This month, our EBP Times takes a different approach to educating our audience on IDDT practices.  Recently, our IDDT Training team consisting of consultants and trainers was expanded to include Bryan Knowles, former IDDT Supervisor at Wyandot Behavioral Health Care.  We asked Bryan to share his experience ‘from the trenches’ on IDDT principles and practices.  We found his article to be engaging, clever, and thought-provoking.  We hope you will too.  We encourage you to pass it along to your team members and colleagues and use it as a basis for discussion at your next team meeting.

IDDT and the Rising Over-Indulgence in Pie and Cookies:
Implications for Practice

By Bryan Knowles, IDDT Consultant and Trainer, University of Kansas, School of Social Welfare

 I don’t know when you will be reading this, but as I write to you it is the holiday season. The lights are up on houses and businesses, and people are asking, “What are your plans for…?”  Popular singers croon that they will be home for Christmas. 

A familiar scene….

      Also in keeping with the season, my friend told me yesterday that a co-worker gave her some holiday snacks: salty, sweet, and a mixture thereof.  My friend complained that the snacks were too good and had led to the heartbreak of over-snacking and the resultant guilt and regret.  I sigh and shake my head as I write this; another good person lost to the temptation of holiday “goodies.”  I know that I, too, will soon succumb. 

      You, too, may be able to relate to the dilemma my friend and I face.  The feasts, treats, leftovers and snacks that look so great and taste so good will, for many of us, lead to…well, consequences.  Clothing that was “a little tight” before may now be relegated to a closet or drawer.  Doctors may wag fingers at checkups, and some folks may swear off pumpkin pie for eternity.

What if this did happen?

      Now, imagine: You friends or family convene a meeting to talk with you.  “Honey,” they say, their tones somber and eyes moist, “it’s out of control.  We’ve told you every way we know how, but….it hasn’t worked.  So, we think it’s best that this year, for your good and ours, you don’t come to the holiday meal.  We know this is hard to hear, and we love you dearly, but…well, some of us want a chance to have a drumstick.”  Or perhaps your doctor, once again advising you about your cholesterol levels tells you that if you’d just stay away from your family and loved ones, you wouldn’t have these problems.  One or all of the above-mentioned parties may strike a harsher tone:  “You just need to leave the pie and candy alone.  Push away from the table.  Make up your mind that you’re not going to over-eat anymore.”

      Please do not dismiss this light-hearted tone as making light of a problem (over-eating) which can be life-threatening in both the short- and long-term.  The point is to start off on familiar ground with a problem affecting a broad range of people, so that I can segue into a topic that many consider as happening to others.

Important Points for Consideration

Ø      Point #1: It’s not about telling people what to do.

      Even if they are delivered with the best of intentions, diatribes and lectures have little hope of success.  This is why many models of intervention (including the IDDT model) have moved away from telling people what not to do and instead have begun listening for what people want to do.

      Suppose knowing that skipping seconds and eating more broccoli would mean that you could fit into those pants you wore to last year’s holiday party.  Would that be enough to inspire a change?  Well, for some of you it might.  For many others, it wouldn’t.  I don’t personally find pants very motivating.  And that’s exactly the point.

Ø      Point #2: Listen for what is important to people – we need to know.

If I’m the person who is supposed to help you with changing your behavior, I want to know what is important to you.  I need to know.  How else am I to even know where to begin?  If I start with what I find motivating (thus assuming it must also motivate you), I’ll never mention pants.  However, pants may be an important issue for you.  Conversely, imagine how aggravating it would be to have someone focus on the importance of last year’s pants when those pants have no meaning or importance to you.

      Consider Harry (not, of course, his real name).  Harry had a dual diagnosis and shortly after release from prison had come to live in a supportive group setting with other people who were recovering from substance abuse issues.  From this environment, Harry had gone to live with his girlfriend and the son they had together.  Harry admitted that the new environment contained a great deal of chaos and stress, and I was his therapist during this transition.  In the midst of this living situation, Harry admitted himself to inpatient psychiatric hospitalization, noting that he had been close to a substance abuse relapse.  After a stay in the hospital, Harry’s parole officer told Harry that he (Harry) could choose for himself where to live, but the parole officer also made it abundantly clear where he (parole officer) wanted Harry to live (i.e., the group setting).  Harry left the hospital to stay with a relative for a night or two while he decided where to settle, and he came to see me for therapy, where we weighed the situation.

Ø      Point #3: Take a step back, let go of your agenda, and truly listen, so that point #2 can be accomplished.

      From where I sat, it wasn’t rocket science.  On one hand was the group setting where Harry had been quite successful, and on the other was an environment which had caused frustration and near-relapse.  Maybe we’d even finish a little early today…  However, Harry didn’t agree that the issue was so clear-cut.  In fact, he disagreed with me about where he should live.  The difficulty I was having was that the answer seemed so obvious.  I had assumed Harry would just fall in line, and here he was arguing with me (with me!).  It wasn’t a bitter argument; Harry and I had great rapport.  We both just kept on beginning statements with “yes, but…” as we made each other more and more aggravated.  After some time of this, I began to get the message.  I put my agenda aside.  I used a simple reflection:  “It sounds like you’ve made this decision already.”  Yes, in fact, he had.  But here’s the crux, the part I missed, the moment where I realized I was talking about last year’s pants and was completely off-base; Harry wanted to live with his son.  The toddler was the center of Harry’s world and was worth the chaos and frustration.  His son made it worth the stress and—for Harry—worth staying clean.  Once I realized how completely I had missed the mark, Harry and I were able to have a much more fruitful conversation about how to be successful while living with his girlfriend and son.

      It’s easy to assume that because in our society there is a predominantly-held value that says substance abuse is bad for your health, your social interactions, and your ability to operate a motor vehicle, then such a value should be (in some minds, must be) the reason to make a change.  Substance abuse has such a stigma in some circles/classes, the assumption is that quitting is an end unto itself.  However, we all have reasons, i.e. positive consequences, for continuing the behaviors we know aren’t very good for us, i.e. behaviors that have negative consequences. And when the time comes for change, we will all have our own reasons for making the change.

Ø      Point #4: IDDT is not only a technique-based intervention.  It relies on our development of knowing and listening to what motivates people to do things.  This can only come from the person.  Allow room for this to emerge.  The answer is always present.

For those who train in the IDDT model, we spend time right up front explaining that people who want to implement this model must first have the “spirit” of the model before they learn any techniques.  What I’ve described above is a glimpse of this very important aspect of IDDT.  People’s opinions and goals must be respected and explored.  The techniques are only tools; the spirit is the foundation lesson in how to use those tools.  Using the techniques without the spirit would be hollow.  It would be like…

      Well, it would be like the holidays without all the food.

SUBSCRIPTION:
To subscribe or unsubscribe from this newsletter, please email us and tell us what you would like for us to do with your subscription to EBP Times.   We continue to gather emails for the EBP Times distribution list, and welcome other emails to include.