Thinking About Making a Change? Questions from Motivational Interviewing to Help You Move Forward

21 June, 2016 Leave a Comment

Motivation for Change

Is there something that’s been sitting in the back of your mind, nagging at the edge of your daily thoughts? Some examples of changes people often consider making are, “I should start exercising”, “I know I need to cut back on smoking” or “I want to communicate better with my partner”. It’s very common for people to have ideas about things they want to change, but once we start thinking about it, the prospect can be very daunting. People often respond to feeling unsure about a change by simply setting it aside and deciding to deal with it later. Unfortunately, this tendency can result in procrastination for weeks, months or even years.

The questions in this article are consistent with an approach called Motivational Interviewing. They are aimed at helping you consider a change you are interested in without becoming overwhelmed and setting it aside, once again, for later. Whenever I really start to consider making a change in my life, I ask myself these questions and sometimes even write out the answers on a piece of paper. I encourage you to grab a sheet of paper and just jot down some ideas in response to each of these questions. Every time I’ve done this, I’ve uncovered important insights that hadn’t previously occurred to me and I hope the same will be true for you.

Desire

To make a change, it has to be something that you want, something you do really care about. If you are thinking about changing something, it’s likely that you already have some desire to change it. To foster that sense of desire, think about the following questions:

  1. What are some of the most appealing things about the possibility of making this change?
  2. What would it mean to you if you were able to follow through with this change successfully?
  3. How will making this change help lead to some of the things you want most in your life?

Ability

When I talk to people about changes they want to make, people sometimes feel that they wish they could change something, but don’t feel confident or capable that they would be able to do it.  For that reason, they downplay their desire to change. They pretend it doesn’t matter. If you really want to foster your desire to change, go ahead and answer the following questions that will help you build your confidence that you really can make this change.

  1. What sorts of things have you changed in the past?
  2. What have you learned from past experience that will be most helpful to you in making this change?
  3. If you knew that you definitely wanted to make this change, what would it take to really make it happen?
  4. What part of this change are you most confident that you can successfully accomplish?

Reasons

You’ve already answered some questions that are focused on your desire for change. Perhaps as you were answering those questions, reasons for making the change emerged. Being as specific as possible about those reasons and having them at the forefront of your mind can increase your desire and motivation for you to move forward with the change.

  1. How will making this change improve your life?
  2. What are some of the biggest benefits of making this change for you?
  3. What are some reasons why other people will be in favor of you making this change?

Need and Urgency

We can have all the desire in the world to make a change, but if we have been putting it off for awhile, we may continue to avoid doing anything about it. Thinking about what is most urgent about making this change can help light a fire under you to get started with the change you have been considering.

  1. What do you feel like you really do need to do, when it comes to making this change?
  2. What part of this change seems most urgent to you?
  3. What makes you want to make this change sooner rather than later?

After completing this exercise, notice how the different questions affected your interest in making the change and spend additional time thinking about the questions and answers that increased your excitement and confidence about going through with it.

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Overcoming Anxiety

11 July, 2013 Leave a Comment

If you’re reading this, chances are that you or someone you care about is suffering from anxiety. You’re definitely not alone. Experiencing anxiety is part of being a human being, but if you’re experiencing it too often it may interfere with your daily enjoyment of people and activities that are important and meaningful to you. Overcoming anxiety doesn’t mean making it go completely away. It means learning to work with it in a way that allows you to really engage with your experience as a human being and not miss out on things that are important to you.

A common response to anxiety is avoidance. This makes sense, right? Fear is a gift that helps us know when a situation may be dangerous and therefore possibly worth avoiding. For example, I can remember the first time my peers pressured me into going off the high dive. I looked down over the edge and thought, “no way”. It makes sense, human beings aren’t supposed to feel comfortable jumping off of high places. I wanted to turn around, climb down the ladder and hide in the kiddie pool. But after a substantial amount of positive self-talk and peer pressure, I summoned the courage to jump off, having a thrilling, exciting experience that left me feeling elated and wanting to do it again.

Avoidance is a great response to anxiety, if it helps you avoid truly dangerous situations which could leave you physically and/or emotionally injured (e.g., jumping off a cliff; an abusive relationship). However, the major limiting factor of avoidance is that it restricts you from experiences that could be adding to the richness and enjoyment of your life (having good relationships, doing fun activities). For that reason, it makes sense that people are interested in overcoming anxiety or at least the over-abundance of anxiety that limits their capacity to enjoy life.

Exposure: When it Does and Doesn’t Work

Many schools of therapy involve some kind of exposure to anxiety provoking situations in the interest of practicing strategies to feel more comfortable with these situations. For instance, if you have a fear of flying and you always avoid airplanes, you won’t have an opportunity to overcome this fear.

That being said, there are people who are confronted by their fears all the time and who report a steady increase of anxiety related to these fears over time. They’ve been exposed to plenty of anxiety provoking situations, but they haven’t gotten any more comfortable with the situations or with the anxiety within them. Why is that?

It doesn’t do any good to have a negative, horrible experience with something you already consider to be negative and horrible. For instance, what if a peer had pushed me off the high dive and I had fallen and injured myself? I can only imagine my anxiety would be higher the next time I found myself high off the ground, despite the exposure to this type of experience. I would also likely find myself avoiding the high dive and perhaps even develop a fear of heights.

What helps is exposure to potentially anxiety-provoking situations while also having some kind of a positive experience with them. In my case with the high dive, my fear only served to make the experience more thrilling and fun, leading not to avoidance, but to a desire to repeat the experience. Over time, even some very anxiety-provoking situations can be transformed into powerfully meaningful experiences.

Fear or Avoidance of Anxiety = More Anxiety

It’s one things to say that you’d like to have a more positive experience in situations that cause anxiety for you, it’s another thing to do it. Most people who come to therapy have had anxiety for awhile and have already tried many things to stop being anxious. Furthermore, most people who come to therapy with anxiety come to get rid of it or to at least substantially reduce it. Ironically, the more one attempts to avoid the experience of anxiety, the greater it often seems to grow. People trying to avoid anxiety fear that they will fail or that their anxiety will come back, which then causes more (not less) anxiety. It reminds me of one of those “Chinese Finger Traps” where the harder you try to pull your fingers out, the more they are trapped.

It’s difficult to get out of this vicious cycle but one method involves not trying to reduce anxiety, but trying to change one’s relationship to anxiety. What would this entail? It’s different for everyone and depends on your experience of anxiety, the situations that make it better and make it worse. One place to start is to build awareness for the different aspects of your experience of anxiety. Start becoming aware of the different physical sensations, thoughts, images, emotions that are a part of it, but try to do this without getting overwhelmed by, or totally sucked into the experience.

From there, you can explore which sensations are ok with you and which aren’t. A lot of people start out feeling that any part of anxiety is unacceptable and horrible, but after breaking down their experience find that certain parts are ok. For example, people have told me that breathing hard is ok after running, but not ok during a panic attack. In that case, even though panic attacks might feel unacceptable, breathing hard actually feels ok. This kind of exploration can start opening up your experience more and start changing your relationship to anxiety.

Therapists practicing ACT therapy (Acceptance and Commitment Therapy) have an extensive toolbox for helping people develop this kind of awareness and to begin changing their relationship to their anxiety. I highly recommend working with a therapist who practices this approach (wink). If therapy isn’t feasible at this time, I recommend working with a workbook that describes some of these techniques. My favorite is, “Get Out of Your Mind and Into Your Life”, by Stephen Hayes and Spencer Smith. (http://www.powells.com/biblio/9781572244252). That being said, applying these techniques is not a simple cut and dry “cure” and it can be very helpful to have an ally to support you through obstacles and confusion that can arise.

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What to do about Negative Thinking When Positive Thinking Doesn’t Work.

17 January, 2013 1 Comment

“I’m not good enough.” “No one listens to me”. “I should be able to do this”. “There’s something wrong with me”. “Other people just don’t get me”. “I just can’t do this”. “I’ll never get married.” “I should just…” “Why can’t I be happy like other people?”. “I don’t think things are ever going to change”.

These are some common thoughts people have when they are feeling bad about themselves, other people or the future. Most people agree that there is a connection between their thoughts and feelings. You feel bad and you end up thinking more negatively than when you’re feeling good. Negative thinking can lead you to feel worse or do things that make the situation worse. So, knowing that, you try to get yourself to think more positively in the hopes that it will improve your mood. Most people tell me that it helps them sometimes, but not always, and surprisingly, sometimes it actually makes it worse.

Have you ever had the experience of someone approaching you and saying, “hey there! smile!!”? or “Hey! Turn that frown upside down!”? Did that ever make you feel better? Most people report that comments like that make them feel annoyed, irritated and even worse than before. In their efforts to cheer people up, these people may not realize that they are actually criticizing other’s facial expressions and being insensitive to their feelings, leaving them in a worse mood than before. When trying to get yourself to think positively to change your mood, you don’t want to make the same mistake.

If you’re in a bad mood and trying to think positively isn’t working, try these things instead.  Give yourself permission to be in a bad mood. Who said you need to be happy all the time? It’s not fun, but bad moods happen, and letting yourself be upset can be a great way to send the message to yourself and other people that you don’t have to be perfect, happy and “on” 100% of the time. Some people will probably have some trouble accepting this, but hey, as long as you are not doing anything to hurt other people verbally or physically, they will survive and be just fine.

Make a List.

Make a list of all of the good reasons that you have to be annoyed, irritated, sad, disappointed, tired or anxious. Try to be generous to yourself without distorting the facts. Notice that you have reasons for feeling the way you do. Keep listing factual reasons until you feel like it makes sense that you would be feeling this way. It’s important that you stick as close to verifiable facts as possible. For example, “I forgot to return several calls at work and my report had a mistake in it”, is more factual than “I suck at my job”. It’s also important that you write these things down. Writing them down helps keep things clear in your head and keeps thoughts from too quickly spiraling into destruction and just more negative thinking.

Put it in Perspective.

Make a second list. You could call this list, “On the Other Hand” and it should include reasons why you might start feeling better or why you don’t have to feel completely horrible. For example, “On the other hand, I turned in a corrected version of the report and I’ve done a lot of good things for this company”, or “I’ve been really tired lately, but I’ll have a chance to relax tonight” or “Lots of other people make mistakes too”. These items should also be facts. Be careful to avoid invalidating (or arguing with) the facts from the first list. The purpose of the second list isn’t to argue with facts or to tell yourself that you are wrong for feeling bad. It’s to put everything on the first list into perspective.

Investigate.

You might find that there are some big assumptions you are making that are contributing to your negative mood. These assumptions might be spot on, giving you every right to feel bad, but they could also be slightly off or way off, meaning you’re feeling bad and you don’t even have to. If you notice any assumptions (negative thoughts that are not verifiable facts), see if you can conduct an investigation like you would if you were a detective or scientist to try to find out if the assumptions are true. For example, “My boss thinks I am a poor employee” might be a fact, but you might want to gather more information to see if this assumption is a fact or not. Asking questions, observing people’s actions and accessing records are all great ways of collecting new information.

Be constructive.

Stay with the facts and think about what you can do to make things better. Being constructive can be different than being positive. An overly positive thinker might have a thought like, “Oops, I didn’t return that phone call and I turned in a report with a mistake, but I have so much to be thankful and I’m great at my job, so it’s ok”. Someone thinking constructively might say, “Uh oh, I forgot to return some calls, and that report had a mistake in it. I’d really like to do better, but I’ve been so tired lately. I’ll have a chance to relax tonight and I’ll try getting more rest and setting up a better routine for returning calls and see if that helps.

These suggestions are based in ideas from Cognitive Behavioral Therapy (CBT) and just scratch the surface of the tools that are available for better coping with emotions and mood. If you like this perspective, you might consider working with a CBT therapist for more support in working toward better coping with moods and emotions.

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6 Tips for Talking with Your Teen

12 November, 2012 Leave a Comment

Keep it Positive. You may not be able to sugar coat everything you have to say. Life isn’t all sunshine and rainbows, but it’s important to emphasize your teen’s role in being able to create positive outcomes for him or herself. Teenagers are prone to hopelessness and powerlessness and surprisingly sensitive to what you think. Since they are easily hurt and secretly afraid of disappointing you, they say things like, “I don’t care what you think” and “Whatever, mom”. These thoughts help them cope with their feelings about making mistakes and disappointing you. But they do care what you think and they should, because you’re their mother or father, you know them well and you have more experience with life than they do. For that reason, what you say and how you say it is very important. I often hear things like, “My dad won’t let me… There’s nothing I can do about it.” or “My mom is ruining my life”. I then try to reassure teens that there is always something they can do to make their life better (e.g., get good grades and your dad may consider letting play sports again). Something like, “Of course you can play soccer next season. You just need to get your grades up and I know you’re definitely capable of doing that” is way healthier of a message than, “Well, I told you to get your grades up, but you haven’t, so the answer is still no”. If you phrase things in a constructive way that emphasizes the role of their actions in moving forward with life in the direction they’d like to go, they will be less prone to anxiety and depression, now and in the future.

Pick the Right Time. Teenagers continually complain to me about being interrupted by parents wanting to talk while they are enjoying relaxing, talking (texting) to friends or their favorite tv show. It may look to you like your son or daughter isn’t busy, but that doesn’t mean they are in the mood for parent-talk time. Just because they don’t want to talk to you when they are “busy” doesn’t mean they don’t want to talk to you at all. Try to establish some regular times for checking in and talking with your teenager, so that everyone is on the same page about what to expect and when. Taking your teen out for ice cream, lunch or to dinner once a week can be a good activity to make a part of your regular routine, and these occasions are usually good for checking in and communicating concerns if you have them. That way, conversations don’t seem unexpected, overly negative, or as if they are occurring only in reaction to poor behavior. If your teen approaches you for communication unexpectedly and outside of your regular check-in times, congratulations, you are doing something right! Try to reward this behavior whenever possible by making yourself available and being responsive to whatever topic your teen brings up to discuss. These occasions are not a good time to discuss concerns you’ve had unless they are directly related to the issues your teen is raising, and even then, do your best to keep your discussion of your needs, concerns and fears minimal and as positive as possible.

Say It Once. One of the most common things for teenagers to complain about when talking with their parents is that you say the same thing, over and over… and over. Your message is important and you know what you’re talking about because you’ve lived a lot longer and have been through a lot more. You really want your teen to listen to you so that they don’t have to go through the same hard experiences you’ve gone through or seen others go through. If you’re like most parents, you repeat yourself because your teen doesn’t appear to be listening, is arguing or engaging in any number of parent-irritating behaviors (e.g., eye rolling, cell phone fidgeting, “having an attitude”). Instead, try making your point clearly and concisely. Once. And then ask your teen what he or she thinks of what you just said.

Listen. And listen with respect for your teens knowledge, experience and intelligence. That’s right, although your teen might be young, relatively inexperienced and totally naive when it comes to the consequences of poor decisions, he or she still got half of their DNA from you and has benefited from years of your instruction. You can afford to think that what he or she is saying has validity and is coming from some sort of reasonable place. Wait at least three seconds (“one thousand and one, one thousand and two…”) before saying anything after he or she stops talking. This helps your teen know that you really were listening and gives him or her a chance to say anything else that comes to mind before you respond.

Validate. Ok, here is where you are really going to blow your kid’s mind. Teens often worry that their parents don’t trust or respect them. They complain that their parents “don’t listen”. Usually “not listening” means that you refuse to do what they want. You don’t have to do what your kid says they want you to do, but you can spend some time helping them feel like you heard them before you say no, or before you negotiate a compromise. Ask yourself, “what part of that made sense to me?” and then tell your teen the answer. Let him or her know that you understand why he or she would ask for what he or she wants, why that’s a good thing, how you can see if it’s important to them or why any other part of it makes sense. Remember, even if your teen acts like he or she knows it all and doesn’t care what you think, underneath all that is the child you used to know who wants your approval and to know he or she is doing something right.

Take a Break. You don’t have to have all your answers right away, and neither does your teenager. Many conversations start with the best of intentions but quickly become tense and uncomfortable. If your teen seems suddenly angry and you’re not sure why, consider setting aside your original agenda for the time being until you can understand why he or she is becoming upset. When people’s emotions shift suddenly, it’s often a sign that an underlying negative belief of some kind has been triggered. It’s a good time for a break, or at least a break from your original agenda. At this time, a shift into listening and validating on your part can greatly help your teen’s mental health. Likewise, if your teen states, “I don’t want to talk about it”, that is a good time to take a break and/or attempt to understand what he or she is afraid will happen if the subject is discussed. Finally, you don’t have to make decisions on the spot. He or she can wait until you’ve had a chance to discuss the issue with your spouse, your best friend, your therapist or your pet dog. As long as both you and your teen feel confident that your concerns will eventually be addressed, you are free to take your time in addressing them in a careful and constructive way. These experience will build your teen’s sense of confidence and competence in his or her capacity to have constructive conversations with others.

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