Motivational Interviewing for Group Therapy - Essay Example

Motivational Interviewing for Group Therapy Introduction One of the major challenges that clinicians face for treatment of dual disorders are those clients who engage in treatment but do not acknowledge substance abuse as a problem. Furthermore, court and jail centers that cater to individuals mandated for drug detention often fail to provide treatment for dual diagnosis of disorders. In most cases, patients who have dual disorders are treated for substance abuse alone while the mental disorder is overlooked. It has also been observed that the lack of motivation is the common and most pervasive characteristics of clients with dual disorders. Although motivational interviewing is commonly associated with substance abuse problems, it has also found varied applicability in clinical problems such as psychosis and other severe mental disorders. Clinical practitioners have reported that “the principles of motivational interviewing have broad applicability for addressing problematic behaviors (including substance abuse and non-adherence to treatment recommendations) that interfere with clients with dual disorders in achieving their personal goals” (Mueser, Noordsy & Drake, 2003, p. 108). It is in light of the issues presented above that I have chosen individuals who have dual disorders – substance abuse and mental disorders – as the treatment population for designing a motivational interviewing group therapy. Many chronic drug abusers, or commonly referred to as addicts, often simultaneously suffer from serious mental disorders. Substance abuse treatment and medical professionals call this condition co-occurring disorder or having dual diagnosis. While doing internship at 26th in California, a court and jail facility, most of the clients have been mandated to attend treatment for substances abuse. While helping clients with substance abuse problems, the court system has no provisions for assistance of co-occurring mental disorders. According to the American Psychiatric Association (DSM-IV), most individuals who have substance abuse problems also have mental disorders as well. Neglecting these mental disorders is not only detrimental to the patient but will further feed the cycle of violence and crime. I believe that treatment of both the substance abuse and mental problems is the most effective way of decreasing crime rate which is the ultimate goal of our judicial system. The succeeding sections of the paper will discuss the treatment population and the group therapy design for motivational interviewing. Description of Target Population As previously discussed, the target population for the therapeutic intervention will be inmates from 26th California court and jail facility who are diagnosed with dual disorders of substance abuse and mental disorders. Literature states that chronic drug abuse is the habitual abuse of licit or illicit drugs to the extent that the abuse substantially injures a persons health or substantially interferes with his or her social or economic functioning. Furthermore, any person who has lost the power of self-control over the use of drugs/ alcohol is considered a chronic substance abuser. The American Psychiatric Association states that chronic substance abuse may occur in conjunction with any mental illness identified in Diagnostic Statistical Manual-IV (DSM-IV). Some common serious mental disorders associated with chronic substance abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and antisocial personality disorder. Some of these disorders carry with them an increased risk of substance abuse.  At the heart of motivational interviewing for group therapy is the creation of safe environment for patients to share with each other their stories, hopes and goals. Referred to as “persuasion groups”, they “provide numerous opportunities for exploring personal goals, developing discrepancy between goals and substance abuse, overcoming resistance to change, and supporting self-efficacy” (Ginsburg, Mann, Rotgers & Weekes, 2002, p.119). There is value therefore, in designing a program that takes into consideration cultural, socio-economic and gender differences to initially structure a safe environment that will allow for open and unbiased interaction among patients. However, it is also important to include individuals from different stages of recovery to “provide a variety of active peers and role models” (Mueser, Noordsy & Drake, 2003, p. 139). All these must be considered in the program design. Program Design Program design begins with the identification of treatment groups. It is proposed that because such group therapy session is still at an initial stage for this particular facility, a more homogenous type of grouping will be implemented. This will also address the issue of facilitator experience which may be relatively less developed at this stage of program implementation. A more homogenous group will be easier to handle and the establishment of a safe environment will be readily achieved. Members of the groups will be identified through similarities in cultural background, socio-economic status and gender. Gender mix in some studies have proven to be reinforcing thus, what this design proposes is that after a certain duration and once trust has been established in the group, similar socio-cultural background of different genders be given an opportunity to interact as a form of advancing into the group therapy treatment. These groups are expected to be long-term groups with the goal of addressing both substance abuse problems and mental disorders. The initial step involves the patient’s acknowledgement of the accompanying mental disorders, despite the fact that the common thread among them is the mandated rehabilitation for substance abuse. There are two major goals therefore, for these treatment groups. First, is the creation of plans and goals to address the substance abuse. Second, is the identification and acknowledgement of associated mental disorders with hopes that this pre-contemplative stage will bring them towards the direction for change. A group size with 6 active members is suggested and must not go beyond 12 members for effective logistical management. Facilitators must make a mental note of including participative members who can encourage the more resistant and less cooperative ones. An assumption of motivational interviewing is the voluntary engagement of the client, but majority of the patients in this case have been court-mandated. There are however, techniques to motivate them to participate and the approaches and strategies of motivational interviewing can address this issue. At this stage, the success of persuading target participation rests on the abilities of social workers, psychologist and other mental health practitioner. The groups will meet on a weekly basis with sessions lasting from 45 – 60 minutes, depending on the size of the group. Preparation of each member is important and thus ground rules must be established. Facilitators must be able to establish mutual trust among members and activities borrowed from adventure therapy, usually fun and engaging activities, may be effective in the creation of a safe environment at the introductory session. Expectations setting and goal setting are important at the beginning of the program. To instill the sense of ownership among the patients, they must set the goals themselves. The facilitator though must structure the discussion such that information is classified according to substance-related or psychological-related problems to present a clear understanding of the circumstances they are in. Moving further into the therapy sessions, art activities may also be employed, as well as the use of genogram to trace patterns in addiction. This will allow the patients to appreciate various models of addiction and in the process impact the attributions that they make about their disorders. Attributions that individuals make regarding substance use have proven to impact recovery significantly. To further motivate and persuade patients for change, resource speakers may also be invited for inspirational talks/ discussions. Social skills training will also be given to equip patients with skills to sustain substance abstinence and handle peer pressure. Certain internal systems such as checking-in, determination of topics or activities and closing remarks must be in place, as well. For this type of intervention, two types of therapists/ facilitators are recommended: one that has an expertise in treating substance-abuse disorders; and the other who has expertise in the field of mental disorders. I come into the treatment program with valuable experience in the field of substance abuse as part of my training background. To monitor progress of the patients, they will be evaluated on a monthly basis from both group members and facilitator/s. Feedback may be given in group sessions or individually from facilitators. In some cases, feedback is given in a letter format which is not very formal and imposing on the patients. Due to the circumstances that brought these individuals into the treatment program, group therapy sessions will also conclude at the conclusion of their mandatory attendance. However, the nature of motivational interviewing gives power to the clients and they are therefore, given the option to continue attending the sessions or move on to other centers which offer group therapy sessions with a more diverse clientele. Doing so, will further benefit their support system and give them a wider scope for social interaction. References: Bilsen, H.V. & Ernst, A.V. (1989). Motivating heroin users for change. In G. Bennett (Ed.), Treating drug abusers (pp. 29-47). London: Routledge. McLellan, A. T. (2008). Evolution in addiction treatment concepts and methods. In M. Galanter & H.D. Kleber, The American Psychiatric publishing textbook of substance abuse treatment. Arlington, VA: American Psychiatric Publishing, Inc. Ginsburg, J.I.D., Mann, R.E., Rotgers, F., Weekes, J.R. (2002). Motivational Interviewing with Criminal Justice Populations. In W.R. Miller & Rollnick, S., Motivational Interviewing: Preparing People for Change, 2nd edition. New York, New York: The Guilford Press. Mueser, K.T., Noordsy, D.L. & Drake R.E. (2003). Integrated treatment for dual disorders: a guide to effective practice. New York, New York: The Guildford Press. Miller, G. (2005). Learning the language of addiction counseling. Hoboken, New Jersey: John Wiley & Sons, Inc. Read More