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Consider becoming an MI trainer. It will put your career on the next level! MI trainers must receive supervision. Audiotaped role plays are submitted and telephonic supervision is conducted with conversation, interactive games, & role-play, to improve your MI skills. Courses are based on “The 8 Stages of Learning Motivational Interviewing” (Miller & Moyers, 2007). Private sessions are available to dramatically increase your skills!

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T.V. Appearance

Look for my appearance on the Emmy Award-winning Showtime series Penn & Teller’s Bullshit! The episode, "12 Stepping,", is now available on the Season 2 DVD. Click here to buy it

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What is gender-responsive, trauma-informed treatment (GRTI)?

Gender-responsive* means any alcohol and other drugs treatment (AOD) that appreciates and specifically treats men, women, and all other genders as unique peoples requiring unique treatment. Trauma-informed treatment is any AOD treatment that is influenced by staff’s understanding of the impact of interpersonal violence (IPV) and victimization on an individual’s life and development. (Elliot, et al, 2005) 

*The State of California is specifically focusing on women’s treatment for GRTI services but we should remember that trauma and gender influence and affect more than just women.

So why this focus on trauma?

Trauma and interpersonal violence have more recently come to be seen as catalysts for substance abuse disorders (SUDs) especially among women.  According to Harvard researcher Lisa Najavits, most women who come to treatment have a history of at least one traumatic event, typically sexual (for men the rates are lower but probably due to under-reporting, not necessarily for less trauma) (Najavits, 2001).  This greatly impacts the type of milieu and treatment modality these trauma-surviving women should receive for best results.  Motivational Interviewing (MI) was developed as a way to elicit the internal motivations of problem drinkers in an effort to engage them in treatment services.  Since that original 1983 article by Dr. William R. Miller, MI has transformed, becoming a way to communicate in a variety of settings beyond addictions, one of the latest being with victims of trauma and interpersonal violence (Wahab, Stout, et al, in press; Miller & Rose, 2009; Miller & Rollnick, 2008).

So what is the connection between MI and IPV?  As a humanistic model of being with people, MI is the perfect vehicle to help transform a typically stressful first meeting with a newly ‘wounded warrior of trauma’ into one of hope, listening and witnessing, and potential assistance with available services.  MI is the perfect fit for those types of potentially transformative meetings.  It allows – no, encourages – workers to take a step back in favor of allowing the safety and space for the client to come forward.  It is within that sacred safe space that a glimpse of the world of the client can peek through, leading to a better understanding by the worker of the types of services from which this client might benefit, knowing that not all services will be appropriate for everyone (another belief espoused by MI).

We are speaking here about a population who have often had so much trauma and violence in their lives - as have their children - that frequently violence has come to be seen as a natural and normal part of life by all involved.  Their chemical use and other less-than-healthy behaviors are also due, in large part, to the need to cope or soothe the psychological, physical, and emotional effects of a violent life.  And these less-than-healthy behaviors and chemicals work - to alleviate the pain and anxiety, and simply to allow folks to leave their surroundings for even a brief moment.  This can sadly lead to some professionals to label these drug/behavior users as being “in denial” rather than fully appreciate what these behaviors are doing for their client.  Moreover, as workers see these client behaviors as “being in denial” and “addict” behavior, they do not “join with” these clients, and may even respond themselves with control (a type of violence) and punishment (abuse).  This hurts not only the client but also the worker.  Our behavior and treatment now mimics the role of the controlling former partner/person and we become the controller/abuser, a role understood and perhaps even expected by this population. But is this who we really want to be? 

This hurtful role of our may also be part of the explanation for why this population fails to often seek treatment.  After all, why leave one abuser for another?  One that is unknown (us) and requires that clients give up the only coping skill they may have - one that works every time, all the time?  We must engage and encourage these ‘wounded warriors’ to treatment - not with lofty promises but with real promises of real treatment, including a sensible menu of options appropriate to the individual, not to us.

The principles of MI are a good place to begin to understand its potential impact on especially these initial meetings with our clients with IPV.  MI has four (4) basic principles:  1) Expressing Empathy, 2) Avoiding Arguments by Rolling with Resistance, 3) Developing Discrepancy, and 4) Supporting Self-Efficacy.  These principles are especially helpful in framing the first stages of trauma recovery - safety, according to Judith Herman (Herman, 1992).  Often our female clients are mothers who are already marginalized, facing stigma and prejudice especially if their lives have intersected with the criminal justice system.  MI can assist workers in providing the safety needed for these client-moms to begin their healing process simply through the use of these MI principles in this client-centered communication.  It is a small but important step toward building rapport with a client, and the effect of building this rapport into a true partnership is the largest of all change effects (this “therapist alliance” can account for as much as 60% of change effects.  For more, see Scott Miller & Barry Duncan’s work at www.talkingcure.com).

With GRTI, we are advocating for a complete shift in traditional SUD’s treatment, using MI as the model.  With its competence world view versus deficit world view, MI sees these clients as able to make change in their lives, able to make healthier decisions for themselves, their children, their families, and able to partner with workers to make these changes.  This is in opposition to the current models of SUD’s treatment who see all drug users and drug use in a negative light, sometimes even as addiction even when no criteria for dependence is seen (i.e., “you use because you’re an addict, and you’re an addict because you use”).  In a traditional deficit model, clients’ problems are the focus of treatment and there is typically a singular way to recover (usually 12-Step based which may also be a trigger for some women and others with trauma histories).  Also, trauma is seen as a “one-to-one” event:  one trauma leads to a singular experience and a singular symptom.  The idea that all persons with a similar problem will have the same symptoms and that they can be successfully treated in the same way is also part of this traditional model.  MI helps us to move away from this ‘singular service’ model through its basic principles.  With MI, we are better able to express empathy and appreciation for the behaviors and lives of these heroic clients; help clients develop discrepancy between the life they would like to have and their current circumstances; roll with the natural resistance of making change through avoiding arguments with clients; and help build a clients’ confidence to make these changes through supporting their self-efficacy and fostering autonomy.  If I’m doing my job well, I’m always working myself out of a job with a client.  My goal is for them to recover their lives and leave me behind as soon as possible!

I hope this has helped to describe GRTI treatment and especially as it intersects with Motivational Interviewing.  If you would like assistance in your program with either training or revamping/developing a policies & procedures (P&P) manual utilizing GRTI principles, please contact me.  It is possible that your agency would be eligible for free training and/or consultation through one of the State grants.  And if you have any comments or questions, please email me.  I’d love to hear from you!  Finally, I know none of us got into this field to purposefully injure anyone.  I also know that we mistakenly injured many early in my career when we didn’t know better.  Well, we know better now.  No more excuses.  Let’s revolutionize treatment and, who knows - maybe clients would even want to come!

(rev Sept 2009)

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Treat people as if they are who they can be and you help them become who they're capable of being.
- Goethe