“Motivational Interviewing offers me an opportunity to be given more information than I could have ever imagined,” explains Sharon Morrison, RN. She works at Health Care for the Homeless in Boston. Often medical professionals only have the opportunity to see a person through their medical records. Standard interview forms pose questions about a person’s medications, diagnosis, and substance use patterns. They may provide a one-dimensional picture. One person might look just like the next person.
Many of the people Sharon works with have struggled with substance use for years. Sharon explains that when she uses Motivational Interviewing strategies, a person’s individual life story will begin to unfold. “A person is not a diagnosis. A person is complex, happy, sad, tragic, joyous…all of these things. When I take the time to ask poignant questions, the complexity of the person comes to life and the story begins to unfold. It is a gift in my lap. I have the opportunity to see people in a different way.”
Sharon believes that limiting interactions with patients to standard questions prevents providers from getting involved in people’s lives. “If we ask the questions, we are then obligated to follow up on the story. If we don’t go down this road and share in another person’s story, then I think we all suffer,” says Sharon.
Four years ago, Sharon was working as a rotating diabetes nurse educator. She traveled from one clinic to another to see patients based on a list provided to her by physicians. One day she found herself at a 300-bed shelter examining a medical chart that read, “Blood sugars continue to be elevated and patient refuses to stop drinking.” Sharon learned that Michael, her patient, had been drinking for over twenty years.
“It occurred to me,” explains Sharon, “that it would be unlikely for this man to stop drinking based on a half hour visit with me. When I realized this, I relaxed and felt that I didn’t have to try to cover everything,” says Sharon. After Michael explained to her what he understood about his diabetes, she asked him to talk about his drinking. Usually this is the point in the provider-client interaction where she tells him why he has to stop drinking. Sharon did not do this. Instead, she sought some common ground, and promised Michael that she would not tell him to stop drinking.
“Can you tell me what you like about drinking?” asked Sharon.
“What do you mean?” said Michael. He was amazed that she was interested in his motivations. From this poignant question, Sharon learned that Michael considered himself to be a shy person and that drinking made it easier for him to talk to people and that it kept him warm when he was sleeping on the streets.
She also asked him what he did not like about drinking.
“There are two things that I don’t like,” he shared. “It causes my mother great sadness, and my sister will not allow me to sleep on her couch unless I am sober because of her children,” explained Michael.
“These answers told me that he was still connected emotionally to his family,” explained Sharon. If he had been drinking for this length of time and was still worried about his family, Sharon understood that this connection could be very valuable in helping Michael over time.
Michael had no awareness of how much alcohol he was drinking every week. This kind of information was important evidence that could help to determine the cause of his high blood sugars. Sharon explained to Michael that she needed to know how much he was drinking so that she could work with his physician to properly adjust his insulin to compensate for the amount of alcohol he was drinking.
“You mean you are not going to tell me to stop drinking?” said Michael. He was still incredulous.
“No, but I do need to help you to control your sugars,” said Sharon.
Michael left Sharon’s office with the agreement that he would keep track of his alcohol consumption in a notebook every day for a week and then return to see her.
A week later, Michael did not return.
Three months later, Michael returned, unannounced and sober. He arrived at Sharon’s office with the notebook that she had given him. In the notebook, he had recorded his alcohol consumption for four days in a row.
“What happened on this day?” said Sharon, pointing to a blank page in the notebook.
“Well, I woke up at two in the morning and looked at my list and said to myself, “this is nuts.” And then I went to detox. I have been sober for three months and now I am living in a halfway house,” said Michael.
Sharon followed Michael’s life for a few years. During this time, he relapsed twice, but always returned within a week. He had reconnected with his family and found something important in recovery.
“I feel very lucky to be working in a field where people trust me enough to tell me their life stories. I know very deeply, that what I have in my hands is an opportunity to help and heal people,” says Sharon.
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