Written by Rebecca Budde • Photography by Jason Johnson
"I had little intention of quitting for most of my life," says James, age 42. "I’ve been in and out of trouble since my teen years." James is an alcoholic.
James tried attending Alcohol Anonymous meetings. He quit attending them. He’s met with approximately half a dozen counselors over the last twenty years. He doesn’t see them anymore. He spent thousands of dollars on a prestigious drug and alcohol abuse clinic. He was drinking again in the third week.
James received Ron Kanwischer’s name from someone; he’s not even sure who or when. "I had a desire to quit by the time I saw Ron," he says. "I promised my family." With Kanwischer’s assistance, James began a new journey of recovery and self-discovery. Ron Kanwischer, LCPC, CADC, assistant professor of psychiatry, is one of the psychotherapists treating patients at SIU’s Department of Psychiatry. The department offers a robust team of therapists available to address a variety of mental health concerns from substance abuse and depression to addictions and relationship concerns.
Both psychotherapists and psychiatrists hold advanced degrees and practice psychotherapy, or counseling, for patients with mental and behavioral health concerns. Though psychotherapists do not hold medical degrees and typically cannot prescribe medication, their expertise is broad and they may specialize in the treatment of specific disorders.
Gone are the days of a patient reclining on a therapist’s couch as the therapist directs the patient to the next step. Rather than this outmoded model, Kanwischer and the other providers in the department employ motivational interviewing to help their patients achieve change to better their mental and medical health. "It’s a collaborative relationship rather than an expert and receiver of services," Kanwischer says. "We draw from the patient what is an important to them and blend in our goals." Kanwischer is a member of the international Motivational Interviewing Network of Trainers.
Motivational interviewing is a patient-centered, collaborative counseling style to elicit and strengthen personal motivation. This goal-oriented therapy focuses on investigating personal reasons for change within an environment of acceptance and compassion. "You can carry a person who’s trying to get better a long way with a little compassion and caring," Kanwischer says. The therapist’s goal is to guide the patient to explore and resolve ambivalence toward aspects of their health without judgment or bias.
Like James, many people are reluctant to change their habits, can’t decide if they should change or simply don’t see the need to change. "Sometimes people die when they stay where they are because they can’t decide," says Kanwischer. "Most patients are ambivalent; the majority are unsure or have tried and failed. Readiness is an important piece to resolving ambivalence." The key for the psychotherapists is to find the piece in the person’s life that can draw out the motivation for change. "Every person that has a behavioral health issue has some concern for themselves, their safety, their family; there’s some reason motivating them for change," SIU psychotherapist Stacy Lee, MS,W says.
For James, no one had hit on a reason for him to change. "Ron laid out an awesome plan for me like no one had ever done before," he said. "It’s all things you know about yourself, but when another person breaks it down, makes it more understandable, it makes sense." And making sense can make change. SIU psychotherapist Gene Brodland, LCSW, says it’s like turning a movie camera’s lens on people so they can actually see what’s going on from another point of view. Rather than seeing an idealized version of themselves, they truly see how they appear to others or the damage they may be doing to themselves.
Motivational interviewing isn’t just for psychotherapists. For physicians, the technique can be used to develop a relationship with the patient that may address the cause of a variety of health concerns. "A skilled clinician can help a person identify what to work on quickly; it doesn’t take months, it takes minutes," Lee says.
For example, a long-time smoker may indicate that though she loves the social time associated with the habit, spending the money on cigarettes has become somewhat of a financial strain. A physician can build upon this doubt to help the patient achieve the goal of quitting. "A simple step to this is for the physician to ask permission – ‘Can I tell you a little bit about how your weight is affecting your health?’ for example," Kanwischer says. "Tuning in to a person and getting them to adhere is sometimes more important than knowing what prescription to write."
Many practitioners struggle with compliance. A conversation with a patient may reveal that situations such as affording medications or proper nutrition are out of the patient’s control. A physician can use this information to help patients with medication compliance, getting to appointments and anxiety over their health or behavioral changes rather than assuming they have no interest in improving their health. "Behavioral health has a direct impact on medical health," Lee says. "We can no longer separate behavioral health issues with medical health issues."
Patients diagnosed with a chronic disease frequently have emotional and mental struggles accepting the diagnosis. "Often a person’s feelings are associated with someone they know who was diagnosed with the same disease or condition," Brodland says. "Physicians can just ask things like, ‘What kind of feelings do you have about this particular disease?’ to get the conversation started."
"I would have loved it if my primary care physician would have done more to help me," James says.
Motivational interviewing is slowly making its way into the primary care physicians’ offices, according to Kanwischer. At the School, students and residents are exposed to the technique and encouraged to use it. "We teach the medical students and residents about reflective listening, empathically restating the idea or emotion that someone is trying to communicate to you," says Kanwischer.
Counseling and mental health services still have a stigma that all mental health providers are fighting. Therapists agree that mental health should be an extension of a patient’s medical care. "We need to make mental health care part of a routine office visit," says Lee. "Everyone experiences life changes. Where else do you get the opportunity to talk to someone and have no one judge you, but rather focus directly on you and your health and goals?"
James has been sober 8½ months. "Ron saved my life," he says. • • •