Motivational Interviewing with Dr Kristin Dempsey

In the first episode of The Good Therapist Is In, Dr Kenneth Edwards interviews Dr Kristin Dempsey. Dr Dempsey is an expert in Motivation Interviewing and how its application can range from working with those with addictions as discussed in her previous book and working with clinicians in their practice. Listeners will have a chance to learn about Dr Dempsey's background, her perspectives and introspectives on clinical treatment, the current political environment and a call to action for the future. Dr Dempsey's book, The Harm Reduction Workbook for Addiction is now for sale wherever books are sold. Her second book, "Advancing Motivational Interviewing: An Experiential Skills Guide for Mental Health Providers" will be available in the spring.

Transcript

SPEAKER_00 0:01

The Good Therapist Is In with Dr. Kenneth Edwards.

SPEAKER_02 0:05

Welcome to The Good Therapist Is In. This is our very first episode, and I'm super excited that you're here. What I'm hoping for is a space to chat about all things counseling, clinical psych, some politics, some mental health, some policy, really a little bit of everything. My name is Kenneth Edwards, also known as the Good Therapist. I'm a PhD work psychologist and a licensed professional clinical counselor in California and Illinois. I've got a lot of thoughts and opinions. And what I'm hoping for is to have some guests on here that'll help me counterbalance that. And today on our show, we've got the great Dr. Kristen Dempsey. Kristen is a psychotherapist, a counselor educator, and a trainer in evidence-based psychotherapy practices. Kristen is a practicing marriage and family therapist and a licensed clinical counselor. She's worked in a variety of clinical settings, schools, community-based organizations, county mental health, training agencies, universities, and professional schools. In addition to training and motivational interview, Kristen trains and provides consultation for clinicians in dialectical behavioral therapy, trauma-informed care, cognitive behavioral therapy, co-occurring mental health and substance use disorders, clinician self-care and suicide prevention and intervention. Kristen is adjunct faculty at the Wright Institute's Counseling Psychology Program in Berkeley, California, and is lecturing faculty at San Francisco State University. Kristen, thank you so much for being here.

SPEAKER_00 1:52

Yeah, thank you, Kenneth. Thank you for that great introduction. And I'm excited to be the first person. I feel very special to be the first person on your podcast.

SPEAKER_02 2:00

Well, thank you for you know, before we dig into the hard-hitting stuff, um, I wanted to ask you a really, really tough question. If there was one annoying thing in your day that you wish you could outsource, what would it be?

SPEAKER_00 2:21

That was actually one of the hardest questions uh thinking about, just because there's so many annoying things. It was hard to just pick one. Um, you know, you start to think about it, like, yeah, I'd like to have someone to do this. But after some careful consideration and sorting through of the alternatives, I decided I'd like to be like um like in a hotel. I'd like to have someone come in every day and like clean my shower for me, like top the bottom again. Just not like I could do that every day. I don't do that every day.

SPEAKER_01 2:50

Yeah, yeah.

SPEAKER_00 2:51

I'd like someone to do that for me every day. That'd make me really happy.

SPEAKER_02 2:56

You know what I would want? I would want someone to iron my sheets.

unknown 3:01

Oh.

SPEAKER_00 3:02

I'd settle for just my clothes.

SPEAKER_02 3:06

They say that's a thing.

SPEAKER_00 3:08

Oh, I've never I've never thought of ironing sheets. But you know, if it can be anything, why not?

SPEAKER_02 3:18

Why not that's right, that's right. If we dream it, we can do it. Um, and then another really hard question. You know, I know that you're a world traveler, okay? What are your two favorite places that you've been?

SPEAKER_00 3:31

This was also very hard for me. Um, there's so many places, and um okay, I'm gonna say one place um that was my favorite um was Bamako Mali. And I worked there for um Festival on the Niger um back in 2008, you know, the musical music festival um of uh um Malian music and all kind of the region, and it was it was amazing, and it was quite a journey. It was a journey getting there and you know getting out. It wasn't actually the the festival of the desert where you go like way out past Timbuktu. I mean, it's it's um a little bit closer, but it was still you know quite you know quite a journey to get there and it was incredible, just people from all over the world, the music, and it was amazing. So I I loved that. And then my other favorite place, and again, I put a lot of thought into this, um, and there's a reason this is over touristed, is I absolutely love Venice. Venice is one of my favorite places in the world. It's just go there and it's just I feel it's so magical. I always feel like I'm on another planet. And if you go like a block or two away from St. Mark's Square, you know, like it's yeah, it's like it's not full. If you can have like a whole street and a canal kind of to yourself to walk around in, it's just a beautiful, magical place. Um, so those are the two places I thought of.

SPEAKER_02 4:54

Oh, that's so great. I haven't been to Mali yet. Um, but I was in Venice last year, and I know exactly that magic that you're talking about, but you have to counterbalance it with the over tourism, right? Right. So it's finding your special spot to go to.

SPEAKER_00 5:09

Right. There's a reason everybody wants to be there.

SPEAKER_02 5:11

Oh, of course, of course. Well, once again, and thank you for sharing those. But once again, thank you for being here. And, you know, I want to get to your book projects in in just a second, but first I want to hear about you. You know, there's a lot happening in the world today, you know, with politics and just all of the stuff, right? And as a counselor, as a writer, as a consultant, as an educator, you know, in all the other roles that you serve, you come across people who are experiencing this world for the first time in this way, and including yourself. How how are you dealing with this? How are you experiencing all of this?

SPEAKER_00 5:52

Yeah, it's um, well, it's it's it's a lot, it's day by day, it's very overwhelming because it's just a constant uh influx of um things that cause harm, you know, it's just another way of really stating that. And so, you know, to stay kind of well in that environment is really difficult. And to stay well and present for people who need me to be well and present, I think for all therapists, this is a really difficult time. Um, so there's a couple things I think about with this. One, uh, I know I'm experiencing probably different levels of authenticity with people that maybe I have before, where there might be um certainly less self-disclosure. And I don't, I'm not doing a lot of self-disclosure, but just being able to have some conversation about like what's happening and how we're all experiencing this. Like, like the the issue, the problem, the concern in the room, uh certainly doesn't just belong to the client. Like every everyone is is being impacted. And and sometimes people have asked me, you know, people I'm working with, like, what do you think about this? Um, do you have people like coming in and talking about this all day long? Is it really hard? And um, you know, I want to be able to respond to that curiosity, you know, and that concern, you know, which is really wonderful, with with some sense of um boundary so they don't feel like they have to take care of me. Like it's a really tough place to be in some ways, but it also I think is an incredible opportunity to have you know very genuine conversations. And as we talk about things that people are experiencing, signs and symptoms and you know what's going on, um you know, to be able to make it like part of the context, I think we get a chance to really step aside from like this individually is your kind of flaw and and more into this is your humanness responding to to cruelty or you know to various aspects of distress. And that puts a different perspective. Um, and then for myself personally, also in terms of providing hope and some sense of agency, um thinking about as I as I do with clients too, like what kinds of things can I do? What kinds of things can I do for hope? So I I certainly participate in some aspects of you know political activism. Um probably not as much as I would like, or you know, but uh I certainly try to try to get out there and you know try to support certain you know activities, just find a place to work and and grab on, you know, like there's there's plenty of work for everyone to do kind of thing. So I just feel like um it's it's it's important, like this is the time to show up and do everyone finding finding a way to be able to show up in the way that they possibly can. And that's gonna be different for different people based on their needs and their abilities.

SPEAKER_02 8:48

Wow, thank you for that. And you know what I what I really sort of hinged on just there was that aspect of this is your humanness showing up in these ways. Um, and I think that that's a really good take-home point. I mean, if I can just remember back to the COVID times, as counselors, we were going through it at the same time as the people that were in our chairs. And I think that the way that we were trained is we we were trained to have empathy for what people were experiencing, not be going through it at the same time. Um, so even as we go through the times that we're in today, you know, it's connecting to that bit of humanness. So I really appreciate that point. Thank you for sharing that.

SPEAKER_00 9:35

Yeah, well, thank you for asking. I think that's really important. And just as another interesting piece around this, I was asked to do a presentation, which I did this week, on moral injury, um, you know, which is basically the pain and the distress, as opposed to we feel when we're having to do something that goes against our values, and generally it's in a professional capacity. So it's it's a concept that came out of the military, right? Folks who may have gone to war and have done things that were against their values, but as part of part of the military deployment, and just what that means in healthcare, in behavioral health care in particular, like times when someone can't be seen in a program because they don't meet the gatekeeping requirements and you have to say no, or uh someone runs out of insurance and they can't be part of a program or whatever it might be. And there's lots of different examples of this. And it was an amazing um conversation. And the way I set it up was like, let's have the conversation and do definitions, but I really focused a lot on, I thought, I think this is what's needed here, just a lot on community building. And it was a really touching, powerful experience, you know, to have people come together and talk about ways they could support each other, ways they could be effective within the context that they were, you know, like the types of um, you know, strategic kind of change making they could do. And yeah, it's really um on the one hand, um, you know, intense, you know, and just see kind of everybody's energy and the ways that people are really responding in some ways, you know, clearly very emotional and also you know very uplifting. Like we have we have community, and and that's I think going to be an important piece.

SPEAKER_02 11:24

Thank you for saying that. Thank you for talking about community. Thank you for kind of tying that together for us. I appreciate it. So on to your your projects. I'm excited to talk about these. So you had a book come out last year, I believe, and I have it here. It's the harm reduction workbook for addiction. Okay. Um, and then I'm really excited to share that you've got the next book coming out in the spring, Advancing Mental Health or Advancing Motivational Interviewing, an experiential skills guide for mental health providers. Um, Kristen, you're a book writing machine. Um that's great. Um, so which should we discuss first?

SPEAKER_00 12:14

Oh my gosh, yeah. It's um it's been something uh, you know, I've never felt like tremendously strong about writing. I've always liked doing it, but never got the time. And I probably still don't have the time, but really enjoyed both of these projects, just getting into it and kind of the more you do it, like the more I do it, the the the more I feel like, okay, I can I can put some of these things together and and be really challenged by this process. So let's see, which one? Um, well, I could I think we could talk about maybe the the one that's coming out in April, the advancing motivational interviewing. Um, I could say a little bit about it in terms of why we decided to do this. So I'm doing this with a colleague of mine, um, Allie Hall, who's a really you know incredibly experienced and well-known motivational interviewing trainer. So I felt really uh grateful to be able to do that with her. And this was born out of our experiences of working with people and doing lots of training and you know, having folks kind of go out there and do it. And the metaphor I've been using is like we're we're giving people like a map of motivational interviewing. Like, here's here's how we you can help engage people in conversations that help promote change and growth, you know, and here's some aspect of the attitude and skills, and some aspect of tasks, you know, change talk, all these great things. And then, you know, folks go out there and then you know, you have this map, but then you also have terrain. You know, there's like mountains and valleys and you know, streets that they weren't expecting. And it's like, what do I do about this? So we did start to think about some of the different contexts and some of the different ways that um we can kind of deepen the conversation. So we have things like, um, what if I only have five minutes? Like, how do I have a conversation? What if I'm doing this like in the virtual space? Like doing motivational interviewing now in chat. Like, what does that mean? Um, or you what do I do if um, you know, I'm told like you have to do an assessment, and that's really how where you have to focus. You need to do your assessment first and you need to get that done. But you know, an assessment is information gathering, it's not exactly engaging for folks. So, how do you, you know, kind of square that with a motivational interviewing approach? So we have a number of of different chapters that are really about that. It's about helping to problem solve in some ways or to give options maybe for dealing with some of these challenges, as well as looking at um deepening uh some of the ways we connect with folks. So we have a piece in there on genuineness and um pieces on empowerment and on developing hope, um, and and ways for providers to open up the book and to read through it. And you could start anywhere if you had a particular interest. And then there's like exercises, like there's things to practice to help build some of the skills. So it was it was a really interesting concept. It was it was fun to write and to come up with these ideas and to test them out and just you know, house is working, and um, hopefully it'll be useful for people.

SPEAKER_02 15:14

Well, I'm not gonna make people jealous, but I somehow, a little bird sent me an advanced copy, so I was able to thumb through and and read. I haven't had a chance to get all the way through it, but there was this concept in, I believe it was chapter six. You mentioned something called the fixing reflex. What what is that? Can you can you talk to me about what that is?

SPEAKER_00 15:37

Sure, I'm really glad you brought that up because that's often a core challenge in motivational interviewing. And what the fixing reflex is, it's uh a reflex on behalf of the providers to want to fix something, to get something done to problem solve. So people are coming to us, you know, they're challenged, they're suffering, they're in pain, whatever it might be. And we want to solve that. You know, it's not comfortable to sit with it, it's um painful to see, we want to help them out. And, you know, the way kind of our behavioral health works um isn't that linear, right? And so sometimes what happens is a fixing reflex often puts us in a position of how do I get this done? And sometimes it could be like, how do I get someone to do something? Like, oh, someone's depressed. How do I get them to maybe go out and do some of these activities that might be helpful? I'm just kind of just making some things up here, right? If you're or you know, some is um using um uh alcohol and they want to stop, they're thinking about stopping. How do I get them to stop? That's a really common one, especially like an abstinence-based programming, that kind of thing. And of course, the more we we press on that button, the more folks potentially might push back. And it's not even necessarily that that people don't want that. It's like people want and need control and agency over their life and their choices. So, what seems to work better is to actually engage people in conversations and to help facilitate their conversations and explorations around change and growth. We do that a lot with just like really, you know, good standard micro skills that are, you know, reflect listening, affirming, summarizing, and helping them focus on the the language of change, really, you know, the things that they want, the things that are that they're um uh that they desire, things they know they can do, things they've tried doing, and that helping them kind of go down that pathway of exploration often builds you know some sense of motivation. So it's it's so much more useful to work in that path instead of trying to again get someone to do something, but it's a common, it's a common reflex. And I think again, the environment influences that. So if there's some sense of, well, we need to have you get something done within like four sessions or whatever it might be, um there's a lot of pressure. So of course, people are like, I just gotta get this, I gotta just solve this issue because I only have to have to fix them. Yeah, yeah. And actually the the the conversations and the engaging in conversation um is really helpful. Uh and and it's counterintuitive. So there's this sense of, well, if we can only start talking about this, um will they uh never change because we're just talking about it. I'm not doing anything. But again, if it's like if it's focused and it's um increasingly focused on the change language and uh you know, perhaps having folks you know test the waters a little bit, you know, there's different things we can do to help um narrow the response or to make the response more robust, uh as opposed to just like just talk about anything for four sessions. So there's a facilitation that we do um using these skills and having this particular type of focus um on some specific tasks uh that is so much more effective than okay, we're just gonna try to help you get fixed.

SPEAKER_02 19:15

And you know, Kristen, you you might have answered my my next question is you know, at what point in a clinician's career would this information be best received? And even as I'm thinking about that question, I'm thinking of myself when I was a brand new therapist, and I had a client come in to talk about their issue, and my fixing reflex picked up immediately, and I'm like, okay, this is what we're gonna do. A, B, and C. That person started crying heavily and said to me after a few minutes, Kenneth, you're not even listening to me. You're trying to fix my problem. And that person never came back into counseling, and that was the wake-up call that I needed that helped to sort of keep my fixing reflex in check. Um, so kind of my question, again, back to you, kind of going back to what I was thinking about, is where do you think that this information could be best inserted into a clinician's career?

SPEAKER_00 20:21

Well, yeah, I think you just answered that absolutely early on. Um it's a it's a way of thinking and approaching the work. And one thing I'll say about motivational interviewing, and I'd be interested to see if other people agree with me around this, but I do hear people, you know, outside of even the motivational interviewing like establishment, so to speak, or you know, outside of the folks who are really um developing and and researching it, uh, that motivational interviewing is foundational. So you'll hear more and more, I think, people talk about like these are just such great skills. It's it's the common therapeutic factors that we're often teaching people when they first come into the field, but we're teaching them, you know, within a structure of like how to actually use them and and this idea of you know not fixing and coming from a certain um spirit or attitude or therapeutic stance that's open and and humble and curious, like how important that is, you know, to create this safe, um, psychologically safe place for people to explore. So I think that even before students start to think about more deeply or start to commit to some aspect of like theoretical orientation, like this is an important piece to start with in like early practicum classes to get a good responsive um and definitely very person centered therapeutic base from which to build out all the other skill sets. Um because I think the attitude and the stance is so so incredibly useful. Because ultimately With every theoretical orientation and all that we're doing, we're really trying to engage in change and growth.

SPEAKER_02 22:07

Right. Right. So it should be this foundational aspect of a new clinician, right? And reinforced really throughout their career.

SPEAKER_00 22:19

Absolutely. Absolutely. And what I think is also kind of exciting, or maybe it's very exciting, is you know, I see this. I see like new clinicians learn these skills, and then I see them in a practicum class and they'll go out and they'll practice and come back. And um, or in other classes where I teach motivational interviewing, like in a substance use disorder like treatment class, and uh students will go and they'll try it out and they'll come back and and they're you know, they're so excited. Like they had a conversation that just felt um so productive and useful. And one of the like little process indicators that we teach people um is such an elegant and wonderful thing. And I was just thinking today, I wish someone would have taught me this when I first learned, was just being able to recognize and to change one's approach when we notice like, am I dancing or in sync with someone, or am I wrestling and out of sync? And just to notice that and just to realize like that's a sign to do something different. Because again, I think the way I was trained, or at least the way I understood it, was like if someone's pushing back, you know, if I'm wrestling with someone, the way it was often framed was like, well, they must be resistant, you know, it must be their problem, it must be difficult. And so, well, you know, it's like you do what you can and maybe they'll come back, maybe they won't, but they're resistant. And this is a different approach where it's like if someone's pushing back, it's like we're we can we can influence that if we just stop, you know, again, trying to push, just step back and be curious and give people space, we can often get back into a more of a dancing or in-sync kind of approach and being able to know, okay, gas here, break here, gas here. Yeah, I have some ability to influence this, not always, you know. Clearly, there's times when um there's more complications, but in a lot of situations, more more than I ever would have expected. That's an important thing to be able to do.

SPEAKER_02 24:22

Be curious and give people space.

SPEAKER_00 24:25

Yeah, yeah.

SPEAKER_02 24:26

Perhaps that's the tagline that all therapists should wear on their shirt.

SPEAKER_00 24:31

Yeah, absolutely. Absolutely.

SPEAKER_02 24:33

Wow. Oh, go ahead.

SPEAKER_00 24:35

Oh, I'm sorry, I was gonna say, um, I have in my slides, I have this, I do them in my training now. I I uh I actually put a slide in around around what I call my Fs. You know, it's like no fixing, and again, it's like um, you know, uh be facilitative instead, you know, and be flexible. So we're we're modeling flexibility. I am uh so what's that again?

SPEAKER_02 24:58

No fixing, no fixing be flexible and um and uh facilitative. Facilitative.

SPEAKER_00 25:05

So I'm trying to facilitate their discussion, facilitate their ability to um explore, and that's through a lot of the use of the skills, especially like reflective listening and perhaps like affirming strengths, you know, in really nicely strategic and evocative open-ended questions, not not too many questions, because questions become exhausting. Um, but there but there's a lot in the reflective listening worlds in terms of you know the the depth of which we can paraphrase or continue the paragraph with someone or use metaphors. There's so much we could do there. And that so and then that's the facilitative part, and then the flexible part is how can I be the one to do more pivoting, you know? So um, you know, definitely talk about like I can I can rise or um uh and and kind of rise and step back as as people need, you know, if I need to be um or if I can be like more guiding or more directive if that's what someone wants or need, but there's times when I may need to step like way back and um just be just be a safe person to talk to and you know really lead and have the space and not get all worried about again trying to get something done, like that being present for someone who's exploring and who might be really ambivalent or scared or whatever. Yeah, that's the work. Creating safety and creating trust, that's the work. So we do, yeah.

SPEAKER_02 26:33

Well, this I I mean, what I'm hearing from you also is you know, we we learn the science in school. And it's the old adage of, you know, we have to know the art and the science of what we do. And what I what I'm hearing you saying is as we, you know, learn the right, you know, foundational elements, we also start to develop our artistic self around when to press the gas and the brake, you know, when to use our empathy skills and listening, knowing how many questions to ask and when to pull back, how to be curious in just the right way without being nosy, right? Um, in helping people through their process.

SPEAKER_00 27:13

Right, exactly. Absolutely. Yeah, there's it's so interesting. We talk about MI being simple but not easy, you know, like these concepts are not um anything that that's mind-bending, like a lot of it's like just really good calm common sense, but putting it into practice, staying out of one's way, like um I often uh use the idea of um uh you know the the Bruce Lee um the Bruce Lee idea of like be like water, my friend. You know, like yeah, we're the ones who are again moving and and uh in this rhythmic way that we're responding in ways that need to be responded to. Like that work, it's excellent and it's fascinating, and it's really makes the work interesting. And it is it's work, it's hard. You have to be really intentive, and it's a lot of there's a lot of clinical sophistication um that comes into yeah, for sure. And it's all through, you know, MI, really anything, but but definitely MI. We talk about the importance of coaching and feedback, of being able to, you know, it's like get some corrective pieces and to practice new things and see how how it's done.

SPEAKER_02 28:22

Okay. Well, Kristen, I I'm I'm looking forward to reading the rest of my you know, secret advanced copy that nobody else yet has. Um, but I'm looking forward to seeing this in in classrooms and in those foundational spaces so that people can learn really the right way to start out. Um shall we move on to the first book that you had?

SPEAKER_00 28:49

Yeah, the harm reduction workbook for for addiction, yeah. And um that came out in January of 2024, so it's been out for a couple of years now. And it's a workbook, um, it's you know, a new Harbinger workbook, and lots of providers, there you go, are are familiar with um some of that format. And I used to use like new harbinger books a lot, and I still do, you know, in in clinical work as you know, to structure sessions or ways for people to practice, help folks, you know, get ideas. So I was excited to write a book um about this for um for New Harbinger. And I think the idea around like the harm reduction workbook for addiction, like harm reduction is it's a it's about like of course reducing harm, right? Increasing safety. I could there's like at that very basic level, but there's there's some complexity there and too in terms of like harm reduction as a movement, um, you know, for the rights of people who use substances or um, you know, and Kristen, do me a favor, really quickly, could you define harm reduction as a as a concept? Yeah, so harm reduction is about um, you know, it could be a couple things. So like there's the the sometimes the harm reduction with a I sometimes they call the small H a small R, which is like, you know, a set of skills and practices that help people um uh reduce harm in their day-to-day life, and it can be applied in a lot of different situations. In this particular case, you know, talking about um uh substance use. And um, back in in the 80s when I first came into the field and I was a teenager and I was doing a lot of work around um AIDS HIV, you know, harm reduction was about things like teaching folks like safer sex practices. So it's not going to be exclusively like completely safe all the time, potentially, right? There could always be something, if we're talking about like viral spread, could happen. But we're we're trying to help people make choices around how they can uh potentially behave and protect themselves and reduce harm. And it's about autonomy and choice. And um, that's kind of an important piece in terms of just like the practicalities of practical work of harm reduction. And then there's like harm reduction with a capital H and capital R that's really about like a movement, you know, a movement to really understand and respect the rights of people. Um, specifically, it's usually talked about people who um who use drugs to be able, you know, to use drugs and make choices and have autonomy and not be criminalized, and to be able to um, you know, make choices about their their lives. And um that's kind of you know the real basic definitions. And there's a lot to that in terms of like how it shows up in policy and in practice. I mean, there's a big public health piece of that's um a part of harm reduction as well. And so in this like book, um, like it was really a chance for folks to come through and to be able to look at their relationship to substances and to make some of their own choices about how they want to um to relate or potentially, you know, um that might be about like cutting back in certain ways, but it might not. It might be about um more right now. I'm I'm using the same amount of my substances, but I might be working on this chapter where I'm exploring my values and I'm wondering about how my use right now fits in with my values, if it does, you know, really a place for people to explore um their relationship and what's meaningful and what's what's important to them. And then there are places if someone does, in fact, want to set goals for themselves, and the goals do not have to be like abstinence or like not you know, not using at all. The whole idea is like there's a whole number of things you could do to potentially you know reduce harm, have um a meaningful life, you know, in the context potentially of use. And and this is a radical thought, right? Especially, you know, um for folks who might have like a more moralistic um sense of substance is bad, you know, like you should be not using, you know, you're if you're using bad, not using good, and you have these two choices. And so we're trying to approach this like more flexibly and again support people's autonomy and choice. Um and you know, there's a lot of different pieces around like motivational interviewing that is um in the in the title of the book as well. It's like using these skills in order to talk about um harm reduction, potentially with others, but certainly with oneself as you're going through this workbook.

SPEAKER_02 33:13

So some of the things that we do at MI, like and can I add one little point in there from the from the first book, from the clinician-focused book, this idea of fixing. The the goal is not to go in and and fix someone and thereby take their autonomy uh from them as they're looking at their values, looking at use and things like that.

SPEAKER_00 33:41

Right, right. Exactly, exactly. It's like we give folks a lot of room, again, back to that kind of idea of room and space and options and and skills and resources. And hopefully, like in a workbook like this, too, where there's places to write and to think and to you know sort things out and to compare chapters and where are we going with this, to really um hopefully find some clarity or focus. Um, maybe not an entire answer, uh, perhaps, but maybe as a way of actually approaching and not avoiding, you know, someone's relationship with a substance. And that to me, if like if that's one thing that someone does as a result of using this book, like that's that's a great thing. And then, you know, some some people, you know, might choose to just stop using, but you know, a lot of people choose to cut back or to take breaks. And it is interesting because I have heard from from folks um who've been using it, who have I've had no idea who they were, but you know, they contacted me or someone contacted me. And uh it's always really exciting to get those kinds of messages for someone's like, this was really helpful. Um, I've I've been I've enjoyed using it, I mean I've found something meaningful. And um, in my practice, you know, people coming to me because I've seen the book, and like, can you help me with this? And it's so interesting just how how we're thinking about substance use like in a really different way compared to when I was trained. About how does someone carve out a path for themselves that um that can be again back to flexible? That can be flexible, but also being you know open and honest with like what data we have about it. Like if someone's having like medical issues, like how do we have a conversation about that? And um, you know, a lot of people aren't necessarily having medical issues, but maybe there's other concerns and like taking all of these things into play, like basically the cost and the rewards, what are you getting from it? How does it help you in terms of living to your values? How does it not help you? And just being able to come to that exploration, people are able to really figure things out for themselves. And to the extent that my expertise is helpful, I can provide that, but I always, again, in the MI spirit, I always ask for permission before I do that. I would never just say, Oh, you should do this, right? It's just like, you know, have some thoughts, would you care for me to share? It's like totally up to you. And you know, if we give options, there's like a number of options people can choose from. And that in of itself is important too, that sense of helping people come to a place of choice and supporting autonomy. Uh just people are so much more open when they're able to do that.

SPEAKER_02 36:22

I I love these takeaway messages. Come to a sense of choice and understanding their own autonomy. That's super important as we go in. And it kind of kind of dovetails into our next question. You know, one of the concepts that I found interesting as a counselor myself is this idea of change talk that you talked about in chapter nine, I believe. Um, and we both know changing behavior is not just about making a decision, or is it making a decision? Help me understand this concept of change talk.

SPEAKER_00 37:00

Yeah, so um sometimes what actually translates into somebody changing their behavior um is mysterious. You know, we don't always know what's entirely always under the hood for each and every person. But one thing that we learned from motivational interviewing, um at least the the research seems to indicate, right? It's it's an interesting um kind of phenomenon, is that people seem, it does make sense if you think about your own lived experience. People seem to do what I what I call like talk the talk before they walk the walk. And like to envision, start to think about it, start to, you know, come up with, you know, I really would like, you know, to um, I don't know, to kind of make up some ideas that, you know, I really would like to have a different job, you know. I I if I if I had a different job, you know, I'd have more flexibility as I get older, you know. It's like I've already started to look around a little bit. So there's these little nuggets of of change talk, and and they're we've categorized them, and they've been categorized in terms of like things that indicate someone's desire, someone's ability to do something, um, a reason like if I did this, then that, or things I don't have happen and needs. And and we find that that happens really early on. Um, even if someone's kind of ambivalent, like I'm not really sure I want to leave my job, I don't know, but you know, I really need to make more money, right? And so what we're doing in MI is we're listening for those little nuggets, and we reinforce that using these micro skills, right? We ask evocative questions, we uh reflect on the content, we uh potentially summarize that change talk, we affirm people's um uh statements, you know. So it can be things like, you know, so you're really thinking about, you know, how you want to live as you get older, and part of what's going on is you're you're wanting to be able to make more money now so you can save, right? So we're referring that back so people are, you know, kind of engaged more into continuing to talk about that. So when you mirror somebody back, right, there's some sense of what you're saying is is landing, it's being heard, it makes sense, it's being accepted. So there's again someone hurt me. Yeah, there's a safety people keep talking and they start to go more deeply into it. And what we found is that if people are talking about their reasons for change and their needs and you know, uh some of the desires they have, like all this different level of preparing about it, and you know, uh envisioning maybe that there's a certain amount of it that starts to um often uh move into more mobilizing change talk, right? Where's where someone starts to think about you know I'm not I'm willing to do something here, or I've already done, you know, I've already started to look at some jobs, you know, taking some steps. So you know, I will go and talk to that, you know, that recruiter, right? So there's things that people start to say that we call mobilizing change talk, that when they're talking about something that they will do, they intend to do, something that they have done, like they've taken some steps or something they're willing to do, um, that they're more likely to actually follow through on some behavior change. So that's why change talk is really important. It's like we're reinforcing what we want to see. So the more we reinforce it, the more we're building that that momentum, that energy. And you know, some of the people are getting more more potentially excited about it or more um uh comfortable with it, you know, more you know, oriented towards I might be doing something different here. And that's why the change talk is such an important angle. We can focus on a lot of things in a counseling session, uh, but what does it mean to actually focus on change? It's really shifting some energy away from the status quo, which might be, you know, I'm really unhappy in my job, yeah, to maybe even some very beginning steps and starting to check some things out.

SPEAKER_02 40:55

Okay. Thank you for explaining that to me. I I was reading about it and I'm like, I knew that I was gonna talk to you, uh, but I think that that was important for listeners to hear exactly, you know, where does that shift take place and how do we change language? How do we sort of help, not sort of, but how do we help our clients to understand exactly what they've just said and how that can motivate them to move forward?

SPEAKER_00 41:21

Right. Yeah, that's right.

SPEAKER_02 41:22

Wow. All right, the harm reduction workbook for addiction. We'll talk about this right at the end of where to get it and and all of that. Um, Kristen, we're coming to a close, but you know, when we spoke um a bit earlier preparing for today, you mentioned that you were working on some other projects. What surprises do you have coming down the pike that you're able to talk about? And what's your favorite thing that you're working on right now?

SPEAKER_00 41:52

Um, well, okay. Yeah, so I'm doing some more kind of writing and thinking about just um process-based uh therapy, which include things like acceptance and commitment therapy, um, and and motivational interviewing is also very much process-based, and you know, how some of these things work together because I tend to use act in my work in addition to MI. So I'm thinking about that and and doing some work with colleagues where I'm writing and thinking about that. I am uh uh hoping to get a Substack uh off the ground, uh which should be Kristen Dempsey Therapist. So I got I got a name, and so I'm starting to build out some of the the training and resources, including these books that'll be on that. And because we have advancing motivational interviewing coming out in April, um, there will be you know a number of webinars, including this one, you know, or or podcasts coming out um for folks to learn more about you know practice and the work and you know, here's some of the conversations like what you and I uh just had. And I think I'm also involved. Um, I want to be involved, and I think I'm becoming more involved in various aspects of um therapist response to like the current, you know, um political climate and how to really support people in terms of this kind of stress. So um there might be other things I'm doing with colleagues or thinking about in terms of helping to empower folks to respond to the current moment.

SPEAKER_02 43:25

Wow, okay. Well, we'll look forward to to seeing all of those things. Um Kristen, this is uh our our last question, kind of sort of, uh, from uh the harm reduction workbook. But what continues to surprise you about yourself?

SPEAKER_00 43:43

Yeah. Um I I saw that question. I'm like, okay, let's see. What continues? Well, I think what might continue to surprise me about myself is that um I I am pleased about the fact that. I always seem to find something of of interest, right? Like I I don't get bored often. So I can be in a situation where I'm not really sure if, you know, if I make this change or this shift or if I take this step, how it's gonna turn out, if it's gonna work out, if I'm gonna be interested, or you know, am I making a mistake? And many times um I find that even if it wasn't like a totally optimal kind of situation, like I find something that's really compelling. So I um I like that aspect of myself um that does surprise me that I'm able to um always I guess it's always being curious, right? And being able to figure out like where do I fit in here and what what might be something I can do to make this better or to work with this or to link this to something else I've been doing. Um so that's that's something I I think I'm particularly um uh interested in and I'm surprised by.

SPEAKER_02 45:05

You know, there's a running theme in your responses today. It's around being curious.

SPEAKER_00 45:11

Yeah, absolutely.

SPEAKER_02 45:12

Asking questions, it's lifting the the veil to see what's what's there and and investigating even more. I really like that. Thank you. Um and you know, I was thinking of, I said that was our last question, but I I have one more. Um what is a call to action to people watching and listening this conversation today? Um there's just so much happening around mental health, around politics, you know, maybe a message from your book, but what would you say is a is sort of a take-home message for people today?

SPEAKER_00 45:53

Um, well, there's a there's a lot going on. There's so much um I think that needs to be done uh for sure. But one thing I have been thinking about a lot and just working on because um I think it's been helpful for me, and I think overall this is some level of answer is just keep building community, um, to find some ways to engage in community, um, to become a part of one, to reconnect with one. Um to, you know, I'm trying to like use the the devices, you know, and all the the electronic pieces to engage in like finding where next meetings are and to do more of that and less of of everything else, like on that device, right? To be kind of in in the world of building community. I mean, it certainly we could do like online communities that that that of course makes sense too. Um, but I guess I'm saying like moving away from like really easy to get into doom scrolling or trying to keep track of every aspect of the news cycle. Um, it's important to stay informed, I think, but to try to contain that a bit for ourselves because it is so um overwhelming and potentially demotivating. And how do we continue to to to connect with each other? Um, because that's what we have and that's what we need, and that's what's gonna help continue to build a movement. And um there's a there's a lot here, and I don't, of course, have all the answers about how things are gonna work out right now, but I do think it's important that we're having a response. I think therapists in particular have um skill sets that are really helpful in this situation, not just like in our work, but just in our communities, in that I think our leadership and our ability to have and to show and to demonstrate compassion is really important. So I think in times when you know there's there's hatred, um, compassion is what's needed. I mean, compassion is the thing that that counters that and to demonstrate like love for each other, love for our communities, um, to you know, advocate to stand up for people. Um, certainly, you know, we've seen this all over the country. And I I think that's you know, one of the main things that have really touched people's hearts about seeing like how folks have shown up in like say Minnesota, you know, and like these way sub-zero temperatures um to really stand up for people. And that's you know incredibly compelling and brave and courageous. And it's all about this place of just being really compassionate, like, you know, right. First, it came from my neighbors, and I said, stay away from my neighbor. You know, I saw a sign that said that, and it was a really great thing about just kind of rethinking that that idea of, you know, first somebody comes for something, and you know, we're gonna say no. Like, you don't come for something to be that part of that community. So I think therapists have have a place um of leadership to be able to model that, yeah, promote that, to help show that it not just again in our offices, but everywhere we are, whether at the grocery store or whether at a demonstration or wherever we might be.

SPEAKER_02 49:01

Right. Thank you.

SPEAKER_01 49:05

Yeah, thank you.

SPEAKER_02 49:06

Thank you, thank you, thank you. And, you know, uh I I think about it this way. Let's get out there, let's take care of one another and ourselves, let's be kind to ourselves and give others grace and give ourselves give ourselves grace. There's enough to worry about right now. We can't worry about everything we do, we can't control everything. Sometimes we try to, um, but you've heard it here, and you've heard it from you, Dr. Kristen Dempsey, and you've heard it from me. Um, let's take care of ourselves. Kristen, thank you so much for being here. Um, we've had a chance to talk about some really, really good stuff. So there's the the two books, the Harm Reduction Workbook for Addiction. Um, where can people buy it, Kristen?

SPEAKER_00 49:54

Yeah, I mean, it's in like um, you know, anywhere they sell books for the most part. But one thing I'll also uh say is if you go to the new Harbinger website and and you buy books there, including mine, and you can become part of their like um book buying community, um there's free like worksheets that are part of that that you can then like sign in for and click on and get printed out. Um some of them are like the same as in the book, but some might I created some new ones that are kind of like an additional little bonus, but it's also nice just having things you can just print out if you're doing something like in a session. So that's kind of nice. And the advancing motivational interviewing is um gonna be put up by Pezy Publishing. And so um like Pezy, uh there's pezzi.com, but if you just look up Pezzi and Advancing Motivational Interviewing, it pops right up. And it's also on all the you know, you know, major uh online booksellers as well. So um those are places where people can find it.

SPEAKER_02 50:52

Oh, good to know. So we will post the link to the harm reduction workbook on the podcast site and on our Substacks. Um, and then when you have the link available, we'll just update and add the second link so that people are able to go and purchase the book. Um, Kristen, I look forward to working with you so much more in the future and get a chance to witness and be just kind of there as you develop more great things. And to our listeners and watchers, thank you so much for being a part of The Good Therapist Is In, um, our first podcast. Please share it with your networks and follow this podcast wherever you consume your podcast. And we'll catch you next time.

SPEAKER_00 51:42

Great, thank you, Kenneth. I really enjoyed it.

SPEAKER_02 51:45

Great. Thank you, Kristen.