Having your heart in the right place

 Motivational Interviewing and Compassion
By Dr Stan Steindl
I recently presented at the International Symposium on Motivational Interviewing (ISMI) in Melbourne on the topic of Motivational Interviewing (MI) and Compassion.
As many will know, MI is a communication style in which clinicians can explore with clients the client’s own motivations for change, helping the client to articulate to themselves what they’d like to change, why, what makes it important to them and how they might go about it. Ultimately, MI helps the client to resolve feelings of ambivalence about change and make a commitment to what actions they will take next.
The presentation at ISMI was all about the role of the clinician’s compassion in all of this. As Miller and Rollnick (2012) have written in their core text on the topic, “To be compassionate is to actively promote the other’s welfare, to give priority to the other’s needs.” (p. 20).
Why Add Compassion?
The MI Spirit, previously comprised of collaboration, evocation and respect or autonomy support, was thought to not completely differentiate what the MI practitioner might be doing from, say, the approach of a salesperson.
A salesperson might work in partnership with their customer, might evoke the customer’s own arguments for buying, and can ultimately accept that the person will make the choice whether to buy or not. In fact, people in sales are often very astute at discerning those customers who are unlikely to buy and moving on to the next potential customer.
Not that there’s anything necessarily wrong with that. It’s just that MI is different…perhaps more. MI is essentially all about the promotion of the other’s welfare, setting aside ourselves, and setting aside creating any benefit for ourselves.
As Miller and Rollnick (2012) pointed out, the MI practitioner endeavours to have their “heart in the right place”. (p. 20).
What Is Compassion?
While I, like many clinicians, have long pondered compassion and its role in the clinical work I do, its recent formal inclusion in the spirit of MI has brought the topic into sharp focus for me. So what is compassion? It seems to me that it is made up of a variety of aspects, and so, just to name a few:
•   Kindness – “Be kind, for everyone you meet is fighting a harder battle.” – Plato
•   Acceptance – “A truly compassionate attitude toward others does not change even if they behave negatively or hurt you.” – Dalai Lama
•   Equality – “Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.” – Pema Chödrön
•   Action – “Compassion is a verb.” – Thich Nhat Han
I also asked my mother, a GP of 40 years. Despite being put on the spot at her Mother’s Day dinner recently, she said, “Compassion is a feeling of understanding, and of sorrow, for the difficulties somebody else is experiencing…and trying to do something about it.” And I think this highlights the two key components of compassion. There is a feeling component in which we feel for, and with, the other person. And there is an action component, where we do something about it.
A Definition of Sorts
While I am no expert on the topic of compassion, I thought I would put out there a definition of sorts for others to consider and elaborate upon.
Compassion is the capacity to see clearly into the nature of another’s life…their values and strengths, dilemmas and challenges, as well as their suffering. It is a recognition that one is both separate from, and not separate from, that suffering, given the shared experience of being a part of humanity. It is being fully present to the whole story, including all aspects that might influence what the other person goes on to do. It is an aspiration towards transforming that suffering, and active efforts to do so, while at the same time not being attached directly to the outcome of that transformation.
Strong Back; Soft Front
We are not eggs! Eggs have a hard shell, protecting an inner softness and vulnerability, but the hard shell is fragile and brittle and breaks easily under too much pressure. The characteristics of a compassionate person is the opposite, involving a strong back and a soft front.
The strong back is about the emotional strength, courage and wisdom to be with a person and their suffering. It is about being able to see clearly the whole person, and with both conviction and humility provide support.
The soft front is about love, the kind of “non-possessive love” that Carl Rogers spoke about. It is about approaching the other person with kindness and care, acceptance and open-heartedness, and calmness and patience. It is treating the other person with respect and being able to empathise, demonstrating an understanding of what they might be thinking or feeling.
And compassion has enemies. Judgement is an enemy of compassion. Negative judgement of course, but also sometimes positive judgement, which can still put the clinician into a position of superiority. Feelings of pity or fear can also undermine compassion, or moral outrage at the person or their behavioural choices. Also arrogance or thinking that we know best…these and other characteristics are like white ants eating away at the core of our compassion.
Cultivating Compassion
With a growing sense of what compassion is, then we consider how to cultivate compassion. Cultivating compassion includes feeling empathy and concern for others, and it goes beyond this. Steps can be taken to foster the strong back to be present with another person and their suffering, as well as the the soft front of acceptance and positive regard. Further, personal commitments to take compassionate action can be developed and solidified. And clinicians can develop the resilience to prevent ‘compassion fatigue’.
The Center for Compassion and Altruism Research and Education (CCARE) at Stanford University (www.ccare.stanford.edu) has been developing and researching practices for cultivating compassion by combining our knowledge of neuroscience, psychological science and spirituality. The Compassion Cultivation Training (CCT) incorporates:
•   mindfulness practices such as breathing, imagery and loving-kindness meditations,
•   colleagial discussion, reflection and communication, and
•   real-world homework practicing compassionate thought, feeling and action.
Practicing Compassion Through Meditation
“I don’t like that man. I must get to know him better.” – Abraham Lincoln
I invite you to close your eyes.
Think of someone you are currently working with. Perhaps someone with whom the work has been challenging.
Develop a picture of that person in your mind. Feel the presence of that person in your life, in this room.
Now consider and say to yourself:
“This person is just like me. Just like me, they have a history…they were a child once, too. And just like me, this person has had ups and downs in their life. Just like me, this person has had goals and dreams. Just like me, they have strengths and qualities…fears and vulnerabilities…they have had successes and they have made mistakes.”
Good Practice of MI
It seems to me now, that with compassion being formally added to the spirit of MI, good practice will include taking active steps to cultivate compassion.
First, the importance of cultivating compassion for ourselves, for self-compassion is itself a key ingredient in being able to feel compassion for others.
Second, cultivating compassion for our colleagues, all of whom come from the same well-intended place and are facing the same challenges as we are.
And finally, cultivating compassion for our clients, and significantly the client we are just about to see, who comes offering us the privilege of being with them while they consider their own question of change.