Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians.

INTRODUCTION: Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. METHODS: This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. OUTCOMES: Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. CONCLUSION: A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program.

Narrative Therapy's Relational Understanding of Identity.

We describe how we think of identity as relational, distributed, performed, and fluid, and we illustrate the use of this conceptualization within a narrative worldview. Drawing on the work of Michael White, we describe how this relational view of identity leads to therapeutic responses that give value to interconnection across multiple contexts and that focus on becoming rather than on being. We show how a narrative worldview helps focus on the relational, co-evolving perspective that was the basis of our early attraction to family therapy. We offer detailed examples from our work of practices that help us stay firmly situated in a relational worldview that is counter to the pervasive influence of individualism in our contemporary culture.

White Privilege: What's a Family Therapist To Do?

Privilege is the freedom to ignore things that other people are forced to confront; dramatic things like being gunned down by a vigilante on the way home from a convenience store or less urban and visible things like having to live on secluded parcels of land that no one else wants. Most family therapists enjoy the freedom not to experience such events. Many of the people who come to us for help don't have that freedom. My intent here is to increase felt awareness of the injustice of institutional racism and to suggest some actions that White family therapists can take to bring forth a more just society in terms of education, housing, access to wealth, and basic safety.

Pearls for Working with People Who Have Personality Disorder Diagnoses.

Personality disorders are a group of diagnostic categories applicable when people show personality traits that are so extreme they cause clear difficulties in their lives and relationships. More widespread agreement is found on sorting by three broad categories (odd/eccentric, dramatic/emotional/erratic, and anxious/fearful) than by more specific subtypes. Primary care physicians need to recognize when extreme personality traits are causing difficulties in their relationships with patients and to have a way to approach these difficulties when they arise. This article reviews current thinking on the diagnosis and treatment of personality disorders, focusing especially on dramatic/emotional/erratic disorders, which are those most often problematic in clinical settings.

Narrative ideas for consulting with communities and organizations: ripples from the gatherings.

This paper reviews Michael White's early work with communities and extends ideas and practices from that work into the realm of consulting with organizations. We draw on Michael's writing and the records of two specific projects, as well as the recollections of team members in those projects, to describe how ideas and practices that were originally developed in working with individuals and families came to be applied in community settings. Specifically, we show how the central intention of the work is to use narrative ideas and practices in ways that allow communities to articulate, appreciate, document, utilize, and share their own knowledges of life and skills of living. We discuss the basic narrative ideas of stories, double listening, telling and retelling, making documents, and linking lives through shared purposes. For these projects, the teams developed structures that made it possible to use the basic idea with whole communities. We show how this work with communities has offered inspiration and ideas for our work in consulting to organizations. Finally, we describe and illustrate a particular way of working with organizations that carries the spirit of Michael's community work into situations requiring shorter blocks of time and more limited commitments than the original community contexts.

Initiating antidepressant therapy? Try these 2 drugs first.

When you initiate antidepressant therapy for patients who have not been treated for depression previously, select either sertraline or escitalopram. A large meta-analysis found these medications to be superior to other "new-generation" antidepressants.

Relationships, not boundaries.

The authors find it more useful to pay attention to relationships than to boundaries. By focusing attention on bounded, individual psychological issues, the metaphor of boundaries can distract helping professionals from thinking about inequities of power. It oversimplifies a complex issue, inviting us to ignore discourses around gender, race, class, culture, and the like that support injustice, abuse, and exploitation. Making boundaries a central metaphor for ethical practice can keep us from critically examining the effects of distance, withdrawal, and non-participation. The authors describe how it is possible to examine the practical, moral, and ethical effects of our participation in relationships by focusing on just relationships rather than on boundaries. They give illustrations and clinical examples of relationally-focused ethical practices that derive from a narrative approach to therapy.