Socratic Motivational Practice: Systematizing an Innovative Treatment Model

“Working with you reminds me how much I have been wasting my time, smoking marijuana and K2, and also how much potential I have and how I can really reach my goals,” said Brett, one of my patients.  “I just like to see black men who are professionals. There are not as many out there; they just make me proud. I see them as role model and seeing them just motivates me to stop using. I really want to stop. I have to,” added Brett, with tears in his eyes.

This was not the first time I heard these words but hearing it once again did make me feel happy, because I knew Brett was at least in the Contemplation Phase, a step closer to Action.

Two weeks later, Brett did not appear for his scheduled appointment. Attempts to reach him on his cell phone were to no avail, and efforts to reach his emergency contacts were unsuccessful as well. After one month, Brett returned to the clinic, unscheduled, asking to meet with me. “I am glad you are here,” I said. “I was worried about you,” I added.

“I’m so sorry, Dr. Sidor. I relapsed; I was so ashamed that I just didn’t have the courage to talk to you. I also asked my brother not to answer your calls, because, frankly, I didn’t know what you’d think of me. But I got to a point where I couldn’t take it anymore. I just stayed home, got high, and it has not been working, so, I decided to come back.”  “Thank you for coming, Brett. How can I be the most helpful at this time?” I asked. “Well, I just need an appointment. I’m ashamed, I’m embarrassed, but I need to do this. I have no choice but to do it.”

One of the most significant challenges for clinicians these days is effectively engaging patients and clients, especially those perceived as being challenging, like those with borderline personality disorder, and maladaptive behaviors, as well as patients and clients with substance use disorder.

“These people are never going to get better,” says Paul. “Yes, they just do not listen and I just don’t know what to do with them anymore,” says Alan. “I no longer know what to try. They say one thing and then do something else,” adds Claude. Do any of these phrases sound familiar? What has been yours? Have you at least articulated one of these sentiments before, or have you had at least one patient or client, who, no matter what you said or did, that patient or client was just not doing what he or she had promised to do? If so, you are not alone.

But, there is a way. The principles of Motivational Interviewing, coupled with Socratic questioning can help move your patients and clients toward recovery. Both Motivational Interviewing and Socratic questioning are well known when considered separately. However, combining the two has not before been systematized, and SWEET is taking on this task, integrating the principles and techniques of Motivational Interviewing and the well-respected Socratic method, all in a systematic way. Harnessing the power of the two approaches accomplishes what neither of them has been able to do alone.

This current article is meant to introduce the concept, and the subsequent articles will serve to elaborate. The next 3 articles will be about Motivational Interviewing. This will be followed by a full description of the Socratic method, and subsequent articles will be about the integration and systematization of these two models.

I hope you found this article enjoyable, informative, and translational to your practice.  If you use it as an empowering tool to continue doing your best for the patients and clients you serve, then, this article has served its purpose.

References:

1. Shannon, S; Smith VJ; Gregory JW (2003). “A pilot study of motivational interviewing in adolescents with diabetes. Arch Dis Child”. 88: 680–683.

2. Handmaker, NS; Miller WR; Manicke M (2001). “Pilot study of motivational interviewing”. 86: 680–683.

3. Motivational Interviewing: An evidence-based approach to counseling helps patients follow treatment recommendations”. American Journal of Nursing. October 2007.

4. Miller, W.R., Zweben, A., DiClemente, C.C., Rychtarik, R.G. (1992) Motivational Enhancement Therapy Manual. Washington, DC: National Institute on Alcohol Abuse and Alcoholism.

5. Brodie, D.A.; Inoue, A.; Shaw, D. G. (2008). “Motivational interviewing to change quality of life for people with chronic heart failure: A randomised controlled trial”. International Journal of Nursing Studies. 45 (4): 489–500.

6. Cummings, S.M.; Cooper, R.L.; Cassie, K.M (2009). “Motivational interviewing to affect behavioral change in older adults”. Research on Social Work Practice. 19 (2): 195–204.

7. Hanson, M; Gutheil, I. A. (2004). “Motivational strategies”. 49.

8. Freedman, J; Combs, G. (1996). “Narrative Therapy: The Social Construction of Preferred Realities”. New York:Norton.

9. Miller, W.R.; J. J. Onken, L. S., & Carroll, K. M. (Eds.) (2000). “Motivational Enhancement Therapy: Description of Counseling Approach”. National Institute on Drug Abuse: 89–93.

10. Miller, W.R.; Rollnick, S. (2002). “Motivational Interviewing: Preparing People to Change”. Guilford press.

11. Miller, W.R.; Zweben, A.; DiClemente, C.C.; Rychtarik, R.G. (1994). “Motivational Enhancement Therapy Manual”. Washington, DC: National Institute on Alcohol Abuse and Alcoholism.

12. Wagner, C.C., Ingersoll, K.S., and contributors (2013). Motivational interviewing in groups. New York: Guilford Press, Inc.

13. Wilcox, J., Kersh, B. C., Jenkins, E. A. (2017). Motivational Interviewing for Leadership: MI-LEAD. Gray Beach Publishing.