 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 AI 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 maslo 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 to meet young people that had just the same experience and revised his theory about that well I got interested in how could you study this phenomenon if it exists and we solicited storytellers through the aluy journal through the local newspaper and just kind of described Peak experience and some of the things that James had talked about and the story said if if you've had an experience like this Dr Miller would like to talk to you we get 87 telephone calls in a week uh it was phenomenal 89 I'm sorry uh we said we would like to come in for two to three hours and we're not going to pay you anything you know we didn't want people making up stories for pay you know uh and and ultimately 55 people came in uh 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 some time had passed some of them were very recent some of them were 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 said 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 that had happened to well as we studied their stories their 55 transcripts which I talk took off to the Oregon coast and sat and just absorbed 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 like had a kind of insight now it 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 right so the insightful type of quantum change happened 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 the meaning of the word noetic uh this was knowledge given to me uh came from outside it was an Abrupt shift in the way they understood the M themselves or the world or reality and the second they saw it they knew it to be true it had that power of of persuasiveness about it all right so let me read you one of these stories of the insightful type that we call taking the AA train this is a 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 spones 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 person's actual words he called me back and said if you'd like me to take you through the first part of the book and 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 20 minutes to me he was so precise intense and exact in answering all my questions and I was full of questions I was supposed to leave the next day on a plane but within that 5 hours of going over the big buk experience just a complete transformation of my understanding not only of the AA 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 you know I was 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'd been looking for I went away and kind of a stoer for the rest of that day uh 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 anger 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 Doom ahead for me if I didn't do certain things that provided certainty and hope I'd gone to this guy feeling like I had all these years of sobriety and I had all this experience and 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 was just looking for some good ideas to help the people I was sponsoring it's 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 essential truth that pulled together all the truths of all the great religions and 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 to me because I knew that This Thread ran through everything else that was of value in a matter of hours this happened to her well that's insightful it's not mystical exactly I 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 uh and are well understood at least in terms of what they look like you have a if you have a mystical experience you have a hard time talking about it 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 know they're transient they don't last long mystical experiences have a kind of beginning in a a fading period but they don't last for a long time person is passive they don't feel like they're doing it it's being like something being downloaded or or happening to me that's not my doing sense of transcendence of 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 maslo 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 right and not all Quantum change has a mystical component so they're they're not the same thing um but these mystical experiences had an immediate profound transforming effect uh 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 Duan knew he was done he was finished drinking and we saw that over over and over and over again as as soon as it happened I knew there was no going back to how I was before here's one of the most interesting experiences to me because it's from a friend of mine 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 he's a musician and was driving across the desert and making a tape to me when one 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 and 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 yeah a 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 is turned into little dots of light you and goes somewhere or 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 dissolve into me it goes into quite a bit of detail about the uh 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 uh but the experiences are strange and if you can imagine if you begin describing this to your friend they really okay yeah and another of my favorite stories called something like a star it's a fellow who has 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 a motor running outside and okay all right I'll go monthlong program 28 day program um and he'd 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 of that being opened up and didn't know what to do uh 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 on 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 and 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 was just Blackness and coldness let's try this I thought see what happens I set my book aside I was alone in the room and I 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 in rays 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 I 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 it was essentially a spiritual Climax and I was gasping for breath and then I was grabbing the bed this thing had a hold 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 seemed 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 was just absolutely the loss for why I 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 that changed him for good well what was going on before these things we were we interested in that you know for about half of the people they were in some kind of Crisis or trauma they were at at hitting a bottom they were at the end of their rope and the Rope broke you know it was it was a in severe pain one man was uh 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 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 I it's hopeless you know was sometimes aimless wandering I don't know where I'm going I'm kind of lost in life you know 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 uh cleaning the toilet it was sitting on the toilet you know mean these were literally the situations in which these things happened 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 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 W's experience he was really in a traumatic hitting bottom situation and said Okay 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 it is everything changed we had them 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 masso's terms of self-actualization it's like they got a fast forward in that process their sense of self-change their trust to 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 roich originally developed what 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 women women's highest values before Family Independence career fitting in attractiveness all right afterwards growth self-esteem spirituality happiness generosity and family still there but further down the tree interestingly yeah 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 well we did a 10-year followup can we find these people 10 years later and we found 41 of them out of the 55 that or 41 were clearly Quantum Changers we as we looked at the stories there were some that I don't know about that one but of the 41 that were clearly Quantum Changers 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% 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 a persistence and and a growth or an extension of the change that began with their Quantum change experience some of them had 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'd be coming in for therapy as I said they were some of the healthiest people I ever met in fact they seem 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 the 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 you know 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 they cannot continue the way they have before there just needs to be a reorganization of some kind uh Jim Jim loer writes about this in the in the transforming moment that that the personality almost decompensates and reassembles 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 so 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 I'll skip over loader's quote here maybe it's personal maturation maybe maybe this is as maslo 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 a kind of maturing that happens to some of us Richard roar'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 they're obviously psychotic or got a personality disorder or something you know but I sure didn't see it 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 the fifth thing is these people had an encounter 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 were very similar even though these people were about as different from each other as you can imagine socioeconomically gender wise age-wise personality wise 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 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 I mean rationality is a piece 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 one kind of surprise me because the these people were not out evangelizing they they were not out trying to convince us 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 I'm not the center of the universe I'm you know and and I need to get over I me my mind you know 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 ought not possess us be careful about what you own because it will own you and use your time taking care of it and and protecting it and trying to keep it from being stolen and you know all those kinds of things everyone who encountered an other and some of them gave it the name God some of them had no name 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 moment acceptance to their very depth being loved completely as they are every person that's the nature of the other that they encountered and 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 were 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 that I think is helpful David primac described this and I think it was autobiographical a man had gone to pick up his children at the library thunderstorm greeted him as he arrived there and as he waited with his engine running he searched his pockets and there was a familiar problem no cigarettes not in the glove compartment not under the seat 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 at the library he caught a glimpse of his children stepping out into the rain but he continued around the corner certain he could find a parking space rush in buy the cigarettes and be back before the children got seriously wet and he said dear heaven I'm a father who would leave his children standing in the rain 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 of 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 had 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 non-smoker latter 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 write about the U the balme writes about the crystallization of discontent that this was s of the last straw that that caus the balance to tip the best thing I can find that makes sense of this to me is Milton Ro's Theory of Personality that there 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 you instrumental the way you do it terminal what you actually want and care about and desire in your life and then 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 com comes into conflict with something dear which is what happened in the prac 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 uh 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 discreet 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 ends of a Continuum maybe there's Behavior Chang over here and then this sort of sweeping personality change over here and everything in between just like R's Model A benevolent presence well that's what we try to be as motivational interviewers someone who is doing what Rogers talked about who is shows positive regard for the person who cares about and listens to what they have to say who is genuine present with them you know and that kind of presence people experience in their Quantum changes and said it changed them you know and 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 coer people in Quantum change have a clear sense of of a choice they go with it or not and in fact we had one person who told us the story and decided not to go with it and was telling us how much he regret readed that u 10 years later but not a sense of being forced still a sense of being there 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 too can have a Quantum change I said ' I don't know I don't know it doesn't feel to me like like this doesn't happen in therapy you know I mean you dream about this happen in therapy but uh 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 and so I didn't and I think in spite of all we've learned and and uh been inspired by in this we still have 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 [Applause] much well thank you so much for that um I think we have uh about seven minutes for questions and we have uh microphones if you'd like to raise your hand you a little well I I mean so bck and others have written about deep change and kind of superficial change and I think you can imagine change at any of those levels in R's model mostly what I do is behavior change and mostly I'm working with people about drinking and smoking and things like that these things I mean are profound sweeping reorganizations within the person I don't know how to do that you know do you know how to change an attitude well actually we have a little more wisdom about that do we know how to change beliefs well yeah we do know something about things that change beliefs uh and and so the behavioral the Behavioral Science helps us at the 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 uh 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 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 uh but there's something about it that just strikes me as boy that matters thank you uh you know it does seem to duvail very strongly with the idea that um 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 maybe there are you know there are lesser examples uh just a lesser degree in everybody's work with with anybody yeah well you you can imagine experiences that change a value the person has which is then going to affect some beliefs and attitudes and behaviors and feelings and so forth and and R said the deeper in the level that changes the more it emanates out through the rest of the system it's very very like Paul velik's writing about levels of change relationship between psychedelic drugs and Quantum change you get mystical experiences but not Quantum change I find um so there there are there are definitely studies with with um psychedelic induced mystical experience and they're just like what James described um um but I'm not aware of situations there may be some I'm not aware of situations where that produced a permanent Sudden Change in personality that endured over time but there probably are some you know um how how are you to um understand or wrap your head around Quantum change if you don't if one doesn't believe in in God or you know um I give you four other options you know so you can you can pick one of those and it doesn't I 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 I have colleagues in in um Neuroscience who say this this is a brain fart this is the this is some epileptic phenomenon or something like that that's going on so you can always explain it away you know when you hear so many of these stories and the content of them is so so consistent I mean to me it was very moving and very persuasive but I'm also a person of Faith so so to me it makes perfect sense to say this person had a contact with whatever that thing is that some of us call God uh and it changed them for good I'm perfectly comfortable with that studies on longm mindful mystical experiences are more common but again I I don't know if quantum changes are more common among uh meditators I I can't think of any of the people that we interviewed who talked about being regular meditators uh or had any sense that something they did produce this you know uh and I 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 you know it's that's extrinsic religion you know so so there are lots of I mean Paradox is a lot of Truth is about Paradox you is there any evidence that um motivational interviewing is more effective when practiced or administered by authority figures teachers parents judges and the like no um 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 um it kind of makes sense that if you have both High Prestige and am I going for for you you get a bigger effect but I don't I couldn't think of any evidence for that MH let have a quick two quick questions one is was there any particular age range at which you found that people most commonly had a a m or 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 you know so yeah so there was not a particular age at which it seemed to happen though and after that happened if you that 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 work to keep it up after they keep up the changes or was it something that they experienced as just easy to maintain those yeah character 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 just was not there uh and people approached it more with gratitude uh and experienced a continued Movement Like following a river in a way you know being in the river but not having to make the river or 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 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 this sense of unity with the universe and the peace and the acceptance and she couldn't think linearly the way before initially but she had this just overwhelming calmness a sense for her it was this Quantum change that happened through that even though it was eight 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 I just there was so much similarity from what I was remembering from the book and what you are saying yeah I 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 them in a scanner you know I mean but that's very hard to do you know so you have to keep a lot of people in scanners for a real long time um so I don't know me it's 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 mble these things and it I mean as as a person of faith it makes sense to me that we're wired to be able to do this you know that that that would that would be a natural part of of how we're wired you can use the very same data to explain it away and say it's just the brain malfunctioning or doing something strange Yeah you mentioned that people um 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 yeah did you facilitate or was there any um 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 uh and I'm kind of sorry we didn't um but we didn't uh so we 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 for coming and to Dr Miller for a wonderful talk