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Motivational Interview and Addiction Counseling

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Marlee Gold

on 24 March 2014

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Transcript of Motivational Interview and Addiction Counseling

Effectiveness of MI
Systematic Review of MI in Health Care
Motivational Interview and Substance Use/Abuse
What exactly is MI?
MI is a multistage sequential model of counselling on the premise that change happens most effectively when it is generated by the client

MI is "client centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence," (Miller & Rollnick, 2002, p.25)
1.
Engaging
- involving client/establishing trust
2.
Focusing
- narrow conversation to habits
3.
Evoking
- increasing client's sense of importance to change
4.
Planning
- making practice sense
Critical Analysis
Using a critical analysis and an anti-oppressive perspective we can see how motivation interviewing can work to empower service users, and how some components can be oppressive
Strengths and Weaknesses
Strengths:
counseling approaches
conversational between the professional and service user
it starts where the client is at, the conversation is guided by the client
MI goes by the the client's motivation to change and deal with their addiction in the way they wish, with guidance (Hettema, Steele & Miller, 2005)
the client is the producer of knowledge, their perspective is highly valued
History of Motivational Interviewing
Motivational Interviewing/therapy was brought to public awareness by William Miller in a 1983 article published in
Behavioural Psychotherapy.


In 1991, Miller and Stephen Rollnick expanded on the fundamental approaches and concepts, while making more detailed descriptions of procedures in the clinical setting and then first publicized what is now motivational interviewing.


Since Miller and Rollnick, other psychologist have introduced models/techniques to try to implement within the Motivational Therapy realm to help with substance Abuse.
Example: Carlo DiClemente proposing the Stages of Change Model
Stages of Change Model
Stages of Change
Precontemplation
Not ready to change

Contemplation
Thinking about change

Preparation
Getting ready to make a change, planning and commitment

Action
Making the change, implementing the plan, and taking the action

Maintenance
Sustaining behaviour change until integrated into lifestyle, maintaing, and integrating

Relapse/Recycling
Slipping back to previous behaviour and re-entering the cycle of change

Termination
Leaving the cycle of change
MI focuses on the present, while cultivating warmth, genuine empathy, and acceptance to foster therapeutic gain
... continued
"Counselors can be helpful in 'tipping the scales' in favor of readiness to make a positive change," (Van Wormer & Davis, 2013, p.423)
MI General Processes:
MI Basic Interaction skills:
1. Open ended questions
2. provide affirmation
3. Reflective listening
4. Summary statement
Skit...
Any thoughts about the interaction between the "client" and "counsellor?" Positives? Negatives?
What worked, What did not?
Purpose:
MI resolves ambivalence about behavioural change

Method:
Search electronic databases for articles specifying the use of MI in physical health care setting

Results:
Eight studies exacted; significant psychological, physiological, and life-style changes

Conclusions:
Quality of trials in this area are inadequate; more research required
A Quantitative review and meta-analysis
Purpose:
Evaluate the effectiveness of MI in areas of disease

Method:
Select of 16 databases; systemic literature; produced 72 randomized trials

Results:
95% positive effect of MI on blood cholesterol, systolic blood pressure, blood alcohol
equal effect on physiological (72%) and psychological (75%) diseases
MI and Feedback for college drinkers
Purpose:
To test the effectiveness of Motivational Interviewing

Method:
279 heavy drinkers: 1 large intake in 2 weeks; 27 UK units
First Group:
randomly selected 1 in 4, for MI & feedback
Second Group:
Lite MI & computerized assessment/no feedback

Results:

First Group:
large reduction in intake by 9 UK units
MI & feedback held major reductions
Second Group:
half a unit reduction only
Randomized Trial of MI: Testing tobacco, alcohol and drug use
Purpose:
Test for MI effectiveness on tobacco, alcohol and drug use cessation

Method:
randomized trial with 416 UK students aged 16-19 years old
MI compared to practice classroom-delivered Drug Awareness intervention
target cigarette, acohol and cannabis users

Results:
MI was not demonstrated to be effective in individualized MI sessions
Unexpected lower levels of cannabis in Drug Awareness control condition
MI and Clinical Psychology
Purpose:
Survey literature on MI - ambivalence and addictions
Discusses possible impact on clinical psychology; on teaching communication skills

Method:
Literature reviews and meta-analysis of numerous clinical trials of motivational interviews for addiction treatment applied to psychiatric settings

Results:
There is no evidence that motivational interviewing achieves better results
Explanation for the method's rapid effectiveness remains speculative
Strengths continued...
power with approach, as opposed to power over
this approach helps service users feel more appreciated as it validates their narratives, goals and concerns
this approach allows relapse (Hartney, 2001), which can help individuals find what triggers addictive behaviours if they bring it up in conversation with the service provider
MI works well in individual sessions and in group sessions
it is anti-oppressive and non-judgmental; and placed value on the service user
MI can be a fast working technique, although its not proven to be better (Chanut et al, 2005),
Weaknesses

resistance to change
when a service provider and the client disagree on what is considered a problem and what needs to be changed in order for the client to progress, it can turn into a dilemma because the service provider may want to evoke change when the client is not at that stage yet (Hettema et al, 2005)
can potentially be oppressive and patronizing if the professional asks leading questions that come off as them being the expert, because they may find it hard to suppress what they feel needs to happen
Weaknesses continued...
Sessions may be too short for some individuals, they may want a longer type of therapy
one may be going through a large change and want an ongoing type of support that MI may not be able to offer them once a treatment plan is put into action and they are done their sessions
Critical Analysis continued...

Miller and Rollnick (1991) have defined motivational interviewing "as an approach designed to help clients build commitment and reach a decision to change. In this appraoch the counselor assumes responsibility for motivating the client by using strategies to enhance the likelihood that the client will become engaged and undertake change," (Annis et al, 1996, pp.39-40)
inherently both empowering and oppressive
issue of MI actually being client-centered
issue of motivating client to increase their own motivation - oppressive or empowering?
However, if counselor is critically conscious and reflexive, MI can be positive and beneficial

therapist using MI does not intend to convince client of their denial
instead facilitates and support client to identify their own concerns
this is consistent with AOP fourth practice principle of working in partnership:
"For anti-oppressive practitioners, any gesture toward partnership must begin with genuine sharing of power at the interpersonal and institutional levels," (Healy, 2005, p.187)
Motivational interviewing allows the room for the client to decide for themselves what their goals are to, and it is further grounded on the notion of respect and developing an egalitarian relationship
This is consistent within an anti-oppressive framework

"Anti-oppressive practice embodies a person-centered philosophy, an egalitarian value system ... and a way of structuring social relationships between individuals that aim to empower service users by reducing the negative...," (Healy, 2005, p.179)
Biopsychosocial-spiritual model:
advantage of addressing more than one problem and use with any philosophical approach
can be consistent with MI
use of MI and maintaining a biopsychosocial-spiritual model can allow service provider to facilitate service user's exploration of all areas of their life
"Some problems cause substance use; some problems result from substance use; and some simply emerge along with substance use as the result of genetic, personality or environmental conditions," (Van Wormer & Davis, 2013, p.16)
Thank You!
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