Motivational Interviewing: Overview of Spirit & Skills

Presentation:

Johanna’s Motivational Interviewing Part 1 Presentation (PDF)

Other videos in series:

• Motivational Interviewing: Overview of Spirit & Skills
• Motivational Interviewing: What is Change Talk?
• The Four Processes of Motivational Interviewing

Welcome to the Community Education Series hosted by The Recovery Village and Advanced Recovery Systems. Hi everybody, my name’s Candi Ader. I’m the director of community outreach with The Recovery Village at Palmer Lake. We are super excited to have you guys all here and to have Johanna speak for us today.

Just really quick, if you’re not familiar with The Recovery Village at Palmer Lake, we are a substance use disorder program for adults ages 18 and up, men and women. We’ve got a 110-bed facility down in Palmer Lake, basically halfway between Denver and Colorado Springs. We have a full medical detox, residential, PHP and IOP with housing onsite for folks that want to live onsite for our programming. I would say one of the big things that really sets us apart from other treatment programs here in Colorado is that we have a medical doctor, a physician’s assistant and two psychiatric nurse practitioners on staff full time. So that’s huge to be able to have medical care access to all of our clients Monday through Friday.

With that, I want to introduce you to Johanna. I’ve got a little bio to read here for her. Johanna has 20 years of experience designing, implementing and evaluating innovative programs and community-based organizations and government entities, including courts, schools, probation, parole, prison, community corrections and behavioral health agencies.

Some of these programs include trauma-informed and community-based victim services, reentry programs, justice reinvestment programs in the community, restorative practices in schools, courts for youth and families and specialized workforce development programs for youth, women and formerly incarcerated people. She also has designed strength-based training, coaching and implementation models to support organizations leading change initiatives and justice reform efforts.

Johanna specializes in working with multiple systems to increase collective impact and tackle complicated problems. She holds a master’s degree in educational psychology with an emphasis on behavioral change from the University of Colorado at Denver, a bachelor’s degree in cultural anthropology and education from the University of California at Santa Cruz and she has a professional coach as a member of the motivational interviewing network of trainers. She is also a current resident for the Goleman EI emotional intelligence certification, offender workforce development, specialist and a global career development facilitator. With that, I’ll turn it over to Johanna to start our presentation.

Thank you, Candi. I’ve enjoyed really seeing where everyone is from. We have a lot of people checking in locally from Colorado and then across the country, so I’m really happy to see you all here. Again, my name is Johanna Leal, and I’m a founding member of the Alliance for Community and Justice Innovation. What we really do is help organizations build their capacity and their people’s capacity to implement evidence-based practices and change initiatives, and one of the evidence-based practices we work on a lot is motivational interviewing.

I’m really excited to be here today to talk to you about MI because it’s one of my favorite topics, and it’s one of my favorite topics for a couple of reasons. One: because it’s more of a practice than a skill. I’ve been working with MI for over 15 years and I am constantly growing in my own arts and skill with MI, and it can be really helpful in a wide range of jobs. Also, I really love working with MI because it works. There is a ton of science and research behind the behavioral outcomes for using motivational interviewing, and I’m also really seeing it myself.

So, let’s jump in — we only have an hour together. This is the first part of a four-part series workshop around MI. We’re going to start with skills and spirit today, and as we go through the four-part series, we will uncover more advanced skills and strategy. If you stick with me to the end of today, I will be sharing a link that has more resources and materials that you can take back to your workplace and practice with your colleagues.

The best place to jump in with MI is with the definition itself. At its most basic, MI is really an intentional conversation about change, and William Miller’s definition kind of explains it all. MI is a person-centered, goal-oriented method of communication for eliciting and strengthening motivation to change. And it’s worth spending a little time unpacking this definition because all the pieces of MI are here.

First, let’s think about “person-centered,” right? This is the belief that every human being strives for and has the capacity to fulfill their own potential. So this really puts people at the center of their own treatment plans as equal partners with a lot of dignity, respect and empathy. The goal-oriented piece of MI really refers to the fact that MI is not just a conversation of encouragement or a conversation exploring ideas. It’s a really strategic, directional conversation about a specific target behavior. So regardless of what that behavior is, MI’s entire framework is a present-future focus around building goals and direction for behavior change.

A lot of people, when they first start working with MI, try to place it in a modality and wonder how it’s different than traditional therapy. And one way that MI kind of departs from traditional therapy is that it’s really present-future focused. It’s not as much as digging into people’s past or what were the circumstances that got them here more as it’s about focusing on the experience of struggle with change now and the vision of what the future could look like and helping bridge that gap.

The method of communication: A piece of MI refers to specific research-based skills and strategies that kind of tune your ear for what to listen for in a behavior change conversation, and then learn the skills on how to respond to what and when. Then, the eliciting intrinsic motivation for positive change. It speaks directly to the MI strategy of what we’re listening for and really trying to build, and encourages people’s own arguments for change rather than imposing our arguments onto them.

There is a huge research base for MI, and many of you may have been using MI for years and it would make sense. Since the first publications of MI came out over 30 years ago, it’s been fascinating. There’s more than 25,000 articles, 200 randomized clinical trials of MI outcomes in so many different fields. So it started with primarily looking at addictions, but it really has unfolded into so many other fields. From palliative care to corrections to alcohol and drug dependents — medical physicians use it, dentistry, anyone. There’s so many people, from teachers to dentists to physical trainers to parole officers, using MI. The one thing they all have in common is, really, they’re all committed to helping people who are struggling with some kind of change in their life.

I get asked a lot: Does MI apply to this group of people or this group of people or people struggling with this or that? And the truth is if people are working on change, MI is an intervention that can work. I think what makes them really unique also is it’s fairly simple to learn with practice, you don’t need an advanced degree and it can be blended really nicely into other treatment modalities you use, or into other program models that you already have that exist. MI can really help when motivation is an issue for treatment adherence in your programs right now. Hopefully, you’ll be able to walk away today with some skills to apply immediately.

I’m a fast talker because we don’t have too much time, so let’s continue. The pyramid of MI, as you can see right here, offers a really nice framework for where we’re going to start today and where we’re going to end up after four sessions. We start with motivational interviewing spirit. And spirit, as it’s implied in the pyramid, really is the foundation. Without the components of spirit, it’s really hard to hold the space and create a safe environment for people to really talk about change. Once there, we’re going to dig into some of the foundational skills of MI — skills like using reflections and more and more complex reflections. And then we’re going to talk about strategy — getting really skilled about what we should be listening for, how we should respond, what we reflect back and how that makes a difference in moving the needle for people towards behavior change.

So, let’s talk about spirit. Spirit really is so foundational to MI because change is hard, right? If you think about something that you’ve tried to change in your life, it oftentimes is preceded by ambivalence, struggle, arguments to stay the same. We’re really wired as human beings to prefer the status quo and to resist change. For instance, we have these cognitive biases that really scrutinize change more than we scrutinize staying the same, even if staying the same has a really bad impact on our lives and the people around us. So our brains are not wired to want to change, and sometimes it takes help. That’s why, with spirit, it’s really about creating the environment conducive of having these authentic conversations about struggle and change.

In MI, they break spirit down into three components, and that’s partnership, empathy and autonomy. I’m sure you’ve all heard these terms before; I just wanted to define them the way they’re framed in motivational interviewing. With partnership, we’re really talking about doing things with people, not to people. And while that seems really straightforward, it can be really hard for a lot of us who are in helping professions or in positions of being experts, where people really look for us to provide solutions or tell them what to do. Partnership is really holding back that reflex to just get in there and solve problems and really get alongside people.

Autonomy refers to people’s need and desire to govern themselves and have agency over their own lives. Autonomy recognizes that people really need to make their own decisions about their life direction, and it’s a really important part of being a human being. Autonomy can be hard to wrap your head around, so sometimes it’s easier to think about autonomy about when it’s taken away. If you’ve ever had the experience of someone changing your work schedule or moving your office, or even that feeling we’re probably all having sheltered at home, right? When you lose that control and it gives you that feeling, that’s the loss of autonomy, and that’s why autonomy is really central in the change process. It can also be challenging in some of the contexts we find ourselves in, such as the justice system, right? Sometimes the concepts of spirit can feel a little bit in conflict with the place people are using MI. Well, it’s good to be aware of that.

And then the last piece is empathy. For our sake today, we’re really talking about empathy as the ability to sense people’s emotions and the ability to imagine what someone else is thinking or feeling and to be able to feel with them. But Bill Miller and Terry Moyers, who are kind of the founding people of MI, talk about a concept of accurate empathy which I find really helpful for helpers and the helping profession. It’s that accurate empathy describes the ability to see the world as the client does, while retaining our ability not to become lost in it.

If you think about that, the ability to understand and share a person’s feelings about getting all caught up in the swirl is really important with MI, especially for those of us who might struggle with things like compassion fatigue or feel really invested in people’s success and failure. So autonomy, partnership, empathy — the foundations for MI — are creating the safety to have a conversation that might be really difficult. When people are stuck, it’s really helpful to think through all of the pieces of MI. Because that should be your spark that, “Oh, this person sounds like they’re stuck.” This is when I can go into using MI. But building the spirit comes with the supportive alliance that you build with your participants or clients the entire time you’re working with them.

Active listening — active listening is the main skill we use to build spirit. When you think about building those components, we do that through active listening. And I am curious; in your chat, if you would chat for me your thoughts about what’s the difference between active listening and just plain listening? I’m gonna give you a minute. Don’t be shy.

“Listening to understand, not respond.” “Intent behind active listening,” I love that. “Using validation, listening for a purpose.” Yes. “Listening to the nonverbal as opposed to just the verbal.” “Reflections being fully present, not jumping in.” Awesome, you are right on. I like this quote because it sort of describes how day-to-day listening can sometimes occur that most people do not listen with the intent to understand — they listen with the intent to reply. So I like that someone wrote that active listening is purposeful, and that’s really a key feature of active listening. It’s actually stunning to look at some statistics about how hard it is for us to be present and focused and not distracted in our day-to-day, and how much work and intention it does take to really listen with people.

You like to break listening down as not just listening or listening deeply, but into three separate skills. This is a skill that we usually practice when we do this together in a group, but today I’m just going to ask you to think about it, and maybe when you leave here today, try and go practice this with someone in your life that you care about. So, three skills in active listening. The first is listening in — when we listen deeply, right? We’re listening with our whole selves, and it means having that intention and not talking. We’re not interrupting. We’re not giving advice. We’re not sharing our experience with it or relating. We’re just listening, and we’re listening deeper than to just the words being said. We’re listening to the nonverbals. We’re noticing the emotional feeling and content of what someone’s saying. We’re really trying to understand.

The “digging in” piece to active listening means digging into ourselves. In every conversation, there’s pretty much two conversations happening, right? There’s the conversation we’re having with the person, and then the conversation inside of our heads. In that conversation with ourselves, we might be forming opinions, forming judgments, making assumptions or even in the best scenarios, thinking through, “Ah, I know how to help them, I’ve got some great advice. I can’t wait to share this, or I can relate. Let me tell you about what I did when I went through that.” This second conversation is happening all the time.

Part of active listening is just becoming very aware that we have our own dialogue internally and it can get in the way of really hearing what other people are saying. So when we practice active listening to become aware of that other voice, acknowledge it and not beat ourselves up over it and let it go so that we can get back to listening.

The third piece is checking in — checking in with someone after they speak to us to clarify if we heard what they’re saying. Checking in can sound like a reflection or a summary: “So what I heard you say is that you’re really struggling being at home all day with your children and working, right?” Checking in gives you an opportunity to go back and forth with someone to see if you really heard what they said and if they feel really understood. As you go about your day today, I invite you to intentionally spend a few minutes practicing these three skills. Listening to someone, paying attention to what is happening inside your head and then checking in with them with a summary or a reflection to check for your understanding. You can really tell it takes so much more energy than the type of listening we do maybe without thinking.

So you’re probably familiar with the “12 Roadblocks to Listening” from Thomas Gordon, and it’s nothing new. It’s been around for decades, but it can be a really helpful framework to think through what can get in the way of listening when we’re creating an MI spirit. Some of these things are pretty straightforward and obvious, right? It definitely is a roadblock to listening when you’re threatening someone or judging or criticizing them. But there’s other pieces here that might be surprising — things like agreeing, approving, praising, giving suggestions, providing solutions, giving advice. What the 12 Roadblocks to Listening are laying out are not what’s positive or negative or what’s right or wrong. All of these functions of listening are functional in certain points, right? There are times we need to ask questions; there are times we need to give suggestions. What Thomas Gordon’s saying about the roadblocks is when we are doing these things, we stop listening.

The human brain is actually really poor at multitasking. What Thomas Gord is saying is without judgment, when we start thinking about the suggestion we want to give someone, in that time, we are not hearing what is being said. So to create some intentionality — that when I started doing these things on the list, to let it go and get back to listening — it’s almost as if you’re sort of emptying yourself out to fully receive and understand what someone else is saying as a baseline. Here are just some interesting takeaways to remind us about active listening, which a lot of you chatted out in the chat box. Which is active listening is really listening to understand, and also this idea of listening deeper. I want to talk about where communication can break down and why active listening is a really important part of that.

When you look at all the different components of two people communicating, there’s what the speaker means. So, what are the thoughts, feelings, the mindsets of the person speaking and what words do they choose and choose to speak? If you’ve ever had that experience of, “I’m just not sure how to explain myself or express myself,” this is really the feeling of our words don’t always reflecting what’s going on inside of us. A lot can be lost in translation just from our own mindsets to our voices. If you’ve ever been misunderstood, you can understand that.

Then there’s this whole other dynamic of what the person thinks. They hear their own framework, biases, life experiences, world views, assumptions that they filter what they hear through and how they make meaning of it. We are meaning-making people, and so there’s so many different pieces of communication breakdown that can make things go wrong. The reason we use MI as the first skill for active listening is that it can really calibrate where we are with the person we’re talking to. Because we’re in roles of being professional problem solvers, it’s really important to first understand: Am I solving the right problem? What’s really going on with this person? Before I jump in and start making plans, prescribing interventions, setting goals, right? To spend a little more time than you think you may need, and really listening and checking for understanding.

It’s unbelievable how transformative listening to someone can be. If you just took away this skill from a mind of truly listening, you’ll see a huge change with the people that you listen to. Every time I train this, I try to remind myself to go home and just deeply listen to my family, and I can see how different they are with me.

Let’s talk about how we do this. One of the foundational skills of MI are reflections, and reflections are one of those skills that sometimes we think we’re doing all the time, but we tend to be asking a lot more questions than using reflections. The way to get better at reflections is to practice; there’s no way around it. Practicing, getting feedback, listening to ourselves, practicing with other people can really give us some great ideas of how to approach listening with reflections as opposed to questions. In MI, reflections are broken down into two different types. There are simple reflections and there are complex reflections.

Simple reflections are helpful; they really just repeat back what you heard the person say. You might be just rephrasing what they said and using their own words. This can be helpful — just to let people know, “I’m here, I’m listening, I’m understanding you.” Complex reflections, on the other hand, are a little deeper. They reflect deeper feeling. They might add additional meaning. They might add a metaphor, or they may even be reflecting what’s not being said. So a really powerful, complex reflection might reflect the emotion that you’re sensing someone’s experiencing or the silence that someone has in between in a conversation that may be reflecting something deeper going on.

The reason why complex reflections are so important in MI is they’re really trying to get deeper into what are the drivers of behavior change. The more that we can add meaning to what someone’s saying, the more direction we can give a conversation. If you’ve ever had — I know I have — the experience of talking maybe with a client or a friend who’s struggling with something, and the conversation seems to be going around in circles, right? I call it the swirl — when you get stuck in the swirl with someone and it just feels like we’re not getting anywhere. That’s typically in an MI context because our reflections are not complex enough. If we start using more complex reflections, we made more progress towards behavior change.

I want to practice this with you a little bit so that you can see how complex reflections really can provide deeper insight for the person you’re working with into what’s holding them back. So, here’s an example. Here’s a sample interview between a practitioner and a client, and the interviewer says, “What have you already been told about managing your drinking?”
The client responds, “Are you kidding? I had the classes, had the videos, I’ve had lectures from the judge, I’ve had all kinds of advice about how to get better at this. I just don’t do it. I don’t know why. Maybe I just have a death wish or something, you know?” So here’s an example where there’s no right or wrong way to answer or respond to this client, but here’s two examples of a simple and complex reflection. Simple: “You’re pretty discouraged about this, right?” So it is trying to connect, conveying, understanding, or that you’re listening.

Then, a complex reflection: “You’re not sure why you’re sabotaging yourself.” Then I can be pretty direct, and it’s a pretty direct, complex reflection. I think that that complex reflection is interesting because it demonstrates how, before you move into using these skills with MI, you need a lot of spirit, right? If I say to someone, “You’re not sure why you’re sabotaging yourself,” and there’s no supportive alliance between us and we don’t have partnership, autonomy and empathy, then this could increase discord for the person you’re talking with. But if you’ve created that environment of safety, and you say authentically, “You’re not sure why you’re sabotaging yourself,” you can unlock some deeper understanding about what’s really going on with someone when they’re talking to you. And if you can, make it get really real, really quickly, so that you know you’re solving the right problem.

Now, let’s say you’re wrong. Maybe that’s not how the person feels at all — that they’re sabotaging themselves. That’s alright too. Remember when I talked about that sometimes things get lost in translation from even our own heads and hearts to our words. The activity of reflecting deeper meaning back to someone gives them the opportunity to consider, “Is that true for me or not?” That process helps them get more clear on what’s really going on with them. And if you have high spirit, they’ll correct you, and it will give your conversation even more meaning.

So let’s try it out. Here’s another reflection activity that I’m going to have you chat out. Here we have, someone says, “I’m so tired after work that sometimes I’m really grumpy, and I just take it out on my kids.” So in this instance, a simple reflection repeats back what the person is saying and conveys understanding, and a complex reflection will add meaning. Here’s an example. A simple reflection: “Work is making you really tired.” True that. Complex: “You’re worried about the impact that work is having on your family life.” Other complex reflections could include, “You’re having a hard time prioritizing self-care. You’re looking for strategies to manage stress.
You want to focus on improving your relationships in your home, or you really want to show up differently for your family.” When you think about those complex reflections there, they may be off, but they’re giving some present-future focus and directionality to what might be really going on and what we are really working on here.

Now it’s your turn. Let’s look at the top statement: “I’m trying to exercise more, but I can’t find the time or energy.” Use your chat box and try to come up with a complex reflection. Think about what might be going on. So, what’s your hunch about what’s going on under the surface for this person, and how could you reflect that back? “You want to be healthier.” That’s great, right? And so in that case, the added meaning is “healthier.” So maybe that’s what we’re really looking at.

“Your goal is being healthier, struggling to find time to do it. You want to increase self-care efforts. That’s great. You’re really tired from your day and you’re struggling to be healthier. You’re concerned that you’re not prioritizing your physical health. You’re struggling to become healthier, and it’s a struggle. You want a better lifestyle.” That would take it in interesting directions. So part of the complex reflection becomes a major piece of MI strategy because you’re thinking ahead. Where is the conversation leading, and how are we diagnosing what’s really underlying the pain and struggle of this person? “You’re ashamed that you aren’t making your health a priority.” That’s adding that feeling of shame and that could be really interesting with high MI spirit — to see where that can go and what you can really do to help create understanding for the person and where they’re stuck.

Let’s do the second one: “I’m struggling with my co-worker; she just doesn’t pull her weight, and I don’t want to take the blame for us not getting the job done.” I love this comment that there’s usually grief underneath avoidance since grief — the sense of loss — is felt when the person goes into body-oriented life. And so, Katrina, you are definitely speaking to the essence of a complex reflection going below the surface, and part of this — through empathy, partnership and autonomy — is relying on your sense and knowledge of people and behavior. What can be driving some of these things? It’s oftentimes that we can’t see it in ourselves, and that’s why we help others.

“You want to be more active and healthier.” I see that. Does anyone want anything for the “struggling with the co-worker” one? “You’re concerned about how your co-worker is reflecting on your integrity with your work, right?” So, “Your integrity at work is really important to you,” would be a wonderful reflection too. “You’re feeling fearful that your performance will be based on your co-worker’s work.” That’s great — introducing this idea of fear. What are we really talking about here? “Are you scared of being misunderstood, being judged? Lack of control? It makes you feel out of control to be judged by someone else’s work. I’m hearing you want to be validated.” You guys are amazing. So the reason I really wanted to chat this out in this forum, and I know it’s a little awkward to practice through Zoom, but MI really is a practice, and you can learn so much from the community around you.

MI outcomes with participants are really coupled with the skills of the practitioner. The more that practitioners use MI with competency, the greater results they see with the people they work with. And the best way to get better at this is to practice and learn from other people. Every time I do a reflection activity, I see what other people reflect, and I think, “Oh, that was brilliant. I wish I had thought of that.” So these types of activities are things that you can bring back to your circle of colleagues to really work with. What are some of the tough things that you encounter when you work with people, and what are some ways that you can practice using reflections to dig deeper? Thank you for all of those. Here I have just a couple of examples, but you came up with better ones. “You’re struggling to put yourself first and keeping this job is really important to you right now.”

Let’s move on. There’s a few tips in using reflections that really can get in our way that we may not realize that we’re doing. One is toning up; we can turn a reflection into a closed question really quickly by toning up. “You’re worried about losing your home” is a reflection. “You’re worried about losing your home” is a closed question, right? So, thinking about when we are saying things and using reflections to make sure we’re not turning them inadvertently into questions, because it can shut a conversation down. Sometimes, we’ll do this because we feel like we’re being too bold or presumptuous with our reflections, so we’ll turn them into questions.

Over time, when you really start using reflections fluently and with ease, you can see how people respond to reflections, and it makes them feel heard. The other thing that could be helpful when you’re starting to use reflections is using a STEM. Lots of people like STEMs. It sounds like you don’t necessarily need a STEM, but like learning anything new, it can feel clunky and uncomfortable and not like you and your style when you start trying it out. The only way to get past that is to practice, so start trying it out. If you feel more comfortable using a STEM like so, go for it. You might end up not needing that, but you have to get started somewhere, and if you’ve ever learned a new language, MI can feel like that at the beginning. Like, awkward — like you’re thinking too much about what you’re trying to say, but it really does become fluent after awhile.

If there were two things beyond active listening I would love you to leave with today, it’s just using reflections as your default response. Sometimes, our default is questions, and if you’re interested in advancing with MI and getting competency and getting coded, we’re really aiming for a two-to-one ratio, reflections to questions. So, we want to be reflecting more. The more you can reflect, the better. And the real key to reflecting and maintaining spirit is to really get curious. People are really interesting, and we all struggle and we all have had that shared experience of feeling stuck. If you’re approaching conversations with a spirit of curiosity, you’re really just trying to understand someone — chances are your reflections are going to get more and more complex.

I love this quote by Peter Drucker. A lot of you have spoken to this in the chat, which is, “The most important thing in communication is to hear what isn’t being said,” and this is really true. We talked about it a little in active listening, but I like the metaphor of the iceberg to reflect kind of what the purpose of MI is — what we’re listening for and what we’re trying to pull out.
Above the surface in the metaphor, it’s things that people say, people skills and knowledge — so, words they use. But the words are really only expressing a fraction of what is going on for someone below the surface in terms of their thoughts, their feelings, their conflicts, their doubts, their beliefs, their attitudes.

When it comes to behavior change, it’s typically not a skills gap that’s preventing us from making lasting change. So when you are working with someone and you’re thinking, “Am I below the surface enough or am I solving the wrong problem,” it’s helpful to ask yourself, “Is this a skills issue or a will issue?” If it’s a skill issue, of course, it’s appropriate and the right time to advise, teach, suggest, train. But the truth is that most change is driven by what’s below the surface. So when we’re thinking about our complex reflections, we’re really listening for that song below the surface — the swirl of what’s going on for someone down below — and trying to surface that so that someone has an opportunity to really look at what is going on for them, and how that’s reflected in their behavior, and what kind of vision they have for their future. But until it’s surfaced, we can’t really do it as the other skills with MI.

Here’s another question: “I’ve been so stressed out that I’m losing my temper with my kids, and I feel really badly about it.” Chat me a few below the surface reflections. What do you think is happening with this person in terms of their beliefs, their mindsets, their values — what’s happening below the surface? Shame, guilt, feeling a failure, guilt, embarrassment. They feel less than, overwhelmed, frustration, mom failure, insecurity. So we can see how really, really important MI spirit is when we can see that when we’re talking about behavior change, whether it’s quitting smoking, managing stress, losing weight, that really what we’re talking about are really deep human conditions below the surface. That’s really why empathy and autonomy are so, so important to the spirit of the mind, the value of family. You guys are awesome.

Let’s do one more: “I know I need to lose weight. I’ve been struggling for a while. I used to be thin and life got busy and things kinda got out of my control.” Let’s try to frame it as a reflection. Self-esteem. Good one. Failure to take time for themselves, not putting yourself first. So, a lot of reflections that I might use in this situation to go below the surface reflect exactly what you’re saying. “You’re worried about your health, you’re struggling to put yourself first, this really doesn’t feel like who you are.” A lot of change also comes with that sense of loss, and so we’ll be moving into the next session what behavior change processes look like and how we can strategically move people through them. Because with change, we can’t assume that people even see the benefit in their change, and with that could come a lot of loss, including the loss of how people know themselves and how people know people around them.

We will end it there because I want to leave a few minutes for questions and kind of tee up what the next phase will be. In week two — next week — we’ll be diving deeper into the whole behavior change process. What we’re going to do is we’re going to have some opportunities to listen to a couple of conversations and just practice tuning our ear and coding where we think people are in the behavior change process. And that will really help us figure out what, from what the person is saying, do we strategically respond to help them move ahead. So I really hope that you will join me next week. Thank you for watching this video. We hope you enjoyed the presentation.