Michaelene Spence is the clinical director at Wayside House, Inc., an organization in St. Louis Park, Minnesota that supports women in overcoming addiction, mental illness, and homelessness. Wayside House has several supportive housing locations. The staff emphasize compassion and validation, which transitions judgment into the acceptance critical to recovery. Ms. Spence explains that, “The women at Wayside House feel that we genuinely care for them.”
For example, “I have been working with a 19-year old woman . . . on and off for close to 3 years now. She has been sober for 3 months. We remain connected through technology, as she e-mails me frequently.” Ms. Spence uses the principles, techniques, and spirit of Motivational Interviewing (MI) through e-mail, as that is the only consistent way to communicate with this consumer.
This young woman lost a child, is experiencing homelessness, has an addiction to pharmaceuticals, struggles with an eating disorder, and has parents with alcohol addictions. In a facility with 40 beds, Wayside has a 41st bed available for her in case of emergencies. She knows she can go there when she is desperate. The last time she came in for bed 41, she was deeply suicidal and Ms. Spence was able to meet with her in person. The use of MI skills got her to the hospital:
We talked about what she wanted in her life. She said she did not know what she wanted in her life. I was tempted to say, “What do you mean you don’t know?” because I know she knows. She has the tools to make changes. . . . I have to remind myself that when I am tempted to tell someone what to do; I have to know that it might backfire. Instead I have to help her gently identify this because she needs to buy-in. It is important to take a step back and walk through it with her, asking, “What is it you feel you might need? What do you think might be helpful?” Maybe I can point out one or two options.
All Wayside House, all staff receive extensive training in MI, on an ongoing basis. Consistent training is critical to their growth. They worked with trainers from the Motivational Interviewing Network of Trainers (MINT), and also trained at the University of New Mexico with William R. Miller and Stephen P. Rollnick, authors of Motivational Interviewing: Preparing People for Change. Today, many people on staff are considered MI champions. The staff is also trained in the Seeking Safety model, developed by Lisa M. Najavits to treat trauma, post-traumatic stress disorder, and substance use. Ms. Spence notes, “I supervise all of our counselors on a weekly basis and we talk specifically about how they can use MI with the people they are working with. We focus on MI as a tool in areas where they are getting stuck.”
In addition to the tools and techniques of MI, Ms. Spence discusses the spirit of MI in the context of 55 years of working with women. Before training in MI, the staff used the Relational Cultural Theory model developed by Jean Baker Miller. “It focuses on the importance of relationships and that women heal in connection with other people, specifically other women. Given that the spirit of MI is about collaboration and non-judgment, we have found these two approaches to be very complementary,” says Ms. Spence.
While there are no immediate solutions to the life struggles of the young woman in bed 41, she does understand that there are well-trained providers in the field deeply committed to the importance of humanity and grace. It is a human instinct to try to fix a problem, or rescue someone who is hurt. Service providers must understand that the longer, but gentler, method is to guide people to understanding their own paths.
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