Podcast Summary
Podcast: Compassion in a T-Shirt
Episode: Using Motivational Interviewing to Create Change With Families | Doug Smith
Host: Dr Stan Steindl
Guest: Professor Doug Smith
Date: February 6, 2026
Main Theme
This episode explores how Motivational Interviewing (MI)—an evidence-based, client-centered counseling style—can be applied in work with families, not just individuals. Host Dr. Stan Steindl and guest Professor Doug Smith delve deeply into Doug’s new book, “Motivational Interviewing with Families,” examining practical strategies, systemic challenges, and philosophical shifts necessary for fostering real, compassionate change in complex family dynamics. The episode is rich with clinical wisdom, practical examples, and new conceptual frameworks for applying MI to families.
Key Discussion Points & Insights
1. Broad Definition and Scope of “Family Work”
[02:02]
- Doug Smith outlines a broad definition of family work, applicable not just to formal family therapists but to any clinician encountering multiple family members in practice.
- Quote: “I define family work as anytime a clinician or a helper is coming into contact with family members on behalf of their clients.” (Doug Smith, 02:17)
- Discusses various constellations (couples, parents with children, adult children with older adults) and takes a lifespan approach.
2. Complexity of MI with Families—Multi-Perspective Listening
[04:44]
- Doug emphasizes the increased complexity when using MI with families due to multiple individuals, perspectives, and motivations.
- Quote: “Rather than listening deeply to just one person, I’m listening deeply to a family system... I’ve seen a lot of what I refer to as doing individual therapy while the family just happens to be sitting there as passive bystanders.” (Doug Smith, 04:51)
- Importance of leveraging the wisdom of all family members, not just focusing on the identified client.
3. Practical “Family MI” Process—Pivoting and Balance
[07:38]
- Doug introduces the concept of “pivoting”—mindfully shifting attention and questions between family members to keep all engaged and prevent disengagement.
- Quote: “You really have to be mindful of talking to one person and then pivoting to the other person... so that they’re not just sitting around and becoming disengaged.” (Doug Smith, 08:10)
- Discusses monitoring “turns” (how often each person contributes) as an analogy to frequency counts of MI reflections/questions in individual MI.
4. Navigating Multiple and Interlocking Change Goals
[10:43 – 17:49]
- The challenge of managing overlapping and sometimes conflicting personal and family-level goals within MI sessions.
- Quote: “Is there a way to think about like a family level target behavior?...You’ve got interlocking goals, essentially. You can’t really separate family functioning goal from the substance use goal. They’re so interconnected.” (Doug Smith, 12:18)
- Introduces “multi-level change talk,” where one change may serve both individual and broader family goals.
5. Reflections as the “Engine” in Family MI—The RAWS Acronym
[18:21] – [23:56]
- Doug proposes reordering the classic MI acronym (OARS: Open questions, Affirmations, Reflections, Summaries) to RAWS, putting Reflections first.
- Quote: “If we truly want MI to be very reflection-heavy… why aren’t we emphasizing that? Why do we start with questions in the acronym?” (Doug Smith, 19:08)
- Explains how reflections can be easily adapted to address the whole family with simple linguistic shifts (“you all,” “everyone here”).
- Quote: “All we really need to do to a reflection... is add a little clause of like, ‘It sounds like all of you are feeling frustrated.’... And all of a sudden you’re opening a space for anyone in the room to talk.” (Doug Smith, 21:44)
6. Double-Sided and Family-Level Reflections
[25:01]
- Doug introduces "family-level double-sided reflections," reflecting two different people’s perspectives rather than two sides of one person’s ambivalence.
- Quote: “In a family level double-sided reflection, what you can do is highlight two different people’s perspectives... It sounds like you’re feeling this way about this, and on the other hand you’re feeling this way about this. So where does that leave us?” (Doug Smith, 25:10)
- Stan proposes a “triangular reflection”: reflecting both individuals' perspectives and identifying common ground.
7. Importance of Reflective Listening and Compassion in Difficult Family Conversations
[28:15 – 30:44]
- Reflections help validate, build understanding, and clarify meaning, reducing miscommunication.
- Quote: “Our client... doesn’t necessarily need that suggestion. Sometimes they just need a clinician that’s going to validate them... and to, you know, feel their pain and to understand their struggle.” (Doug Smith, 29:13)
- MI’s spirit of compassion is explicitly connected to the Latin root of “compassion”—“with pain.”
8. Navigating Autonomy, Messiness, and Outcomes in Family Work
[34:05]
- Balancing respect for autonomy (especially when family members want different things) is challenging but critical.
- Quote: “We as clinicians can’t make everything better for our clients... What we need to do to kind of plant that seed is... were still being empathic to their situation, still there with their feelings, and acknowledging their frustrations that things didn’t go well.” (Doug Smith, 35:13)
- The necessity of clinician acceptance of limited control over outcomes.
9. Family-Level Equipoise and “Not Taking Sides”
[38:31]
- The imperative to balance the MI spirit and affirmations evenly among all family members.
- Quote: “You can’t have one person’s affirmation be another person’s confrontation.” (Doug Smith, 39:14)
- The concept of “family-level equipoise” means not forming alliances, but maintaining a stance of neutrality and support for all.
10. Engagement, Attendance, and Working with Absent Family Members
[47:26]
- Strategies for dealing with missing family members, including using MI techniques to engage those not present or reluctant to participate.
- Quote: “There’s a way of having a whole motivational interviewing conversation about [bringing a family member], generating change talk about that as a potential target behavior, as a potential benefit.” (Doug Smith, 48:13)
11. The “Superfluous Engagement Trap” and Knowing When to Transition
[49:52]
- Warning against staying too long in engagement and rapport-building (“the superfluous engagement trap”) without moving toward evoking change and planning.
- Quote: “We've maybe spent a little bit too much thinking about, you know, maybe we have a tendency to lean too long into rapport... But I wonder if... somewhere between kind of a premature focus trap and a superfluous engagement trap is this middle ground.” (Doug Smith, 51:36)
12. The Art of Moving from Engagement to Evocation & Planning in Family MI
[54:21 – 57:54]
- Discusses the skillful transitions necessary as families (with different members at different readiness stages) move from engagement, to focus, to evocation, to planning.
13. Motivational Send-Offs: Ending Well, Every Time
[60:53]
- Importance of “motivational send-offs” — ending every session on a positive, compassionate, and hopeful note since families may not return.
- Quote: “What can I say to wrap this session up on a positive note, not knowing if they're ever going to come back and see me again?” (Doug Smith, 61:43)
14. Research, Hope, and the Future of MI with Families
[64:22]
- Doug shares enthusiasm for future research directions—such as tracking change talk at the individual and family level, and optimism about the broader benefits of family MI.
- Quote: “If we can improve the quality of life of multiple people with a single MI session, that would be really exciting.” (Doug Smith, 65:08)
Notable Quotes & Timestamps
-
“I define family work as anytime a clinician or a helper is coming into contact with family members on behalf of their clients.”
— Doug Smith [02:17] -
“You really have to be mindful of talking to one person and then pivoting to the other person...so that they’re not just sitting around and becoming disengaged.”
— Doug Smith [08:10] -
“You can’t have one person’s affirmation be another person’s confrontation.”
— Doug Smith [39:14] -
“If we truly want MI to be very reflection heavy...why aren't we emphasizing that? Why do we start with questions in the acronym?”
— Doug Smith [19:08] -
“It sounds like all of you are feeling frustrated. It sounds like all of you are committed to doing this.”
— Doug Smith [21:44] -
“In a family level double-sided reflection, you highlight two different people’s perspectives...and again, it’s another strategy for communicating to both parties that you’re listening to them both, that you’re not taking sides, that you want to work with them as a unit.”
— Doug Smith [25:10] -
“Sometimes they just need a clinician that’s going to validate them... and to, you know, feel their pain and to understand their struggle.”
— Doug Smith [29:13] -
“What can I say to wrap this session up on a positive note, not knowing if they're ever going to come back and see me again?”
— Doug Smith [61:43] -
“If we can improve the quality of life of multiple people with a single MI session, that would be really exciting.”
— Doug Smith [65:08]
Timestamps for Key Segments
- 00:00–02:51: Introduction & framing of family work in MI
- 04:44–07:00: Multi-perspective listening and the complexity of family systems
- 07:38–09:22: Pivoting, turn-taking, and practical session structure
- 10:43–17:49: Defining “change talk” at individual vs. family level
- 18:21–23:56: RAWS (Reflections first) and why MI should prioritize reflections
- 25:01–26:36: Double-sided and family-level reflections
- 30:44–33:01: Compassion, humility, and reflections for understanding and clarification
- 34:05–37:25: Navigating autonomy, family messiness, and managing clinician expectations
- 38:31–42:25: Family-level equipoise and avoiding taking sides
- 47:26–49:52: Engaging absent or reluctant family members
- 49:52–54:21: The “superfluous engagement trap” and transition to planning
- 60:53–62:58: Motivational send-offs and compassionate closure
- 64:22–65:31: Research directions and future optimism
Memorable Moments
- Doug’s “acronym heresy” (RAWS instead of OARS) and the relief at positive reception: “I haven’t had any hate mail about it yet.” [20:14]
- Stan’s spontaneous proposal of “triangular reflection” and Doug’s openness to future editions: “You’ve given me a lot to think about for the second edition.” [27:20]
- Bill Miller’s personal MI intervention with Doug to overcome his writer’s block: “They had an MI conversation with me about writer’s block—and it was brilliant!” [51:09]
Tone
Thoughtful, lively, deeply compassionate and practical, with an undercurrent of innovation and hopefulness for improving real-world family therapy outcomes. Both speakers model clinical humility, curiosity, and collaborative spirit throughout.
Conclusion
Professor Doug Smith’s approach to applying Motivational Interviewing with families offers both practical tools (pivoting, family-level reflections, RAWS acronym, motivational send-offs) and theoretical expansion (multi-level change talk, family-level equipoise) to meet the unique relational complexities of families. Clinicians are encouraged to thoughtfully integrate these concepts, fostering genuine compassion and systemic change—one family at a time.