Pros and Cons: Reflections on Motivational Interviewing in Correctional Settings

 

William Miller, Ph.D.

Reprinted with permission from the Motivational Interviewing Newsletter: Updates, Education and Training
(MINUET; 1999; Vol 6, No. 1; p. 2-3)

At first I was curious as to why this is happening. Now my sense is, "Why not?" I realize, too, that my own initial surprise and reluctance were based on inaccurate stereotypes. "Lock ‘em up and throw away the key" is rather opposite to the perspective that we seek to promote in MI. Yet the limitations of punishment and imprisonment are apparent to no one more than to those who work in correctional systems every day. More than the vast majority, who never set foot behind bars, they know first-hand that what American society is doing is simply not working. They understand well the passionate plea made in Karl Menninger's The Crime of Punishment. In training probation officers this year I met a group of profoundly patient and compassionate professionals who were doing their best, not to exact society's revenge, but to change behavior. Far from media fantasies of good guys versus bad guys, they work daily with the real people who are sentenced to temporarily restricted freedom.

I am, on reflection, particularly thankful that there seems to be interest and openness to a personally respectful MI approach within criminal justice settings. "Prisoners" and "criminals" are among society's most despised and rejected members. In the name of justice, they are routinely subjected in prisons to isolation, crowding, dehumanization, humiliation, terror, drug abuse, privation, and physical and sexual violence. These conditions are widely known (even as a subject of TV comedian monologues) and are tolerated, as if they were "good for" offenders and for society. Among nations, America has one of the world's highest rates of incarcerated citizens, ranking with the most oppressive societies; yet the building of new prisons remains a growth industry.

It reminds me of how things once were in the addiction treatment field in the United States. The boot camp atmosphere of Synanon. The in-your-face screaming of insults and obscenities. Denial busting. The hot seat, "tearing them down to build them up." The surprise confrontational meetings that could feature on the front page of the Wall Street Journal, as exemplary practice, a physician shouting at an executive, "Shut up and listen! Alcoholics are liars, and we don't want to hear what you have to say!" The "family week" where people were told they had the fatal disease of co-dependency by virtue of being related to an alcoholic, and that they were thereby out of touch with reality and required treatment. It seems like a bad dream now, but it was very common just two decades ago. There are far too many places where these things still occur.

Something happened in the addiction field. A punitive, moralistic, and arrogant stance that was common in U.S. treatment twenty years ago has given way to a much more respectful and collaborative approach. I'm not sure that motivational interviewing had anything to do with it, but the field's amazing receptiveness to MI is at least a reflection of this profound change. In the 1979s it was acceptable, even laudable, to abuse "alcoholics" and "drug addicts" because it was good for them, it was what they needed, the only way to get through to them. It's no surprise, given this treatment, that there arose the impression that defensiveness is a natural concomitant of substance use disorders. Something happened. In a relatively short period of time, treatment has changed.

Is it too much to hope, then, that the field of corrections could see a similarly major change in the next twenty years? Offenders are the last major group in our society whom it is generally acceptable to abuse because they "need" and "deserve" it - because it is good for them and for society, and is "the only language they can understand." All evidence to the contrary, we collectively imagine somehow that it makes them better, and makes us a safer and more just society.

What would happen if motivational interviewing became a routine part of the training of correctional workers? What if large numbers of volunteers were trained to go into prisons and listen to offenders in this way? How would it affect outcomes if offenders were generally seen as preparing for change (like those entering treatment), rather than as less-than-human cons? What if we assumed that the central purpose of correctional systems is not to enact vengeance, but to change behavior? I know it is possible. Remarkable changes sometimes happen, in people and in systems, in a relatively short period of time. There are so many points in societal justice systems where motivational interviewing could be tried. Ed Bernstein, Morris Chafetz, Damaris Rohsenow and others have offered brief empathic interventions to people in hospital emergency rooms, in the midst of crisis. What if, upon arrest, someone besides a lawyer met with people at the police station, just to listen in an MI style? Follow them through the system: in the jail, meeting with their lawyer, pre-trial, pre-sentencing, post-sentencing, on probation, beginning and during incarceration, on work release, pre-parole, post-release, before and after the end of a term of sentence. There are so many points in the system where motivational interviewing could be done. One can imagine many obstacles and objections. Yet it is possible. Motivational interviewers belong behind bars.

Perhaps, just perhaps, in twenty years' time we will look back on today's criminal justice practices and ask in disbelief, "How could it ever have been so?" Who in the addiction field imagined, twenty years ago, that we would be looking back disapprovingly, even shamefully at the confrontational models of the 1970s? These days when I begin talks with my old slides on the confrontation-of-denial model, even U.S. audiences sometimes refuse to believe that these things would ever actually be done in practice, and they accuse me of manufacturing a straw man. Who would have believed it? The straw man is dancing!

In cooperation with the Motivational Interviewing Network of Trainers (MINT), William R. Miller, Ph.D., and Stephen Rollnick, Ph.D. 

Revised 2/01