Wise Counsel Interview Transcript: An Interview with Annie Fahy, MSW on Motivational Interviewing
Dr. David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by mentalhelp.net covering topics in mental health, wellness and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.
On today's show we'll be talking about a psychotherapeutic approach known as Motivational Interviewing with social worker and registered nurse, Annie Fahy. Annie is a behavior change specialist with expertise in substance abuse, high risk lifestyle behaviors, harm reduction, trauma, compassion fatigue and mind body disorders.
Annie is an experienced trainer in motivational interviewing, an evidence-based interviewing method that motivates people toward health behavior change. She's affiliated with the MINT that is the Motivational Network of Trainers. She was recently published in the Clinical Social Journal concerning her work with compassionate fatigue.
She's currently a therapist/trainer for the Harm Reduction Therapy Center in San Francisco and offers consultation and skilled coaching in addition to formal training.
Now here's the interview.
Annie Fahy, welcome to Wise Counsel.
Annie Fahy: Thank you David, it's good to be here.
Dr. Van Nuys: Well, I've been wanting to find out about motivational interviewing for some time. It's been on my to do list and I recently interview Pat Denney on harm reduction and I saw on the harm reduction site your name in connection with motivational interviewing. I asked Pat about you and she said, "Oh yes, she would be great to interview".
Then motivation interviewing popped up again on my radar screen just a few days ago when I was interviewing Dr. Allen Marlat at the University of Washington.
Annie: Yes, it's quite the topic all over research circles certainly. It's been around for a while but it's catching on like wild fire I would say.
Dr. Van Nuys: Oh that's interesting. Well before we get into the topic of motivational interviewing though, let's start out with a bit about your background. You know where you grew up, how you got into the field of psychotherapy, where you went to school, all that good stuff.
Annie: Sure, I'll give you the nutshell. I grew up in Connecticut and then shortly after I became voting age moved down to Georgia, Athens Georgia. Had about a 27-year career there. I became a nurse initially and was a labor and delivery nurse, which we can talk about the parallels of my work now. I found when I was doing that I really had a specialty in terms of sitting with painful situations and families in pain and with long labors as well. Kind of waiting for the baby and doing whatever is necessary.
Through some circumstances in life I needed to make a change in the place I was working. I ended up working in an addiction center, hospital based addiction treatment. This was back in the 80's and early 90's when the Hazelton method of addiction treatment was sort of in a heyday. Insurance companies were still funding that.
I found that there was a lot, I was able to sort of draw from in terms of labor and delivery experience and that I was also pretty good at it. Just developed more interest in counseling and psychotherapy and as a nurse it's hard to get in those room sometimes.
So, I developed, I got a certification in addiction counseling in Georgia and then eventually got a masters degree from the University of Georgia in social work. Around the start of the century 2000 I started a business with a partner called Recovery Cafe. It was then that I got involved in harm reduction. I had run a lot of traditional treatment programs for mandated clients and also for women and their children. I set up a comprehensive program with therapeutic child care. I was frustrated, we helped a lot of people but we left a lot people at the door. We ended up losing a lot of people.
So harm reduction and motivational interviewing around the end of the 90's really opened up my practice to a more client centered approach and that certainly what Recovery Cafe was. Around that time I got to train will Bill Miller who developed motivational interviewing with Steve Rollnick and some other people he was working with at the University of New Mexico. Just began training.
I had had some training in it myself and didn't really get it from the training and then I just started to think about how people could learn it and what they needed to learn. At the same time Bill and Steve Rollnick and Theresa Moyers, some other people were really thinking about how to teach this set of skills and strategies that was called motivational interviewing.
I began to train further at the Emory School of Medicine and the Georgia Counsel on Substance Abuse, the Georgia Counsel for the Prevention of Child Abuse, the Georgia Nurses Association, did a lot of organizations and settings. Then was recruited out here by Pat Benning to be her harm reduction work in Oakland and San Francisco and came out here in January.
Dr. Van Nuys: Oh, so you're a pretty recent immigrant then to California.
Annie: Yes, I'm born again California but don't tell anybody how good it is out here.
Dr. Van Nuys: OK, we'll keep it under our hats.
So you had the experience of going to a training program that you found to be not very effective and then went on to be a trainer it sounds like.
Annie: Yes, when I started to do the women's treatment program I got brought into a big motivational interviewing training. The book had come out in I believe the first article came out in '82 and the book came out somewhat after that. I can actually get it off the shelf and read it.
Dr. Van Nuys: Yes, what's the title of that book? That's the book by William R. Miller PhD and Steven Rollnick.
Annie: It's Steve Rollnick. It's Gilford Press and the book came out in '91.
Dr. Van Nuys: What's the title?
Annie: It's called, "Motivational Interviewing: Preparing People to Change Addictive Behavior". That's the first edition, there's subsequent second edition and another book that just came out last year about health behavior change. I believe that title was, "Motivational Interviewing for Health Behavior Change", same authors, Miller and Rollnick and actually an additional author.
When I had been trained in it I didn't really think it was anything special. I didn't understand it. I began to read the book as a follow up to that and the book was interesting but it didn't really grab me. Then what happened was, I was surfing around the Internet and noticed that Bill Miller was offering a free training if you were willing to send in some tapes because he was trying to figure out how to teach motivational interviewing to therapists.
I thought that was interesting and so I submitted an application and a practice tape with a client. It was a session tape and got accepted into the study. Got to spend three days learning motivational interviewing. That study is called the EMMEE study, that's E- M as in Mary-M as in Mary-E- E. It took a pretty large cohort of people and looked at what helped them learn this complex task of motivational interviewing.
Dr. Van Nuys: Well before we go any further because our listeners are probably scratching their heads.
Dr. Van Nuys: And going well what is motivational interviewing?
Annie: What the heck is it?
Dr. Van Nuys: Yes, what is it and what's the rational? What's the theory? Take us through it.
Annie: OK, well it actually didn't come from a theory. It came out of a practice, kind of a practice career that Bill Miller had where he had been working a lot with alcoholics and people who had a lot of difficulty making behavior change with substance abuse.
In the early 80's he was able to go take a sabbatical in Norway and so out of that year of working with students asking him questions about why he did this and why he did that, he came up with a set of strategies that he thought were comprehensive, sort of cohesive that he called motivational interviewing, then wrote this little article that was published in '82.
Add into that Steve Rollnick who is a psychologist and was practicing. I think he was from South Africa but he might have been up in the UK. He read the article and began to talk to Bill about this idea. The whole idea of motivational interviewing was developed from practice. After they developed it, they decided to look at where it met up with some theories. There are a lot of different theories it meets up with.
What it is, is a client centered set of skills and strategies applied by the interviewer to a client who is in relationship to behavior change. Usually the client has some ambivalence, a yeah-but stance about behavior change. "I need to quit drinking, but..." "I know I should eat better, but it's not possible." That kind of ambivalence.
Motivational Interviewing is simple, but it's not easy. It takes these real simple client centered techniques and strategies that you probably learn in counseling school, like reflective listening and open questions, summarizing what you hear the clients say. And really giving it back to the person in a somewhat directional way, that's also watching for acceptance or resistance. As the client gets moving toward behavior change, they're able to tolerate and receive more of the statements that are directional towards the change.
Dr. Van Nuys: They're able to receive more of the statements directed towards change because...
Annie: Because they're moving in the direction of the change. Let me give you an example. There's a person who's sitting in my office who want to - doesn't necessarily want to stop drinking, but they know they need to make a change. And we start talking, and I start asking them open questions. Tell me about your drinking. As they answer, instead of me continuing to ask questions, I reflect back to them what I hear them say.
As I hear them moving towards reasons why they might want to make the change or how they would go about it, I put that back into the reflection. When I do that, the person lets me know whether they accept that or they reject it. For instance, if I said, "You're not sure if this is going to work for you, but you'd really like to drink differently because it's causing you some problems in your marriage?" And the person would say something like, "Yeah. It is really something that is making me fight a lot with my wife, and I'm not sure that I can change drinking. But I definitely want to do something about my marriage."
So, they start to crystallize and get very aware of where they're motivated and what they're motivated for. Clarify their values, and all sorts of stuff. Motivational Interviewing is just this really conversational way of creating that space for people to explore the ambivalence and to resolve the ambivalence with their own thoughts, because I'm not actually adding much in. I may add a little twist to push a person to see if they would take that direction, but if they put up their resistance, then I would back off.
Dr. Van Nuys: Now, this sounds an awful lot like Carl Rogers person centered therapy. Is there something in addition that's added to it to turn it from classic Carl Rogers into Motivational Interviewing?
Annie: Yeah, that's a great question. Bill Miller is actually an old Rogerian. He studied a lot about Carl Rogers, so that's one of the theories that came up as they were trying to see where does this fit. Another one would be Self Perception theory. I think that's Bem. So there's lots of different ways that you can apply theory to this.
The thing that makes Motivational Interviewing different, there's a couple of things. One is the directional quality of it. And there're four principles, four guiding principles. To support self-efficacy. To roll with resist, you don't confront resistance, you just kind of back off and come at it a different way. To be very empathic, which, of course, is very Rogerian, to be expressing empathy. And to develop discrepancy, to really develop this sort of awareness in the person of what their vision is for themselves in the future, what it's been like in the past. How have they made change in the past. So there's a lot of packaging up those pieces for people, as you're talking.
The second piece that makes Motivational Interviewing very interesting is this piece called change talk. Let me back up a little bit, and just tell you when Miller and Rollnick got this going, and they really felt like they had something there, they wanted to study it. So they put it in a big research study called the Project Match study. Project Match study was a large cohort of low-bottom drinking men who weren't really likely to make change.
What they wanted to do was compare Motivational Interviewing to two other pieces. One was facilitated self-help, or 12-Steps. And the second one was psycho education, traditional cognitive behavioral psycho education that we do with people when they come into treatment.
One group got facilitated support, 12 weeks of it. One group got traditional psycho education. And Miller said, "Let's do one session of Motivational Interview." And while the research...
Dr. Van Nuys: Oh, this sounds interesting.
Annie: It's very interesting. The research folks said, no you can't do that, because it doesn't line up. You've got 12 and 12, so you've got to do something else. So they agreed to do four. They did four sessions of Motivational Interviewing compared to these other 12. What they found was that, they found a lot of different things, but what they found was none of the groups made significantly more change in terms of developing abstinence over the course of the treatment and over the course of the subsequent follow-up time.
Everybody developed the same amount of change. However, when they looked at each group, the Motivational Interviewing group, over time, changed significantly in terms of lowering amounts and frequency of drinks. So there was a significant change in terms of harm reduction, although not a significant change if you're only coding for abstinence.
So that got everybody's attention, because 12 of something compared to four of something. That's a big money saver.
Dr. Van Nuys: Yes.
Annie: When Miller started to look at what they had, what they had were these tapes of these sessions, because they needed to make sure that the technique was actually happening. So Motivational Interviewing is always coded and taped for validity. When they listened to the tapes, they couldn't really tell why some people were making changes, and why they weren't.
So Bill brought the tapes to this guy, Paul Arnheim, who's a linguist, and said, "Could you tell me if you think anything's going on here that we're missing?" And he listened to the tapes, listened to quite a lot of them, and came up with this idea of change talk. That when people are likely to make changes, they begin to start to talk in this way of saying, "I want to...", "I need to...", "I have reasons to...," "I know I can..." And then the jewel of change talk, which is commitment. "I will, " "I'm going to."
So it's desire, ability, reasons, need. And then commitment really seals the deal. Actually, if you listen to tapes of Motivational Interviewing sessions and you get a lot of change talk, then you begin to reflect the change talk. Reflecting the change talk creates more momentum for change, and that actually is predictive of future change in clients and subjects.
Dr. Van Nuys: That's fascinating. So the reflection, also, I supposed, could be seen as kind of reinforcement.
Annie: It's reinforcement with a caveat that you're not pushing farther than the client is willing to go. Part of the difficulty in training Motivational Interviewing, you're training people to be reflective, you're training them to reflect the right things, you're training them to be directional, and you're also training them to hold the pace that the client is holding.
And this is where I come back to my labor of delivery metaphor, because it is really like being in a labor with somebody. They're not going to be ready to push out that baby until they're ready, until they're completely ready from the inside out. So I can wish it would happen all day long, but as a Motivational Interviewer, I have to hold back, and I have to really read what that client is giving me.
If I'm getting a lot of resistance, negativity or the client getting, maybe they're avoiding the question, or they're being really polite, "Yes, mam," which happened a lot in the cells. If I'm getting a lot of resistance, I have to back off in a way that allows the client the space to put something else on the table, or to bring that subject back up, because they don't feel like I'm going to push them in a direction.
So it's very counter to what happened in traditional treatment for many, many years. Where you put somebody on the hot seat and you confronted them, and if they didn't like it you told them that they had to learn to like it. So it's very much different. What Miller actually set it up... a forum that I was just in recently, which I loved, is we provide the labor, we don't provide the baby.
We want to create the best climate for somebody to think about making that change and develop their confidence that they can and will make that change. But we're not in charge of that, the client's still in charge.
Dr. Van Nuys: Well, what you're saying makes a lot of sense to me, and at the same time I'm remembering what you said about four sessions being a savings over 12 sessions. It sounds like this could be interminable if you're not pushing them towards that change. Is there any sort of standard length of time, or is it really open-ended? Sometimes people, in my experience with myself, if not with other people, I can get stuck in my ambivalence interminably.
Annie: Well, it's true. I think that this method is really helpful to people to help them clarify where they are in that ambivalence, and maybe where they are in that change. Sometimes, when you're talking to people, they'll move right along into, "Wow, I don't understand why I waited so long. I didn't realize I was as ready as I was."
And sometimes you'll get somebody who says, "I don't think I'm anywhere near doing this." You have to respect where the person is and what's getting in the way. A lot of it just depends on what the change is and what the story is, and where they've made change in the past.
I'll give you an example from my own life. I needed to go to graduate school because I was doing a lot of counseling and a lot of things that I wasn't really trained for as a nurse. And I kept putting it off, and I didn't want to think about it. It was really something I just would say, "Well, I don't really need school. I don't really want to go to school." And it wasn't until I had a time with somebody who was really listening to me, and telling me back what I was saying, that I realized that the big thing that was the barrier for me was that I had a lot of anxiety about taking a math test again. Doing the GRE.
Then that became such a pin-pointed issue, that I realized, well, I could take a course and I could do practice tests, and I could find a grad school that didn't need a GRE. So there were a lot of ways to solve that and get me moving. But I had no idea that that was getting in the way.
A lot of times it's a simple sort of unfolding for somebody of what's getting in the way. In my practice experience, when I'm working with somebody who's pretty ambivalent about a big change, what I'll see is a three- to four-month window, if there is true ambivalence. Often, there are little bitty changes all along the way. So I'm seeing change that's building on their momentum for other change. Sometimes it just snaps in, though. It's variable.
The trick and they key is to really read what the client is giving you, because they're going to teach you how to do this method. It's a learning to learn method. That's another piece of this puzzle. It is four sessions, and it sounds real simple. We just do some reflection and you listen for the change talk. It's actually not that simple to learn. It takes some practice and it takes some coaching and feedback. That's what Miller and others who have studied this have figured out.
And I think it's going to change the way we do all sorts of counseling, supervision and consultation, because people don't really learn much from a single training. They don't go in and do six hours of Motivational Interviewing and then: OK, got it, done, check. It's not like that. What Miller found when he did the MA study was that you needed to have consultation to follow-up, coaching and feedback to follow up the training information, the taped examples and the book, just reading about the method. That seems to be the thing that helps people learn the best.
So we are going to move, if we adopt Motivational Interviewing into a closed-door supervision where you close the door, and the magic happens, and you can't really say what you're doing what's working, into a more transparent kind of supervision of clinicians where we really supervise for techniques and try to tune and fine-tune the things that aren't working. Does that make sense?
Dr. Van Nuys: Yeah, it makes a lot of sense to me. I've been a long-time fan of Carl Roger's. I think that his approach seems simple on the outside, and he's had a much bigger impact on the profession than most people realize. He's often caricatured as simply repeating back what the person said. When I was teaching I would show a film of Carl Rogers working, and I would challenge the students to try to anticipate what he was going to say next.
Actually, you couldn't. So whatever he was doing was more subtle than simply saying back to the person what they had said.
Annie: There is some new writing about Rogers, and I can't quote it to you. I'm sorry, I can probably get it for you later. Where they're looking at old tapes of Rogers, it was a student of his. And seeing some of that subtle directionality that he may have actually been employing, it would be impossible not to be directional. Actually, the art of good reflection requires that you do some guessing. It requires that you...
So when I teach this, I teach people to, if they have a question, to turn that into a reflection. If there's something you want to know about a client, you put it in the form of a reflection. The client is going to help you get it right. If you're wrong, they're going to say, "No, that's wrong." But they're not going to be so defensive. You could also put a guess out there to see if the client would adapt with it, would take it on with you. "You know, it sounds like you're really at the end of your line with drinking."
That might be my spin on it. If the client says, "Yeah. You know, you're right, " then we're lining up together and they're taking my reflection in. And we're collaborating together. If a client says, "No, you've got that all wrong, " I still haven't lost any ground with client. There is a lot of...
Dr. Van Nuys: Where do you go from there? You say you haven't lost any ground. But where do you go when they say, "No. You've got it all wrong."
Annie: Well, you get this great opportunity to do the "tell me more" question. Because you want to be listening more from the, "Oh, Man. I got it wrong. Tell me how, explain more to me. Give me some more to go on." And as long as you're in reflection mode with people, there's no getting it wrong. Because you're just trying to get it right so they can think and experience more about what's going on with them.
If you're doing Motivational Interviewing right, you're actually talking less than 50% of the time. The client is doing most of the talking. And now, it's demonstrated. I think the number is over the center. But definitely shown efficacy, Motivational Interviewing shows efficacy toward behavior change in over 190 randomized trials, probably more now.
When they do qualitative discussion with clients after they've had it, clients really come up with almost the same language that Miller and Rollnick came what as they were describing it. They'll say stuff like, "I felt like that person really got it. I felt like he understood me. I got my own sense of what I need to do. I understood, for the first time, what was holding me back."
So, clients will give you this sort of language of feeling connected to, and feeling the presence of the other person, but not pushed in any way.
Dr. Van Nuys: OK. Well, so far, we've talked about Motivational Interviewing in the context of addiction. Is that the only context in which it's used?
Annie: No, it's actually, like I said, it's catching on like wildfire in terms of applications. What's happened is people are using it with health behavior change. That was Rollnick's specialty. There's a big application in alternative work with HIV, so I'm thinking cardiovascular disease, diabetes, HIV. People are using it now with severe mental illness, head injury. Definitely it's got a great application with adolescents, I can attest to that in my work and also with my own kids.
Just having a sort of wildfire. Anything you can think of, somebody's thinking of Motivational Interview. We're thinking about it now a lot with aging in adult populations who have a hard time thinking about change, because change means loss. Losing their ability to drive, losing their house, losing their independence. Those kinds of things.
So anything you can think of, you can Google Motivational Interviewing and Pregnant Sex Workers and you can find a study. It's awesome, actually, and it's quite daunting, as well.
Dr. Van Nuys: What's the daunting part?
Annie: Well, I think that the idea that's it's growing so fast that it's you know what I think about. I think about how, when self-help really took over in the seventies and people started to speak the language of self-help.
We had Betty Ford going to treatment, not just creating her own treatment center, but going to treatment. We had this language of recovery, this language of self-help.
Well, motivational interviewing is a culture change agent for different places. There's a great promise and opportunity there, and then there's also this thing of people trying to use it every which way, and teach it every which way and not really reflecting, "is this the place to use it?" . It's not the panacea; it's a tool.
It's quite an effective tool and it works it lots of settings and lots of situations, but people get resistant to it if they think your saying, "this is it for everything." It's very effective. It's a very effective therapeutic tool, and I think it's going to be the standard in education and clinical practice.
I think people are really going to need to learn how to do it, and develop and demonstrate proficiency at it. I love teaching doctors and nurses about it. I love teaching brief interventions, people who are seeing somebody for maybe five minutes, or people who don't have a lot of time because they have a lot of applications.
It needs a lot of training, it's not something you can just sit in six hours and say, "OK I got it." So, agencies and systems are going to have to revamp how they train their people if they're going to value the method. Because they want to be sure they're getting a good version of the method, not something that's co-opted or hi-jacked.
Dr. Van Nuys: Yea, I can hear that that's one of the challenges. It could get so popular that it gets, as you say; co-opted, hi-jacked, diluted. Then people say "oh this doesn't work." And it doesn't work because it was not properly applied.
Annie: I'm actually experiencing now a lot, where I'll go into trainings and ask people how many people have had trainings in it. They raise their hand, but they don't really know some of the components that I'm talking about.
So, somebody's put something out there and said this is it. There are a lot of people that I train that have a viewpoint of it that's not real and/or they haven't really been exposed to it.
It takes a lot of work; you have to be pretty motivated to do it. What I'm asking people to do is to practice in front of me, to role play and real play in workshops, to submit tapes back for feedback; to really open up that part of themselves.
When you begin to do it... When I started to do it, I had been doing my work for seven to ten years. I was good at it, I had a style, and it asked me to suspend all that and practice these skills. Then to find a way to integrate it into my style and also to integrate it into everything else I think that works.
Dr. Van Nuys: And that's scary right?
Annie: It is. You feel kind of scrutinized.
Dr. Van Nuys: To embark on that kind of change and expose your. Yeah.
Annie: The other thing I will say though is, it's a wonderful, it's a great thing. It integrates well with so many other practices. It integrates well with narrative therapy, it integrates well cognitive behavioral, it integrates well with psychotherapy. There's a lot of ways that you can use it when it's useful, and put it up on the shelf and use something else.
Dr. Van Nuys: Wouldn't cognitive behavioral tend to be more directional? More directive?
Annie: Yea, and there's definitely a place where people get ready to make the change. One of the big pitfalls for therapists, even good therapists, when their using motivational interviewing is; they get people in their ambivalence, they're really good at exploring their ambivalence, and then get a client who's ready to move on, actually made a decision, and ready to take some action.
That is the time to move out of motivational interviewing, because you don't need to explore any more ambivalence and resolve it; you need to move into action steps.
So, you do get more directional. There are ways to do it, to hold to the philosophy of motivational interviewing. Where you ask the person for permission, you give them little bite sized steps to take, you make sure that what you're offering is a menu rather than just one solution. You may move them into some other especially in a long-term relationship, you're not going to just do motivational interviewing. You're going to move into whatever else you think is going to work for the person.
Dr. Van Nuys: Well, this has really been fascinating. As we wrap up here is there anything that you haven't had a chance to say that you'd like our listeners to know?
Annie: Yea. I'd like them to know that I, of course, am very passionate about this, and love to train it, talk about it, teach it, and think about it. There's a whole network of people, it's really international, on the Internet, it's called the Motivational Interviewing Network of Trainers, called the MINT. If you go to the website, motivationalinterviewing.org, you can find many, many things around research, around how people are using it. There are training of trainers. You can get advanced trainings, beginning trainings, you can find a trainer in your area. I would really encourage people to do that.
The other thing I want to say is that; Miller and Rollnick have created this model that is not stagnate. They've opened it up, that's why there's so much research. There is this open dialogue with them. I could call either of them tomorrow and say, "Hey, I was thinking about this, " or email them "Hey, you know what, what do you think about this?" There's quite a network of communication going on around it.
They don't try to own this, even though they are the innovators. They've really opened it up for other innovation. Which I think is phenomenal and post-modern and very exciting.
Dr. Van Nuys: Excellent. Well Annie Fahy, thanks so much for being my guest today on Wise Counsel.
Dr. Van Nuys: I hope you learned as much as I did from this conversation with Annie Fahy. I loved her enthusiasm for the motivational interviewing approach. One of the things she kept emphasizing was the need for extensive supervision through direct observation, role-plays, listening to audio, or watching videotapes.
Annie: Thanks for asking me.
Clearly this work is rooted in the work of Carl Rogers. Something many people don't realize is that one of Rogers' major contributions to the field was the taping of therapy sessions for research and supervision purposes. Up until Rogers' appearance on the scene, psychoanalysis was the dominant therapeutic model in this country. Psychoanalytic practitioners held that the privacy of the therapeutic hour needed to be held sacred, much like between the priest and parishioner in Catholic confession. However, Rogers argued that for psychotherapy to progress, as both a science and an art, it was essential that the process be open to study. Today that once radical idea is widely taken for granted.
You've been listening to Wise Counsel, a podcast interview series sponsored by mentalhelp.net. If you've found today's show interesting, we encourage you to visit mentalhelp.net, where you can add a comment or question to this shows web page, view other shows in this series, or simply page through the site, which is full of interesting mental health and wellness content.
Access this shows page and show archived information via the podcast box on the mentalhelp.net home page. If you like Wise Counsel, you might also like Shrink Rap Radio, my other interview podcast series which is available online at www.shrinkrapradio.com, and rap is spelled RAP. Until next time this is Doctor David Van Nuys and you've been listening to Wise Council.