Approaches of Solution Focused Therapy and Motivational Interviewing in the Treatment of Alcoholism - Essay Example

THE APPROACHES OF SOLUTION FOCUSED BRIEF THERAPY AND MOTIVATIONAL INTERVIEWING IN THE TREATMENT OF ALCOHOLISM/ EXCESSIVE DRINKING By 15 March 2010 The Approaches of Solution Focused Brief Therapy and Motivational Interviewing in the Treatment of Alcoholism/ Excessive Drinking Introduction The current state of literature provides an extensive review of various therapeutic approaches to alcohol and drug problems. Solution focused brief therapy (SFBT) and motivational interviewing (MI) are often cited among the most popular, the most effective, and the most productive approaches to addiction counseling. In the current state of addiction studies, it would be fair to say that SFBT and MI represent the two opposite ends of one therapeutic continuum: while MI leads individuals to recognize their substance-abuse problems and to realize the need for a profound behavioral change, SFBT, instead, seeks identify and utilize inner resources necessary for individuals to find effective solutions, build future hopes/ goals, and the ways of achieving them. Brief description SFBT became a turning point in the evolution of psychotherapy from long to short forms of treatment (Bannink 2007). SFBT was developed in the 1980s and aimed to shift the emphasis of psychotherapy from conventional problem solving techniques to building effective solutions. SFBT claims that “the development of a solution is not necessarily related to the problem; the client is the expert; if it is not broken, do not fix it; if something works, continue with it; if something does not work, do something else” (Bannink 2007). In simpler terms, SFBT does not explore the reasons and motives of the past failures but concentrates on exploring the resources available to build future hopes, future goals, and the strategies for achieving them. One of the most radical assumptions ever proposed by SFBT is in that solutions do not need to have much in common with the problem (Stalker, Levene & Coady 1999). In its turn, motivational interviewing comprises a set of formalized, theory-based and empirically tested interpersonal communication approaches that should lead individuals to recognize their substance abuse problems and the need to address them (Compton, Monahan & Simmons-Cody 1999). Motivational interviewing utilizes the benefits of nonconfrontational communication approaches to make patients express their concern about substance abuse problems and move them closer to cessation (Compton, Monahan & Simmons-Cody 1999). In MI, clinicians never advise patients directly to stop drinking, nor do they confront individuals about their problems; but they develop and use communication strategies to enhance drinkers’ motivation and raise the probability that they will make a positive change in their habits (Compton, Monahan & Simmons-Cody 1999). How strategies work SFBT creates conditions that allow the client to produce a spontaneous solution and does not focus on the reasons and symptoms of the addiction problem. That is why SFBT interventions usually begin with obtaining limited information about their clients (Stalker, Levene & Coady 1999). In distinction from other, similar approaches to addiction therapies, SFBT intentionally avoids discussing past problems and needs only information about how the problem could be solved. The search for and analysis of the exception is the next stage of SFBT: therapists should help the client to imagine and describe a situation, in which the client would be and live if the problem were solved (Stalker, Levene & Coady 1999). In its current state, however, professionals in SFBT gradually shift their attention from exploring exceptions to analyzing what the client is doing to achieve an effective solution (Iveson 2002). In this way, SFBT implies that all clients are inherently motivated to solve their problems in an efficient and productive way. Even if clients engage in SFBT without believing that they may have a different life, the mere desire of something different can suffice to enhance the quality of SFBT interventions and to bring the client to the anticipated outcome. At later stages of therapy, SFBT applies to a system of clues and compliments that encourage clients to see themselves as normal with normal problems (Stalker, Levene & Coady 1999). SFBT makes clients accept these clues, compliments, and encouragements as the elements that would lead them in the right direction. SFBT usually requires up to five sessions, with each no longer than 45 minutes, and rarely goes beyond eight sessions (Iveson 2002). These can be further complemented with follow-up sessions, to sustain a long-term change in clients’ habits. Motivational interview begins with substance abuse assessment that analyzes the client’s drinking history (Compton, Monahan & Simmons-Cody 1999). The information about psychiatric disorders, child abuse and, possibly, the results of physical examination help clinicians to establish the need for motivational treatment. MI works through close interpersonal relationships with the client that are based on trust and acceptance, and clinicians should begin their MI interventions by identifying the most positive way of establishing rapport and positive tone for the motivational interview (Compton, Monahan & Simmons-Cody 1999). These are usually followed by building motivation through reflective listening and/ or encouraging self-motivational statements (Compton, Monahan & Simmons-Cody 1999). Supporting commitment to change is the third stage of the MI process, when clinicians should build and maintain long-term alliance with the patient, continuously explore the client’s substance abuse problem, and set incremental goals (Compton, Monahan & Simmons-Cody 1999). This stage usually implies that the client and the clinician will develop and sign a formal plan of how to sustain a long-term positive change in drinking habits. SFBT vs. MI: addressing excessive drinking Both SFBT and MI seek to build an effective motivation to change and aim to utilize available inner resources to lead clients to a positive behavioral change, but these addiction approaches display serious practical variations and represent the two dramatically different visions of one substance abuse problem. To begin with, clinicians tend to differentiate between a psychosocial and a disease concept of alcoholism/ excessive drinking, and individuals with the psychosocial beliefs about excessive drinking are reported to have better chances to engage in and benefit of SFBT (Osborn 1997). Simultaneously, SFBT should meet the three main objectives: to change client’s perceptions, to change client’s behavior, and to help clients to assess their strengths (Miller 2004). In general terms, SFBT with substance abusers will focus on interviews to help the client use available strengths and resources to increase the frequency of times when alcohol is not used (Miller 2004). SFBT will seek to define what the client had been able to do to function until he (she) engaged in SFBT (Yeager 2002). The detailed discussion of what the client’s life will be like without excessive drinking will follow. Clinicians will ask questions necessary to identify actions and strategies that will help the patient to capitalize his (her) inner strengths and move toward cessation (Yeager 2002). SFBT will establish a change goal and explore what the client wants to change when the problem is no longer relevant (exceptions) and what the client will do differently when he (she) resolves the problem (Miller 2004). Like SFBT, MI will encourage patients to discuss their excessive drinking issues but, in distinction from SFBT, the focus will be on evaluating and analyzing the problem itself, the pros and cons of quitting this habit, and discussing potentially high-risk situations, which may prevent clients from improving their drinking behaviors (LaBrie et al 2006). MI often requires that clients with excessive drinking problems analyze the antecedents of drinking episodes and, simultaneously, identify the skills they currently have to deal with the problem effectively; in this sense, MI bears some kind of resemblance with SFBT. Yet, unlike SFBT, MI pushes clients to discuss the benefits they used to perceive in excessive drinking and the social expectations they held about their drinking habits: for example, sexual-enhancing effects are often linked to drinking (LaBrie et al 2006). As a result, while MI is focused on the problem, SFBT moves clients away from the problem toward the most productive solution. SFBT and MI: strengths and limitations Needless to say, both techniques have significant strengths and numerous limitations. First, SFBT zeroes the relevance of the therapeutic resistance concept and treats all clients as those, who inherently want to change (Stalker, Levene & Coady 1999). Second, in distinction from the approaches where therapists and clinicians act as experts, SFBT is believed to be a form of client-focused collaborative therapy, in which clients identify the goals and the ways to accomplish them (Stalker, Levene & Coady 1999). Third, SFBT is easy to understand and to transform into convenient schematic techniques (Stalker, Levene & Coady 1999). Unfortunately, the brief character of SFBT is still an issue of the major professional concern, and long-term sessions are considered as more effective compared to SFBT. SFBT is also blamed for negligence and no attention toward clients’ history and broader problem assessment (Stalker, Levene & Coady 1999). Finally, SFBT is sometimes linked to a problematic tendency toward “rigid adherence to narrow models and the belief that one model can be all things to all people” (Stalker, Levene & Coady 1999). In no way is SFBT universal and its applicability should be evaluated against each particular situation. Like SFBT, MI is a form of client-centered therapy, and its focus on individual concerns is fairly regarded as one of its basic strengths. MI is consciously directive – it is aimed to resolve the ambivalence as the critical stage of moving toward positive change (Miller & Rollnick 2002). MI is not a set of fixed techniques but is a method of communication, which makes MI extremely flexible and applicable in a variety of treatment contexts. Like SFBT, MI seeks to elicit patients’ intrinsic motivation to make a change in their habits and does not apply to extrinsic instruments like social pressure or punishment (Miller & Rollnick 2002). That MI focuses on producing change, which is consistent with one’s values and beliefs, is also one of its strengths. Nevertheless, in its current state, MI is not well understood and can hardly serve a panacea to all substance abuse problems. The outer limits of MI applicability are rather obscure, and there is no clear understanding as for when MI should not be used (Miller & Rollnick 2002). Objectively, there is still much to learn and understand about SFBT and MI. Personal opinion I believe that both SFBT and MI have their benefits and limitations, and both can serve the needs of clients in need for a profound behavioral change. However, I am confident that the current state of knowledge about these techniques is still in its infancy. Recent research findings are surrounded by much controversy, and the exact pros and cons of each technique are yet to be discovered. More important, however, are the strategies and approaches, which clinicians and social workers should utilize to sustain the positive results of SFBT and MI in the long run. Obviously, there is still a long way ahead before SFBT and MI become the integral components of psychotherapy approaches to substance abuse. Conclusion SFBT and MI represent the two ends of the one therapeutic continuum but can be equally effective in addressing substance abuse problems, including excessive drinking. Both techniques have significant strengths and numerous limitations. SFBT zeroes the relevance of the therapeutic resistance concept and treats all clients as those, who inherently want to change MI works through close interpersonal relationships with the client that are based on trust and acceptance, and clinicians should begin their MI interventions by identifying the most positive way of establishing rapport and positive tone for the motivational interview. Like SFBT, MI is a form of client-centered therapy, and its focus on individual concerns is fairly regarded as one of its basic strengths. MI is consciously directive – it is aimed to resolve the ambivalence as the critical stage of moving toward positive change. While SFBT if focused on finding the most appropriate and productive solution, MI seeks to analyze the problem itself, along with the sources and potential strength the client possesses to cope with behavioral difficulties. Both strategies have benefits and limitations, but more important are the ways, in which clinicians can sustain positive behavioral shifts in clients in the long run. As a result, there is still much to be done before SFBT and MI and their effects on drinking are well understood. References Bannink, FP 2007, ‘Solution-focused brief therapy’, J Contemp Psychother, vol. 37, pp. 87- 94. Compton, P, Monahan, G & Simmons-Cody, H 1999, ‘Motivational interviewing: An effective grief intervention for alcohol and drug abuse patients’, Nurse Practitioner, vol. 24, no. 11, pp. 27-49. Iveson, C 2002, ‘Solution-focused brief therapy’, Advances in Psychiatric Treatment, vol. 8, pp. 149-157. LaBrie, JW, Lamb, TF, Pedersen, ER & Quinlan, T 2006, ‘A group motivational interviewing reduces drinking and alcohol-related consequences in adjudicated college students’, Journal of College Student Development, vol. 47, no. 3, pp. 267-280. Miller, GA 2004, Learning the language of addiction counseling, 2nd ed, John Wiley & Sons. Miller, WR & Rollnick, S 2002, Motivational interviewing: Preparing people for change, Guilford Press. Osborn, CJ 1997, ‘Does disease matter? Incorporating solution-focused brief therapy in alcoholism treatment’, Journal of Alcohol and Drug Education, vol. 32, no. 1, pp. 18-30. Stalker, CA, Levene, JE & Coady, NF 1999, ‘Solution-focused brief therapy – one model fits all?’, Families in Society, vol. 80, no. 5, pp. 468-477. Yeager, KR 2002, ‘Crisis intervention with mentally ill chemical abusers: Application of brief solution-focused therapy and strengths perspective’, Brief Treatment and Crisis Intervention, vol. 2, no. 3, pp. 197-216. Read More