MI, DSM, IPS, and Surströmming


This week I’ve been apart of a Motivational Interviewing training, and as I do with all my trainings and classes I take that stand out to me, I’m going to share the experience. Tomorrow is the last training day, but I’m going to end up having to leave a couple hours early, so since today was my last full day I decided it would be a good idea to share what I’ve learned.

If you have no clue what I’m talking about, don’t worry, I didn’t know what the fuck it was either. All I know was that for me and my coworker it was free, and you can never get too much training in human services.

It’s actually not really about interviewing, but it is. I feel when people see the word interviewing they immediately think about that one job they went in to get where the woman with the bright red lipstick and the blonde hair asks you to sit in front of her as she rolls off your basic “what are you strengths, what are your weaknesses, tell me about a time when you accomplished something, tell me your mother’s father’s, mother’s maiden name and sign here at the dotted line to say you consent in giving me your first born child’s left leg.”

hqdefaultMI is more of a form of communication. You stray away from too many questions because too many questions turns into Motivational Interrogation, and people who are struggling don’t need to be interrogated. MI focuses on encouragement and affirmation with the aim of guiding someone towards change. The belief here, which is the most important part as I see it, is that everyone has the capability to change what they want to change, that everyone has choice, and when we’re stuck sometimes we just need a little compassion to help us see our choices again.

It’s also about focus. You all know my focus is shit, so you could imagine my grief in training myself to not wander off or black out during role plays. But, I learned when I did focus in all my energy in listening to the words someone was saying, so I could “reflect” back what they were saying, I found I was interested enough in what the person was saying to keep my attention.

I still hate Role Plays though. Nothing will ever change that. They were created by the devil.

By reflecting, I essentially mean interpreting–in a sense. For example, one guy in a role play said, as we focused on change talk, “one thing I’d like to change about myself is to be more extroverted” so my response was “it sounds like you want to make more connections with people”. I was right. It was a guess, but it was an educated one. And this is why MI is both extremely useful and extremely difficult at times.

In MI, you phrase your sentences with “It sounds like” or “So you . . .” or “It seems to you that” or “You’re feeling . . .”. You’re encouraged not to inflect your voice at the end of your phrases so as to make sure it doesn’t sound like a question, which is even harder to do when you speak English and are used to the fail-safe of counseling: asking only questions.

And at first, it feels like you’re telling someone how they feel. This was a reservation I and many others in the room felt. But the more you practice, the less invasive you feel. Instead, you start to get a bit of an intuition on how someone is feeling. If you’re wrong, they’ll correct you. Then you can say “oh, then tell me more about . . .”.


I’ve experienced the opposite of MI from an LCSW at the hospital. She blabbered on about herself, about how I need to change my mindset and about how depressed I apparently was. She needs this training like a hog needs slop. 

But my real excitement about this training is the crossover I see between it and Intentional Peer Support. I think it’s great that clinicians and certified counselors and licensed counselors have opportunities to do MI (if they go through progressive, or holistic studies), but the truth is many of them will never know what it feels like to go through things their “clients” might. And while love and compassion for your fellow human is wonderfully healing, it’s an advantage if you can also relate through your experience. So when someone says their voices are really frightening them today, you’re going to know what that feels like.

It’s not that you have to blurt your experiences 24/7 at this person to prove you can relate. In fact, you don’t necessarily have to mention your experience at all to connect and understand. The difference is that when you engage as a peer, that compassion you put into it will be from a different place. Mixed with MI, I’d say that’s a very powerful relationship to grow with someone.

The thing is, the world is very focused on quantifying mental health and the human experience. We’ve started to ignore the human part of being human. We want cures and answers and we love labels and the idea of “brain disease” to pawn off someone’s behavior on a reason we tell them they can’t control. Good for profit.


dsm5-smWhich brings me, quickly, to the DSM. Were we to see and speak with people in the format of MI, perhaps we wouldn’t see this “rise in mental disorders”. The rise isn’t in the “disorders”, the rise is in the diagnosis. Before the DSM III, all these “disorders” were called “reactions”. Everything. What we call psychosis now, was a reaction. What we call the symptoms of “Bipolar” now, was a reaction. Don’t you see? All they’re doing is changing what we call things. It doesn’t mean we’ve “discovered” more disorders. It doesn’t mean people are broken. It doesn’t mean we have “diseases” or “illnesses”. It means some people in white coats are sitting on the board of the APA playing word games. And the more you believe you’re crazy, the crazier you are.

My fail-safe of DSM critique: Schizoid Personality Disorder. Fucking god-forbid someone wants to keep to themselves and have a restricted range of emotions and NOT be upset about it. Fuck. Kick those people off the fucking planet, am I right? Because, from what I’ve heard from people experiencing this, most of them could care less if they appease society or not. They keep the same job for 30 years, they mind themselves, and they don’t get bothered by it. You know who gets bothered? EVERYONE ELSE.

I get asked at work by guests sometimes what my diagnosis is. I answered the first few times, not because I believed in the terms, but because I felt I needed to appease their questions–they speak the language of diagnosis, so I figured I had to too. After a while I’ve stopped giving a direct answer. Instead, I say “I can’t answer that question–but I can tell you a couple experiences I’ve had.”

surst1So what do I think as a peer counselor and psychology student, of the DSM? You ever heard of “Surströmming”? The fermented fish? The one people have to open under water because it smells so horrible? The one people have to dress up with onions and bread to get a decent taste out of it?

That’s what the DSM is in the world of mental health.

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