What is Motivational Interviewing? A brief description and demonstration video

The following content is adapted from Clinical Interviewing (6th ed., 2017).

********************************

In their 2013 edition of Motivational Interviewing, Miller and Rollnick offer “Layperson’s,” Practitioner’s,” and “Technical” definitions of MI.  For practitioners, Motivational interviewing is:

. . . a person-centered counseling style for addressing the common problem of ambivalence about change. (p. 29)

As a person-centered approach to therapy, MI relies substantially on four central listening skills, referred to as OARS (open questions, affirming, reflecting, and summarizing). MI is designed to help clients change from less healthy to more healthy behavior patterns. However, consistent with PCT, MI practitioners don’t interpret, confront, or pressure clients in any way. Instead, they use listening skills to encourage clients to talk about reasons for engaging in healthy or positive behaviors.

Moving Away From Confrontation and Education

In his research with problem drinkers, William R. Miller was studying the efficacy of behavioral self-control techniques. To his surprise, he found that structured behavioral treatments were no more effective than an encouragement-based control group. When he explored the data for an explanation, he found that regardless of treatment protocol, therapist empathy ratings were the strongest predictors of positive outcomes at 6 months (r = .82), 12 months (r = .71), and 2 years (r = .51; W. R. Miller, 1978; W. R. Miller & Taylor, 1980). Consequently, he concluded that positive treatment outcomes with problem drinkers were less related to behavioral treatment and more related to reflective listening and empathy. He also found that active confrontation and education generally triggered client resistance. These discoveries led him to develop motivational interviewing (MI).

Miller met Stephen Rollnick while on sabbatical in Australia in 1989. Rollnick was enthused about MI and its popularity in the UK. Miller and Rollnick began collaborating and subsequently published the first edition of Motivational Interviewing in 1991. Rollnick is credited with identifying client ambivalence as a central focus for change (Jones-Smith, 2016, p. 320).

Client Ambivalence

Client ambivalence is a primary target of MI. Miller and Rollnick (2013) have consistently noted that ambivalence is a natural part of individual decision-making. They wrote: “Ambivalence is simultaneously wanting and not wanting something, or wanting both of two incompatible things. It has been human nature since the dawn of time” (2013, p. 6).

Although MI has been used as an intervention for a variety of problems and integrated into many different treatment protocols, it was originally a treatment approach for addictions and later became popular for influencing other health-related behaviors. This focus is important because ambivalence is especially prevalent among individuals who are contemplating their personal health. Smokers, problem drinkers, and sedentary individuals often recognize they could choose more healthy behaviors, but they also want to keep smoking, drinking, or being sedentary. This is the essence of ambivalence as it relates to health behaviors. When faced with clients who are ambivalent about whether to make changes, it’s not unusual for professional helpers to be tempted to push those clients toward health. Miller and Rollnick (2013) call this the “righting reflex” (p. 10). They described what happens when well-meaning helping professionals try to nudge clients toward healthy behaviors (note that this description is an apt rationale for a person-centered approach, but that it’s also consistent with the Gestalt therapy ideas of polarizing forces within individuals):

[The therapist] then proceeds to advise, teach, persuade, counsel or argue for this particular resolution to [the client’s] ambivalence. One does not need a doctorate in psychology to anticipate [how clients are likely to respond] in this situation. By virtue of ambivalence, [clients are] apt to argue the opposite, or at least point out problems and shortcomings of the proposed solution. It is natural for [clients] to do so, because [they] feels at least two ways about this or almost any prescribed solution. It is the very nature of ambivalence. (2002, pp. 20–21)

The ubiquity of ambivalence leads to Miller and Rollnick’s (2013) foundational person-centered principle of treatment:

Ideally, the client should be voicing the reasons for change (p. 9).

MI is both a set of techniques and a person-centered philosophy. The philosophical MI perspective emphasizes that motivation for change is not something therapists should impose on clients. Change must be drawn out from clients, gently, and with careful timing. Motivational interviewers do not use direct persuasion.

The Spirit of MI

The “underlying spirit” of MI “lies squarely within the long-standing tradition of person-centered care” (Miller & Rollnick, 2013, p. 22). They identified four overlapping components that the spirit of MI “emerges” from. These include:

  • Collaboration
  • Acceptance
  • Compassion
  • Evocation

MI involves partnership or collaboration. It’s described as dancing, not wrestling. Your goal is not to “pin” the client; in fact, you should even avoid stepping on their toes. This is consistent with the first principle of person-centered therapy. The counselor and client make contact, and in that contact there’s an inherent or implied partnership to work together on behalf of the client.

Person centered (and MI) counselors de-emphasize their expertness. Miller and Rollnick refer to this as avoiding the expert trap. Expert traps occur when you communicate “that, based on your professional expertise, you have the answer to the person’s dilemma” (p. 16). In writing about collaboration, Miller and Rollnick (2013) sound very much like Carl Rogers, “Your purpose is to understand the life before you, to see the world through this person’s eyes rather than superimposing your own vision” (p.16).

Consistent with Rogerian philosophy, MI counselors hold an “attitude of profound acceptance of what the client brings” (p. 16). This profound acceptance includes four parts:

  1. Absolute Worth: This is Rogerian unconditional positive regard
  2. Accurate Empathy: This is pure Rogerian.
  3. Autonomy Support: This part of acceptance involves honoring each person’s “irrevocable right and capacity of self-direction” (p. 17)
  4. Affirmation: This involves an active search or focus on what’s right with people instead of what’s wrong or pathological about people.

In the third edition of Motivational Interviewing, Miller and Rollnick added compassion to their previous list of the three elements of MI spirit. Why? Their reasoning was that it was possible for practitioners to adopt the other three elements, but still be operating from a place of self-interest. In other words, practitioners could use collaboration, acceptance, and evocation to further their self-interest to get clients to change. By adding compassion and defining it as “a deliberate commitment to pursue the welfare and best interests of the other” Miller and Rollnick are protecting against practitioners confusing self-interest with the client’s best interests.

Evocation is somewhat unique, but also consistent with person-centered theory. Miller and Rollnick contend that clients have already explored both sides of their natural ambivalence. As a consequence, they know the arguments in both directions and know their own positive motivations for change. Additionally, they note, “From an MI perspective, the assumption is that there is a deep well of wisdom and experience within the person from which the counselor can draw” (p. 21). It’s the counselor’s job to use evocation to draw out (or evoke) client strengths so these strengths can be used to initiate and maintain change.

A Sampling of MI Techniques

One distinction between MI and classical PCT is that Miller and Rollnick (2013) identify techniques that practitioners can and should use. These techniques are generally designed to operate within the spirit of MI and to help clients engage in change talk instead of sustain talk. Change talk is defined as client talk that focuses on their desire, ability, reason, and need to change their behavior, as well as their commitment to change.  Sustain talk is the opposite; clients may be talking about lack of desire, ability, reason, and need to change. Overall, researchers have shown that clients who engage in more MI change talk are more likely to make efforts to enact positive change.

MI appears simple, but it’s a complicated approach and challenging to learn (Atkinson & Woods, 2017). Miller and Rollnick (2013) have noted that having a solid foundation of person-centered listening skills makes learning MI much easier. The following content is only a sampling of MI techniques.

MI practitioners use techniques from the OARS listening skills. In particular, there’s a strong emphasis on skillful and intentional use of reflections, instead of questions or directives. Here are examples.

Simple reflections stick very closely to what the client said.

Client: I’ve just been pretty anxious lately.

Simple Reflection: Seems like you’ve been feeling anxious.

 

Client: Being sober sucks.

Simple Reflection: You don’t like being sober.

Simple reflections have two primary functions. First, they convey to clients that you’ve heard what they said. This usually enhances rapport and interpersonal connection. Second, as you provide a simple reflection, it lets clients hear what they’ve said. Hearing their words back—from the outside in—can be illuminating for clients.

Complex reflections add meaning, focus, or a particular emphasis to what the client said.

Client: I haven’t had an HIV test for quite a while.

Complex reflection: Getting an HIV test has been on your mind.

 

Client: I only had a couple drinks. Even when I got pulled over, I didn’t think I was over the limit.

Complex reflection: That was a surprise to you. You might have assumed “I can tell when I’m over the limit” but in this case you couldn’t really tell.

Complex reflections go beyond the surface and make educated guesses about what clients are thinking, feeling, or doing. Clients tend to talk more and get deeper into their issues when MI therapists use complex reflections effectively. Also, if your complex reflection is correct, it’s likely to deepen rapport and might evoke change talk.

An amplified reflection involves an intentional overstatement of the client’s main message. Generally, when therapists overstate, clients make an effort to correct the reflection.

Client: I’m pissed at my roommate. She won’t pick up her clothes or do the dishes or anything.

Interviewer: You’d like to fire her as a roommate.

Client: No. Not that. There are lots of things I like about her, but her messiness really annoys me. (from Sommers-Flanagan & Sommers-Flanagan, 2017, p. 440)

 

Client: My child has a serious disability and so I have to be home for him.

Interviewer: You really need to be home 24/7 and have to turn off any needs you have to get out and take a break.

Client: Actually, that’s not totally true. Sometimes, I think I need to take some breaks so I can do a better job when I am home. (from Sommers-Flanagan & Sommers-Flanagan, 2017, p. 441)

Sometimes MI practitioners accidentally amplify a reflection. Other times amplification is intentional. When intentionally amplifying reflections, it’s important to be careful because it can feel manipulative.

The opposite of amplified reflection is undershooting. Undershooting involves intentionally understating what your client is saying.

Client: I can’t stand it when my mom criticizes my friends right in front of me.

Therapist: You find that a little annoying.

Client: It’s way more than annoying. It pisses me off.

Therapist: What is it that pisses you off when your mom criticizes your friends?

Client: It’s because she doesn’t trust me and my judgment. (from Sommers-Flanagan & Sommers-Flanagan, 2017, p. 441)

In this example, the therapist undershoots the client’s emotion and then follows with an open question. Clients often elaborate when therapists undershoot.

As noted, the preceding content is a small taste of MI technical strategies; if you want to become a competent MI practitioner, advanced training is needed (see Atkinson & Woods, 2017; Miller & Rollnick, 2013).

Now that you’ve read a brief summary of MI, check out the following video link. In this link, John S-F is using a few MI techniques/strategies with a client who has a history of excessive alcohol use. The video is part of our published video package accompanying our Clinical Interviewing textbook, and includes me weaving in a few more traditional clinical interviewing questions (e.g., the CAGE) along with the MI content. There’s also light commentary by Rita and me, as well as a short clip in the middle of me interviewing a Licensed Addictions Counselor on the topic of how to handle clients who are probably lying. Here’s the link to the approximately 22 minute video: https://youtu.be/rtN7kEk0Sv4

If you have questions, comments, praise, or constructive feedback on this blog or the video, I’d love to hear from you. You can post here, on Youtube, or email me directly at john.sf@mso.umt.edu.

Happy Tuesday.

John S-F

 

Op-Ed Piece — Suicide prevention in Montana: We must do better — In today’s Bozeman Daily Chronicle

Boze Coop

It’s a short piece, but given that I’m in Bozeman tomorrow evening for a public lecture on suicide and spending the day on Friday doing a day-long suicide workshop for professionals, the timing is good.

You can read the Op-Ed piece in the Chronicle: https://www.bozemandailychronicle.com/opinions/guest_columnists/suicide-prevention-in-montana-we-must-do-better/article_0607e973-2b96-500f-93ba-bf9e85f2a7a8.html

Or you can read it right here . . .

In 1973, Edwin Shneidman, widely recognized as the father of American suicidology, was asked to provide the Encyclopedia Britannica’s definition of suicide: He wrote: Suicide is not a disease (although there are those who think so); it is not, in the view of the most detached observers, an immorality (although . . . it has often been so treated in Western and other cultures).

Shneidman’s definition captured two elements of suicide that many of us still get wrong. First, suicidality is neither abnormal nor a product of a mental disorder. At one time or another, many ordinary people think about suicide. Wishing for death is a natural human response to excruciating psychological, social, or emotional distress.

Second, suicidal thoughts or acts are not moral failings. Shneidman noted that society and religion often harshly judge and marginalize anyone who experiences suicidal thoughts and feelings. People who struggle with thoughts of suicide are already feeling immense shame. Adding more shame makes people feel worse, increases the tendency toward isolation, and serves no preventative function.

If you live in Montana, you’re probably aware that news about suicide in the U.S. and suicide in Montana is nearly always bad news. By some estimates, suicide rates have risen 60% over the past 18 years, and Montana has the highest per-capita suicide rates in the nation. Although national and local efforts at suicide prevention have proliferated, these efforts haven’t stemmed the rising tide. There are many reasons for this, some of which are sociological or political and consequently not responsive to suicide prevention programming.

But, as Shneidman emphasized, we need to stop equating suicide with mental or moral weakness. Suicide prevention and intervention efforts shaped around quick, superficial questions or influenced by pathology orientations are unlikely to succeed, and in some cases, may do harm. Compassionate, collaborative, and strength-based models constitute the best path forward for improving the effectiveness of our prevention efforts. If we want people who are in suicidal crisis to open up, talk about their pain, and seek help we must make absolutely sure that we’re communicating the following message—that suicidal thoughts are natural responses to difficult life circumstances, that opening up and talking with others will be met with compassion, not judgment, and that people who seek help from others should be respected for having the strength to reach out and be vulnerable.

To help the Bozeman community learn more about a strength-based model for suicide prevention and treatment, the Big Sky Youth Empowerment Project (BYEP) is sponsoring a free public lecture on Thursday, May 16th from 6:30pm to 8:30pm in SUB Ballroom D on the campus of Montana State University. Please join me for an evening of thinking differently about suicide—with the goal of saving lives in Montana.

****************

John Sommers-Flanagan is a Professor of Counselor Education at the University of Montana, a clinical psychologist, and the author of over 100 professional publications, including eight books. He has a professional resource and opinion blog at https://johnsommersflanagan.com/

 

Why You Should Avoid Small Talk with God — Short visits with an honest God

Happy Mother’s Day Rita!

“Hey big fella,” I said, making small talk with my co-author–the entity commonly referred to as God in many parts of the world. “What’s your favorite name for yourself?” At that moment, one of God’s legs was flung across the valley, the other tucked up like a mountain under his stubbly chin. Wild, unruly hair […]

via Why You Should Avoid Small Talk with God — Short visits with an honest God

Spending Time with the Jackson Contractor’s Group in Big Sky

Missoula-College-Exterior_Web-Op

Have you ever looked at the Jackson Contractor’s Group (JCG) website? You should, it’s filled with statements about values, integrity, company culture, and they talk about “unapologetic authenticity of each Jackson employee.” Pretty cool. Oh yeah, and there are the many astounding projects they’ve done, like the new Missoula College Building, featured above. You can check out their website here: https://jacksoncontractorgroup.com/culture/

JCG is a company that’s all about construction. Other than being an admirer of their website, why are Rita and I hanging out with them in Big Sky, Montana?

The reason is that JCG cares about its employees. They also recognize that the construction industry has one of the highest (or the highest) rate of employee suicides in the U.S., and so they invited me to their corporate retreat to talk about suicide and suicide prevention.

While preparing for tomorrow’s talk, I discovered, among other things, that the Construction Financial Management Association lists several specific employment-related risk factors, including:

  • Tough guy culture
  • High pressure environment with a potential for failure and shame
  • Physical strain and psychological trauma
  • Travel away from family and friends
  • Stressful working hours/conditions
  • Stigma – Activities
  • Access to lethal means

I’m very impressed with JCG and honored to share time with them tomorrow. For those interested, I’m pasting a link to tomorrow’s powerpoints right here: Jackson Understanding and Preventing Suicide

The Pediatric Sleep & Wellness Conference in Seattle and The Suicide Prevention and Intervention in Bozeman: Informational Flyers Flying

In the coming weeks I’m honored to be able to present on two of my favorite topics: Parenting and Suicide Assessment.

These two upcoming events (in Seattle, April 27 and in Bozeman, May 16 and 17) have nice landing urls for information and registration.

If you happen to be in one or both of these areas, I’d be happy to see you. Please let me know, so we can say a real, non-virtual hello.

The links.

Seattle: https://pediatrictrainingacademy.com/conference/?fbclid=IwAR0ov1b6RgqIY3qHRG7qPAC2Nf9PyHpkbI5fOodtp8umUUTMbDW2sh9v438

Bozeman: https://www.byep.org/saw

Boze Coop

Happy Wednesday! JSF

 

The Brain-Based Truth of Donald Trump’s Social Dominance

Snowy Sunset

Although everyone is arguing with everyone else about everything—especially everything involving presidential politics, no one argues about whether Donald Trump can work a room, work up an audience, and dominate a news cycle. Love or hate him, Trump has a special talent.

But what is that talent? How can it be that despite clear evidence of Trump lying at unprecedented rates, despite the small blue wave that swept the House of Representatives this past November, and despite substantial evidence that his policies are not benefiting rural Americans, Trump’s approval ratings continue to hover at around 40%. Given his flirtation with the Russians, his legal problems with the Department of Justice and in the Southern District of New York, and his incessant outrageous and vulgar tweeting, why don’t his approval ratings dip even lower?

Perhaps even more puzzling is the apparent inability or unwillingness of previously powerful republicans to push back on Trump’s wanton disregard for family values and morality. Many of Trumps tweets are, at best, rated PG-13. The fact that Googling “bullshit” and “circle jerk” takes us to commentaries about Trump’s tweets is a testimony to his ubiquitous disrespect for whatever moral codes republicans have retreated behind.

Never mind the well-documented porn star payments, “shithole” references, and stories about bullets dipped in pig’s blood. Unless they’re still commenting on Obama, the Clintons, or other targets designed to distract from rational argument, the collective chorus of outrage among republican politicians is no louder than you’d expect from a band of Buddhists practicing mindful acceptance at a silent retreat.

Sure, Mitt Romney and a few others have occasionally (and carefully) expressed their sickened feelings. And although Bill Kristol and other #neverTrumpers have held forth—even purchasing political advertisings to counter Trump rhetoric—to date, no current republican office-holder has publicly confronted Trump and provided an alternative leadership narrative. What’s up with the formerly assertive republican leaders? Whether we’re watching blank looks from Chris Christie, John Kelly, or Rod Rosenstein, republican power brokers appear frightened, intimidated, and only a meek shadow of their former selves.

What’s the best explanation for Trump’s stable approval ratings and the continued shriveling of republican leadership? You might be inclined to consider favorable economic indicators, or the Fox News phenomenon, or some other rational explanation. But I’m leaning a different direction—toward a theory to explain the irrational.

Like all dangerous populist politicians, Trump is a master manipulator. He can bend minds like psychics bend spoons. Although many—including my father—refer to him as a run-of-the-mill con man, Trump is much more than that. Trump is no expert on the art of the deal; but he’s a wizard at the art of mass hypnosis.

Among others, two Canadian academics, Drs. Erik Woody and Henry Szechtman, have written about how mass hypnosis works. They say it involves the activation of a particular evolutionarily-important part of the brain. They’ve labeled this neural network in the brain as the “security motivation system.” Essentially, the security motivation system is an ancient part of the brain that scans for “hints, inklings, whiffs, and foreshadowings” of danger. The problem, as Woody and Szechtman put it, is that contemporary human brains are now connected to the internet, and the internet is filled with perpetual news, Facebook forwards, Russian bot activity, and political messages. Much of this instant information has hints and whiffs of danger and those hints and whiffs activate the security motivation system. The louder the call of dark, scary, danger, the more activated our collective security motivation systems become. And what do our collectively activated security motivational systems want? Action! Specifically, action leading to safety. All this can direct us to embrace politicians who offer big actions that will hypothetically protect us from danger. Woody and Szectman wrote: “. . . support for politicians promoting bold action [like building a big, impenetrable border wall] is itself an action . . . which may help” de-activate our heightened security motivation.

In contrast to Reagan’s message of the late 1970s and early 1980s, Trump’s message has been consistently about doom, gloom, and danger. His speech at the 2016 Republican National Convention was a bleak frightening portrait of America. But, in contrast to Trump’s portrait of America as under attack from Mexican rapists, Muslim terrorists, and international commerce, he simultaneously promised (and continues to promise) to make America great again with big, albeit unrealistic and unfounded, actions.

For a substantial minority of Americans, Trump is a charismatic speaker. He ramps up crowds to an emotional fever-pitch. He combines extremes. On the one hand, America is under attack from Mexicans, Muslims, and Democrats. On the other hand, he—and only he—can offer a future filled with beauty, safety, and financial success. As he speaks, he sometimes riffs like a hypnotist employing a specific hypnotic induction procedure called the “confusion technique.” When he employs this strategy, Trump’s words barely make sense. He offers a rhythmic narrative absent any real content. Take this example from the 2016 campaign trail:

You are going to be so proud of your country. Because we’re gonna turn it around, and we’re gonna start winning again! We’re gonna win so much! We’re going to win at every level. We’re going to win economically. We’re going to win with the economy. We’re gonna win with military. We’re gonna win with healthcare and for our veterans. We’re gonna win every single facet.

We’re gonna win so much, you may even get tired of winning. And you’ll say, “Please, please. It’s too much winning. We can’t take it anymore. Mr. President, it’s too much.” And I’ll say, “No, it isn’t!”

We have to keep winning. We have to win more! We’re gonna win more. We’re gonna win so much.

Ashley Feinberg of Gawker, described this verbal dispatch from Trump as: “His best Howard Dean impression if Howard Dean had been given a whole lot of cocaine and also a thesaurus with just the word “winning” followed by the word “winning” again in progressively larger fonts.” Not surprisingly, Woody and Szechtman described it differently, noting nuanced differences between the oral and written word:

Through repetition, this type of communication stays “on message,” almost to the point of caricature. More importantly, it presents no line of argument or supporting material whatever that would call for higher thought. Such communication, which can be effective in person, is similarly effective when replayed on media as video [or audio]. By contrast, it becomes ineffective in print, where its paucity of intellectual content is painfully obvious. (p. 14)

Most observers agree, Trump is best when on the stump. When it comes to governing or foreign policy or role-modeling moral behavior, Trump is less effective. On the stump Trump uses other hypnotic methods, beyond the previously mentioned confusion technique. He continually pounds away messages about current dissatisfaction, combined with an orientation to the future. Under him, future life will always be better, more beautiful, a Shangri-La for the masses. He uses the words “believe me” and “trust me” like a mantra. Even though nearly every rational person in the U.S. knows they should quickly run away whenever a salesperson (or con-man) says “trust me” Trump’s hypnotic reverie has weakened the rational mind to the point where the words believe me and trust me actually work. As Roger Cohen opined in the New York Times,

Tolstoy wrote of “epidemic suggestion” to describe those moments when humanity seems to be gripped by a mass hypnosis that no force can counter. . . . We find ourselves in such a moment.

But there is a countering force. There always has been. And there always will be.

Let’s go back to Woody and Szechtman, and their ideas about the brain’s security motivation system.

When activated, the security motivation system directs humans toward actions that enhance safety. When looking for safety, nearly always, humans follow their evolutionary noses. And where do their evolutionary noses point . . . toward the person with the most social dominance.

Think about it. Who can keep us safe? Then, think about Trump’s hulking figure looming in the background as Hillary Clinton speaks in one of the televised debates. Then, think of what he has (wealth and property) and think of what he offers in his hollow narratives (winning, beauty, and safety, so much winning).

Republican politicians are cowed like never before. They can’t match Trump’s verbal skills and hypnotic persona. They can’t match his wealth and connections. And republicans have historically been motivated by fear. Trump’s presence activates their security motivation systems. On their own, most White, male republicans fear immigration. On their own, most White, male republicans are drawn to wealth and power. For them, Trump stokes their fears and activates their security motivation system in a way that goes back to primitive human thinking: “Save yourself” . . . is the irresistible unconscious motive that weakens republicans. Open conflict with Trump is too dangerous. Alone, individual republicans don’t have the verbal or financial prowess to compete with Trump. So, they slink into the background and do what frightened people have done since the beginning of time—they follow a socially dominant and powerful leader.

The answer to the problem of Trump is simple, but not easy.

There are two roads to countering a socially dominant, hypnotically adept bully. Both roads necessarily include an alternative socially dominant discourse. How to get there? Republicans, if they can find their courage, might band together to push back against Trump. This would be risky. And the outcome is dicey.

The other road is to latch our trailer to an alternative socially dominant political figure. The hazard here is we could end up jumping from the socially dominant frying pan into the socially dominant fire. Consequently, we need to be very careful when selecting the socially forceful leader who can take on Trump and win. Perhaps of greatest importance, along with powerful messaging, to ensure safety of all Americans, our new leader needs to have two characteristics that Trump lacks and that make Trump dangerous. We need a leader who can be a team player (and not just deputize family members) and we need a leader who is able to experience and express compassion.

Methods for resisting and awakening from a hypnotic trance exist. They begin as all things begin, with awareness. Now is the time to wake up. Listen closely as I count backward from five to one. When I get to the number one, you’ll awaken, you’ll stretch, look around, and realize that finding an alternative socially dominant and yet compassionate leader is urgent.

5

4

3

2

1

You can wake up now. If you stay asleep, you face a greater danger. If you stay asleep, you may act in ways that are incompatible with your deep values. If you stay asleep, you may need forgiveness, because although you will act, you . . . will . . . know . . . not . . . what . . . you . . . do.

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.