Mind Dive

Episode 59: Changing Behavior with Dr. Carlo DiClemente

• The Menninger Clinic

Share episode

Carlo C. DiClemente, Ph.D., codeveloper of the transtheoretical model of behavior change, discusses bringing a human touch to the fabric of therapeutic intervention. Dr. DiClemente’s work emphasizes the importance of creating an environment where patients feel comfortable expressing their hesitation about change and tying a patient’s personal values to their therapeutic goals. Given his years of experience, Dr. DiClemente has concluded that a straightforward path to recovery is a misconception and, for clinicians, ensuring that a patient’s intrinsic motivation stays consistent is crucial for long-term recovery success.  

 This episode of Menninger Clinic’s Mind Dive Podcast features Dr. DiClemente, accomplished psychologist, author and codeveloper of the transtheoretical model of behavior change, joining hosts Dr. Kerry Horrell  and Dr. Bob Boland for a conversation on how CPT became a first-line therapy for PTSD, the fundamentals of this treatment, and how to approach it within comorbidities.  

 Dr. Carlo DiClemente is an emeritus professor of psychology at the University of Maryland Baltimore County. In developing the  transtheoretical model of behavior change,  he published the second edition in 2018 of Addiction and Change: How Addictions Develop and Addicted People Recover, and a self-help book, Changing for Good.  

 “Change is an internal decisional balance that they’re got to come to see and part of the challenge is helping tip that balance but in a way that doesn’t pressure them to move backwards,” says Dr. DiClemente. “It’s important for me to find the values that a patient cherishes and connect those ideals with the act of changing.”

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Dr. Bob Boland:

Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, dr Bob Bowe and Dr Keri Harrell.

Dr. Kerry Horrell:

Monthly we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

Dr. Bob Boland:

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

Dr. Kerry Horrell:

So thanks for joining us.

Dr. Bob Boland:

Let's dive in.

Dr. Kerry Horrell:

I am so excited to welcome our guest today. Today we have on Dr Carlo DiClemente. He is an emeritus professor of psychology at the University of Maryland, baltimore County. He is the and very well known for being the co-developer of the trans-theoretical model of behavior change. He served as the principal investigator on numerous funded research projects and an author of numerous scientific publications on motivation and behavior change, spanning a variety of health and addictive behaviors. He published the second edition in 2018 of Addiction and Change how Addictions Develop and Addicted People Recover, and has co-authored several professional books and self-help books, including Changing for Good and continuing, even in your retirement, to work on many projects. But welcome, dr DeColendi, we're so happy to have you.

Dr. Carlo DiClemente:

Thank you, it's a pleasure to be here.

Dr. Kerry Horrell:

I was saying before we officially were on air that you're a dream guest. I mean the work that you've done around the Trans-Tibetan.

Dr. Bob Boland:

She's been talking about you for quite some time.

Dr. Kerry Horrell:

She's just so exciting.

Dr. Carlo DiClemente:

That's why my ears are ringing. I got it.

Dr. Kerry Horrell:

You know I'm relatively young in my career as a psychologist. I don't know if I mentioned that I'm a psychologist, bob is a psychiatrist but obviously in my training I mean this model is a huge part of how we learn about and think about people's change and their capacity to change. So it's just really it's really nice to get to talk with you and pick your brain around this. I wonder if you do want to start with telling us a little bit about your career, how your career developed, how you got interested in kind of understanding behavior change.

Dr. Carlo DiClemente:

Sure, so psychology wasn't my first career. I was an ordained Roman Catholic priest for a while and then left and kind of went into psychology. I got up to University of Rhode Island and was up there doing my PhD work and went in a class with Jim Prochaska, who was actually at that time trying to understand the mechanisms of what happens in psychotherapy.

Dr. Carlo DiClemente:

And so how do people change in psychotherapy? So I was intrigued by that question and so he had come up with some way to kind of summarize the processes of change and I foolishly and probably said oh, I think I'm going to study those processes of change in smoking. Well, he had to convince me of smoking because I really didn't want to do smoking, because I was smoking at the time, and so basically I kind of did, but anyway. So I did a dissertation on the processes of change and I believed, if the processes were generic and worked for all types of changes, that self-change and therapy change should yield similar processes a group of people who quit smoking on their own, a group of people who quit through SmokeEnders, which was a cognitive behavioral program, and a group who quit through SHIC, which was a program, an aversive conditioning program, and so I looked at all three of those, and when I was looking at people who I successfully quit and then was going to follow them, and when I start asking my questions about what processes did they see as really important, they said when, when do you mean Before I went into treatment, when I was during treatment, now that I've actually kind of ended treatment and I'm off cigarettes, and I realized that you can't think about the processes without thinking about the process, and that the process is a larger thing than just one thing, and so that's really what got me interested in going, and luckily, nih actually NCI was interested in how people quit smoking on their own, and so they put a RFA out, and Jim and I had some data about people who quit on their own, and so they put a RFA out, and Jim and I had some data about people who quit on their own.

Dr. Carlo DiClemente:

So we kind of put that together and we went in and got the grant, and that was the beginning of the trans-theoretical model. We kind of then sat down and discussed how to develop the stages of change and incorporate the process of change and how we can put that into an intervention. So the first study, though, was really a study of individuals who quit on their own. We just followed them for two years, so we didn't do any interventions, because we were just trying to kind of understand the process. So that's what got me interested. I mean, the whole thing of psychotherapy was there were lots of different psychotherapies, especially in the late 60s, early 70s. There were hundreds of them, and when you put them head to head. They all did better than weightless controls, but they didn't do better than each other.

Dr. Kerry Horrell:

But I think it's still the case.

Dr. Bob Boland:

Yeah, but you mentioned the trans-theoretical model and obviously you know it's widely known and I think a lot of people already know about that. But you know, can you give us like a reminder about that? And just you know about what the model is and what the different stages are.

Dr. Carlo DiClemente:

Sure. So the essential elements of the model are this kind of interaction between what we have called stages of change and what we called processes of change. And the processes are like coping activities. We have a more abstract view of them consciousness raising All types of things can be consciousness raising, but those are the processes. The stages, however, try to identify tasks. So what we did at that time when we were doing research, especially in addictions, you had to bring motivation with you before people would treat you, because people just got thrown out of treatment if they didn't do 90 and 90, or they didn't do this, or they wouldn't do that, or they were resistant or whatever.

Dr. Bob Boland:

And so I trained in that period. I remember that well.

Dr. Carlo DiClemente:

Yeah.

Dr. Bob Boland:

They're just not ready yet.

Dr. Carlo DiClemente:

Yes and, and so what we, what we tried to do, was to try and see well, wait a minute, there's a there's gotta be this contemplation phase and maybe there's a pre-contemplation phase. And so we thought about people. You know this resistance being kind of just pre-contemplation. It was a much softer, user-friendly kind of way of thinking about it. They're just not thinking about stuff right now. A change, this change.

Dr. Carlo DiClemente:

And then the contemplation piece was really focused on decision-making. There were lots of people doing some work with decision-making and subjective expected utility and pros and cons, decisional balance, and so we thought, well, there's a stage then of really decision-making. And then we thought of it as determination but it's actually now called preparation in my work where people kind of then build commitment and planning and then you implement the plan and that's an action phase. And from the data that we saw in our research, it was like action takes the relapse curves show you that dramatic relapse occurs from day one of quitting to about three to six months out. And so we thought of action phase being three to six months and then you move into maintenance, which is really sustaining change over the long haul. So that's how we kind of began conceptualizing it.

Dr. Kerry Horrell:

So that's how we kind of began conceptualizing it, and we actually then measured that in multiple ways trying to kind of understand the readiness of the people and then kind of following them over those two years that we followed them.

Dr. Kerry Horrell:

You know, like I think if people didn't have ambivalence about change, therapy and treatment would be probably pretty easy. Just do it, yeah, we just help them and then they get better. And I remember you know that felt really critical was he said it's part of our job as clinicians to be helping people with motivation, like this isn't this thing that we're like oh, hopefully they'll just show up motivated. This is part of our job and it is, I think, the reason why so often we disavow. That is because it's so challenging to try to get people to feel motivated to make change in their life and to give up the stuff that's probably helped them feel like they can survive. And I think one of the places where we've just seen, I think so often this model get connected to, is addiction and addiction psychiatry. And I wonder if you want to tell us a little bit about why it especially with smoking, with drinking, with substance use why this model has been so important.

Dr. Carlo DiClemente:

So I think of addictions as a prototype of the process of change and in my book on addiction and change basically there's two segments of it.

Dr. Carlo DiClemente:

One is becoming addicted.

Dr. Carlo DiClemente:

You go through stages of change to become addicted and addiction itself is kind of a well-maintained change if you think about it that way, because people when they're addicted, they're very connected to that behavior. That behavior is very prized, it's something that you don't want to mess up with. They protect it, they do everything they can to kind of get this substance or do this behavior. That is an addictive behavior. So addiction is a prototype of a well-maintained change. And then when you are there, you're in pre-contemplation for making a recovery change.

Dr. Carlo DiClemente:

So you have stages of initiation and stages of recovery and I think the other reason that I think addiction has made part of it is because we started with smoking and using the model for that and then expanded out to a lot of other health behaviors. But the other is that I think it becomes clearer in addictions a lot of times the pre-contemplation when you do a survey of smokers I'm never going to quit so you have a clear picture of somebody who says that you have the ambivalence of people going back and forth. You have the planning and what people need to do to kind of do that, the processes of change and the interaction of that. They seem to have worked pretty well. We've replicated relationships between the processes and the stages of change in smoking, in alcohol, in drug use, in condom use, in working with pregnant women. So we've been able to kind of look at addiction in a variety of settings and this model seems to fit really nicely.

Dr. Kerry Horrell:

I have a thought too, but maybe it's also because addiction feels so clear and I don't know if this is actually the best way to say this, but to me it feels like it's so clear that there's a negative outcome. So often with addictive behaviors, there's stuff that it's getting in the way of people's life, right, right.

Dr. Carlo DiClemente:

And that's why originally I mean people thought, oh, people have to hit bottom before they get motivated and you go. Okay, but if it's not bottom, it should be bottom for some of these people. There's two divorces, there's three DUIs, there's five of these other things that have happened. So consequences are happening, but the behavior is so important that it doesn't. They don't want to change it.

Dr. Bob Boland:

Yeah, I mean and you sort of already touched a little bit now but that even though, like I, originally associated with certain addictions when the model first came out, it's been generalized and used in lots of clinical situations now and I wonder if you could say more about that. I mean, it seems applicable in much of what we do.

Dr. Carlo DiClemente:

Yeah, I think that's really been the wonderful part about this. I mean, we kind of looked at it, we thought about it as a model, a generic model of human intentional behavior change. So I don't think it covers every change. I mean there are developmental changes, there's every change. I mean there are developmental changes, there's imposed change, and both of those are different kinds of changes than the intentional change that we talk about.

Dr. Carlo DiClemente:

But if you're talking about needing to change a behavior, whatever that behavior is, you have people who are more or less ready to do that, and that's why I think you can look at in cognitive behavioral therapy if you have people who we used to teach anxiety management but many people would go home and never do the relaxation exercises.

Dr. Carlo DiClemente:

It's kind of like, okay, well, what's going on? And maybe I didn't teach them well enough? Well, no, they're not motivated to do that particular thing. So whenever you have a clinical presentation where you need the individual to make a voluntary change, you have the possibility of using the model and you have the possibility of them being in very different places. And that's true then when you kind of expand it out to diabetes, for example, some people are willing to take medication but unwilling to monitor their glucose. So they're in pre-contemplation for this and they're in action for something else. So you can think about the multiple behaviors that we're asking people to do and really stage each one of those to try and see where these people are and try and move them along, the idea being you need to do something different if somebody's in pre-contemplation than if they're in preparation and ready to do something.

Dr. Kerry Horrell:

And I think that's the question where my mind is at and I know this is, especially given your work, probably a pretty elementary question, but especially with when people come in, they're in that pre-contemplative or contemplative stage. How do clinicians intervene? Like, how do we, you know? I'll tell you an example, for you know I work with young adults A lot of times they're coming in at the behest of their parents or of someone in their life, being like you need to get help.

Dr. Kerry Horrell:

And they perhaps even say I want to feel better, I want to do better in college, I want my life to look better. And then we start as psychologists and psychiatrists and clinical team looking at their life and we're like well, what we know about doing better is we probably need to think about some of that trauma you've had and we probably need to think about some of the ways that, yeah, you use substances and then they're like oh, no, no, no, no, I want to get better, I just don't want it. That doesn't seem useful. And so how do we think about intervening at that level?

Dr. Carlo DiClemente:

Well, I like to kind of say, when I'm talking to folks, that you know, people are not unmotivated, they're just motivated to do what they want to do and not motivated to do what you want them to do. So that's really the dilemma. And so I think finding the road to change means finding something that that person can connect with important value and maybe explaining a little more how this fits into that process for this particular individual. Because, like you say, I mean people have goals. They just don't necessarily want to do the things that they need to do in order to reach those goals, and so you have to kind of connect the goals with the means in some way. And you know, whenever I present the model, I talk about motivational interviewing, because I think that's clearly you had Bill on Because I think that's clearly you had.

Dr. Carlo DiClemente:

Bill on. Clearly one of the things that is important to kind of do is use some of the spirit and skills of motivational interviewing to explore some of that and to let the client talk. I mean, that's the other thing in motivational interviewing. You know what the secret is right Talk less and let the client talk more.

Dr. Kerry Horrell:

It's a beautiful, that's a beautiful way to say it. Well, and you're referring to Dr Bill Miller, who we just had on a couple months ago talking about motivational interviewing, and I think one of the things with him that really stood out to me, and I think what you're talking about is that people have ambivalence. Most people have ambivalence, even with, like smoking. They might be like I just cannot imagine, I cannot imagine quitting. Now, again, with young people, it's a lot of it's vaping. They're like I just can't imagine it.

Dr. Kerry Horrell:

But like there's ambivalence there, Like, yeah, it's expensive, it's, you know, it's inconvenient. If I have to go on a long plane ride, you know there's these ways that it's not feeling good. And I think that's the thing that I always, with our young people, especially think about is not to take up one side, because then they hold onto the other one, but instead try to get the ambivalence in them Like, do you know, I think using those motivational techniques to be like this is this tension of wanting to quit inside of you. But if I, as the therapist, like you have to quit and they're like, no, I don't want to quit, Then all of a sudden we've each taken up a side of the tug of war and it's not that useful. The tug of war is inside of them, if you will Right.

Dr. Carlo DiClemente:

No, it's an internal decisional balance that they've got to come to see, and that's part of the challenge is kind of helping to tip that, but in a way that doesn't pressure them so that they move backwards and have to put something. When you put something on one side, they have to put something on the other side of the balanced measure there. So you've got to kind of be careful that you're not contributing to ambivalence. But at the same time it's really important to kind of for me finding the values that might be helpful, that this person could connect with the changing.

Dr. Bob Boland:

So I mean, how do you, can you give us examples of like if a person's really struggling coming into treatment, you know, how do you use the model at that point? How do you help patients to use the model?

Dr. Carlo DiClemente:

Well, I mean, people are also ambivalent about coming into treatment, as you know.

Dr. Bob Boland:

But we only see the ones who do.

Dr. Carlo DiClemente:

Yeah, though, even the ones who do a lot of times. I mean, there was an interesting study a while back that kind of looked at people who were mandated to treatment versus people who weren't mandated to treatment, and even the people who weren't mandated to treatment felt they were forced. So they all kind of felt like, okay, my wife is kind of pushing me to go this, my family's pushing me to do this, I mean. So they have some ambivalence about that because they also have some pressure to come in. And so I do think that finding some of the reasons that this might be helpful for you yeah, I know your mother wants you to change and your family wants you to change and other people want you to change, but what's in this for you? Because again, it's that personal investment that's going to move them forward and then, if they say nothing, then I think you're a little bit stuck Because again, you have to find some way to have a conversation or build a conversation that will allow them to open up with you, and maybe it takes some time. So you have a relationship that you've got to work with. We worked with a lot of pregnant women who were smoking and trying to kind of talk with them, and many of them did quit because of the baby but went back postpartum even after eight months of not doing it because they could protect the baby some other way and the distress of being a new mom was just horrendous. So I think the idea is kind of getting alongside the person and trying to kind of find out where they want to go and then trying to kind of work with them to try and find some value and maybe it's changing some other thing that they need or they want to change.

Dr. Carlo DiClemente:

Steve Rolnick was interesting when he did some work. He does a lot of consultation, liaison stuff. So he would get people sent to him and say, well, they're drinking too much, they got this, they got that, and he would put circles and he'd have all these circles out there that said, okay, well, there's some alcohol issues that they talk about, there's this issue, this issue. But he always left two circles blank and said, okay, I don't know what. So these are the things that the doctor said Are there other things that you are concerned about that we should put in these other circles? And so letting them kind of move forward and do that and the one video that I saw was the woman didn't want to change her diet because she was just diagnosed with diabetes.

Dr. Carlo DiClemente:

But her concern was will my kids get diabetes? And that was the entree. If you talk about her kids, she will change the diets for the kids and making sure that the kids don't do it. So she can kind of change diet for that. But she wasn't going to do it because she just had diabetes.

Dr. Kerry Horrell:

That, I feel like, is that that feels really familiar? I mean, like that idea that like doing it for someone else, do you find that that's like a sustainable way to change? I feel like that's kind of a bit of an ethos is like, especially in addiction medicine, like you have to want it just for you. If you're doing it for someone else, that's not going to last.

Dr. Carlo DiClemente:

It's interesting because, as you said, I'm working on a book now on relapse and recycling and I was just working on the chapter on recontemplation, interest and concern and looking at intrinsic and extrinsic motivations. And I don't think the idea is to get rid of a totally extrinsic motivation, but to be able to make sure that you're incorporating intrinsic motivation in the extrinsic motivation along with the extrinsic motivation, because if you just rely on extrinsic motivation, I agree with you, when they leave, they necessarily go back. Or when the extrinsic motivation is no longer relevant, like with the pregnant women, why am I going to keep doing this? So I do think you have to kind of you don't want only extrinsic motivation, you do want intrinsic motivation along with it.

Dr. Carlo DiClemente:

And that's where I think, like the courts now there are drug courts and alcohol courts and I think those can be very helpful because they can first of all, they're voluntary you have to agree to kind of go into the treatment program and there are people who decide I prefer jail rather than treatment. So they go to jail instead, and it's better to serve six months in jail than it is to kind of go to this awful treatment thing that I have to do for years or whatever. So it doesn't make sense to us, but for them it has power. It is an explanatory thing that they do. So I do think that you've got to engage the intrinsic, you've got to have a program that's going to at least help that person turn extrinsic into somewhat intrinsic as well.

Dr. Bob Boland:

Wow, you mentioned the relapse and recovery.

Dr. Carlo DiClemente:

And recycling yeah.

Dr. Bob Boland:

And recycling. Sorry, Can you say more about that and then what that means?

Dr. Carlo DiClemente:

Yeah, it really has been interesting to me that we have kind of seen relapse as a failure, and I've been reading a lot of books on failure recently, and so the failure piece is really interesting, because most of the books on failure say that failure is important, that you have to learn from failure. The airlines you know NHTSA goes out and and works the, the, the failure, and tries to find out every little piece of what could have possibly contributed to this going wrong.

Dr. Kerry Horrell:

Okay.

Dr. Carlo DiClemente:

And I think what we've done in addictions is really kind of focus on failure as kind of the at the at the end point when the person begins to drink. So we focused on cues and and coping and what I've been. I think what the purpose of recycling is is to get the whole process right. So there are people who fail to sustain change because of their pre-contemplation tasks. They didn't have enough interest and concern. That was theirs that really kind of supported all the stuff they would have to go through to make the change.

Dr. Carlo DiClemente:

Others it's been a decision. Decisional balance hasn't been strong enough. With others it's the commitment. With others it may be the plan that there were flaws in that plan. And with others it may be that they started the plan and then there got to be some hiccups in the plan and they didn't revise the plan, they quit the change. And so the book that I'm working on is trying to kind of understand the whole process and trying to help people to understand when you're debriefing a relapse, helping people to understand the different pieces of that and then kind of what went wrong, what do you think went wrong in this process so that the next time successful recycling is learning from the past and beginning to do it differently the next time and again. The next time may not be perfect, you may fail again, but we can learn again and you can kind of figure out what's going on in this process and how they can make the best change attempt that they can.

Dr. Kerry Horrell:

And this is a book that you're co-authoring with Mary Velasquez, called Relapse, recycling and Recovery the Function of Failure in Successful Behavior Change.

Dr. Carlo DiClemente:

That's the working title. Yep, Do we?

Dr. Kerry Horrell:

have any signs of when it'll be out.

Dr. Carlo DiClemente:

We're working on it now. I'm hoping to kind of have at least a draft to the end of the year and maybe out next year, if it's next spring, maybe.

Dr. Kerry Horrell:

It feels like such a relevant, such an important topic because you know, we say this right, like I say this to my patients change is not linear. Things don't you know, like if we expect you come into treatment and I think when patients come into treatment they have that sort of like. I'm going to really get this right. And you know, here I'm working inpatient there's a lot of there's, there's removing of a lot of stressors. Right, my patients don't even have their phone, they're not on social media, they're not texting with their friends, they don't have access to drugs and alcohol. So there's no, you know. So there's like this real they're convicted.

Dr. Carlo DiClemente:

Yeah, I'm good, I'm good, I'm good.

Dr. Kerry Horrell:

And then again, and then, as they transition, and I follow some patients through different, as they step down to different levels of care, and then they face struggles, they relapse, and then it feels like I am back at square one. Like this is I have completely failed and now none of it mattered. And I think like giving more language to like no, because I have completely failed and now none of it mattered. And I think like giving more language to like?

Dr. Carlo DiClemente:

no, because when I tell, them.

Dr. Kerry Horrell:

I'm like I don't see it that way, like I'm like you know what can we learn from it? How can we approach this where it's not again like none of it mattered? We learn from what happens, you know.

Dr. Carlo DiClemente:

Right, and I think most people, when they try again, figure they're doing it a little bit differently. But a lot of times I mean, they're just repeating what they did before. You know, I'm learning how to play golf, and so you know, there is the mulligan, okay, where you can take a second shot, okay. Well, a lot of times my second shot is as bad as my first shot, so I don't learn from the error of the way I hit it. So a lot of times people just aren't learning and that's because I think a lot of times we have too much stigma.

Dr. Carlo DiClemente:

Even treatment programs don't want to see their failures. I mean, they don't want to see them come back. And when you're really it's like, I think, of people on residential units and in hospitals, as in that the furthest along they can get in the process of change is preparation, because they think they're in action. Even people in jail, they go, oh yeah, no, I got this, I'm good. And then they walk out and they go start using in two days and you go okay, wait a minute, what went wrong with that? It's hard to get to think of people more further along than preparation, and some of them aren't even quite there. They're still quite ambivalent about doing it and they kind of get out and that ambivalence kind of undermines their change.

Dr. Kerry Horrell:

Maybe, as we start to wrap up, the thing that's really on my mind and I've been thinking about this a lot in my clinical work is just the importance of human agency and autonomy, and I think that so often I've been transparent about my even getting into psychology had something to do with the fact that I have had mental illness and addiction in my own family.

Dr. Kerry Horrell:

And I think we get into this right Because we're like we want to help people and I don't think we would say this, I don't think many of us would say this, but there's also a sense of like I want to be able to control these things that feel so out of control, and I think a big part of becoming a clinician and being a therapist is recognizing like we have limited control over people's lives and what they choose. And I wonder if in your work, if you've seen that like a sense of like letting go of, like I'm not going to be able to make this choice for people gives more freedom to actually be like thinking with them about the choice, because I get the sense of that's where people might get stuck sometimes is they get really wrapped up and like it has to be this way, and then people get stressed and there's the resistance, and there's the reaction.

Dr. Carlo DiClemente:

Yeah, it's interesting. A number of years ago I had a guy come up to me and said I want to thank you and I go. What would you thank me for? He says you saved my career. Want to thank you and I go? What would he thank me for? He says you saved my career. He said I was burned out. I kind of was ready to leave. I was doing addiction treatment. I'm ready to leave.

Dr. Carlo DiClemente:

And then I read your model and read about where people are in the process of change and realized that I'm not responsible, that they have to do the work, and so he was trying to fix it, which is what a lot of people try to do you try and go in and you're going to fix it.

Dr. Carlo DiClemente:

Even when I teach my students motivation interviewing, a lot of times it's kind of like, as soon as the client says well, I am having problems over here, there's a wealth of ways that they can change it that you dump all on them immediately they're going no, no, no, no, no. Don't Just be quiet, listen, don't say it, don't give them all these kind of solutions before you know where the heck they are in terms of their readiness to adopt any of those solutions. So, yeah, I think that's a normal thing. Most of us are in this business not for the money, but to really help people, and so you really want to help people. But there is the story of the Boy Scout who helped a woman across the street. The only problem was she didn't want to go across the street.

Dr. Carlo DiClemente:

She was standing on the corner but she didn't want to go. So we try to help people but sometimes we get our own solutions get in the way and we need to kind of help them find their solutions. Sometimes our solutions are helpful I mean things that we've done in the past but sometimes they're just not relevant.

Dr. Kerry Horrell:

And my sense is it gives people permission. I think it gives people more permission to be honest, open about their ambivalence, their internal conflict, when they can tell they have someone in their corner who's invested but not overly attached to you, know, like there's freedom to explore this. I think that's been one of the most foundational things with my patients is when they can tell like I'm invested in you meeting your goals, I'm also not going to sit here and push stuff on it. I want us to get to know how this makes sense to you.

Dr. Bob Boland:

And I think it's probably helpful also, I imagine, to just give more agency back to the patient. When you sort of take over for them and kind of do everything for them, then why should they and that's sort of like, and there's times right where I've had and sort of like once the person kind of like takes over on their own and stuff like that.

Dr. Carlo DiClemente:

That's often when the improvement starts to happen.

Dr. Kerry Horrell:

That's a good point, excellent, gosh. Well, I feel like we could talk about this for so long, cause, again, this is this has been your life's work and just such an important, I think, again model that we use throughout psychiatry and psychology to help people think about change and know that change is possible and that when people feel like they're struggling with wanting to change, there's interventions for that, and that people are trained to meet their clients where they're at. I think is very helpful. So I just want to say thank you again for your work and for coming on and sharing with us Any last words or thoughts for our listeners on and sharing with us Any last words or thoughts for our listeners.

Dr. Carlo DiClemente:

No, it's been very gratifying actually to kind of see how far this model has gone and how it has really crossed behaviors, but across continents also. I mean, I get emails from people about using this measure or that measure from a variety of countries around the world and it's kind of like interesting and applying it to things that I wouldn't have guessed. So it is kind of interesting. I mean, people have used it even in terms of looking at social change and some of the organizational change that's interesting.

Dr. Carlo DiClemente:

So no, it's just very gratifying to kind of be part of that and I'm glad. If any of this helps anybody, that's really, really terrific. I'm glad to have contributed.

Dr. Bob Boland:

Well, it's been really wonderful talking with you and once again we're listening to Dr Carla DiClemente and I'm your host. I'm Bob Boland.

Dr. Kerry Horrell:

And I'm Keri Harrell and thanks for your host.

Dr. Bob Boland:

I'm Bob Boland and I'm Keri Harrell, and thanks for diving in.

Dr. Kerry Horrell:

The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Bob Boland:

For more episodes like this, visit wwwmenningerclinicorg.

Dr. Kerry Horrell:

To submit a topic for discussion. Send us an email at podcast at menningeredu.