Motivational Interviewing as an Alternative to Direct Persuasion and Intervention to the Problem - Essay Example

?Motivational interviewing of the of the supervisor Motivational interviewing Introduction The traditional behavioral change dealt mainly with enhancing skills and reducing barriers to changes in a person’s behavior. But in order to achieve a total change in behavior, many social and economic factors should be addressed. Actually, individuals cannot be told only what to do and how to change their behavior in order to overcome their problems, but they need much support in order to overcome their problems. As such, motivational interviewing was introduced as an alternative to direct persuasion and intervention to client’s problem during behavioral therapy (Miller &Rollnick,1991). Asma’s case offers a practical example that motivational interview, which is client centered, assists the client to know her problems and develop appropriate solution to tackle the issues at hand. Motivational interviewing can be described as a client centered and directive style of counseling that is aimed at bringing behavioral change by assisting clients to explore, analyze and resolve difficult conditions. When compared to other types of counseling techniques, motivation interviewing is goal oriented and focuses directly on options that are available for behavioral change. The analysis and resolution of the difficult condition facing the client is the main focus of eliciting behavioral change (Longshore &Grills,2000). Motivational interviewing, which applies the trans-theoretical model of change, promotes behavioral change by terminating unhealthy behavior or adopting healthy behaviors through six stages of behavioral change. These are preparation, action, relapse, contemplation, maintenance and pre- contemplation. Motivation to change is stimulated by the client and is not imposed by other people such as counselors. Other motivational approaches stress on persuasion, coercion, and constructive confrontation but unlike motivation interviewing, they fail to mobilize and identify the intrinsic values and goals that are essential to stimulate client’s behavioral change. In motivation intervention, a client’s readiness to change is a gradual product of interpersonal relationship and so a therapist should be responsive and highly attentive to the motivational signs of the client. In motivation interviewing, therapeutic relationship is like a partnership which is aimed at creating a positive environment for change (Miller &Rollnick,1991). Substance abuse has become a disturbing and dangerous contemporary trend that has affected the political, social and economic lives of people. Its implications are far fetching and many stakeholders have proposed appropriate measures to curb it. One of the concrete measures of eradicating substance abuse and minimizing its effects is to assist people to change their attitudes and behaviors towards its use and develop habits that will deter them from using drugs. Motivation interviewing has become an essential tool of assisting people to minimize drug intake or stop the vice altogether (Block &Wulfert,2000). As a group, our role is to apply motivation interviewing principles in eradicating and minimizing the impact of substance abuse. The name of our client is Asma. Our group consists of four members, who work as a team in assisting substance abuse clients to come out of the condition through motivational interviewing. The members are Fadumo, Glyn, Sharon, and Perpetua. Fadumo played a key role by choosing an appropriate culture that the group would draw the client from. The culture chosen was Somali culture. Glyn managed to make appropriate arrangements for the meeting and later informed the members about it. Sharon managed to observe the interviewing environment, detected the mistakes for correction and recorded the interview. Perpetua was mandated with the role of managing issues involved with recording of the interview and communication issues such as managing email communication. The client approaches the group to assist her to stop taking substances. As such, the group makes several appointments with her. The key issues in the interview were client’s social issues, culture, education, environment, religion, and drug problems. Client’s profile Asma is a fictitious female client of Somali origin. She comes from a black minority. She was born in Somalia but arrived in UK when she was 8 years old. Her siblings were born in UK. Although she comes from Somalia and is supposed to uphold Somalia culture, she constantly rebels against her cultural norms and values. She practices Islam, a religion that is practised by her parents and most of her community. Her parents, who are a married couple, are non skilled workers. They always engage in domestic quarrels and violence. The family lives in a single house thus making the environment difficult for privacy and personal development. Asma is a student although she faces many hurdles in her education. She is forced to take care of her sibling and so she misses out of school. She faces racial discrimination from her fellow students who despise her for being black. She has problems with grasping major subjects such as Geography and history and her parents feel that she is better when she is taking care of her siblings at home. Although she has positive ambitions of going to university and become a teacher, the cultural and environmental issues bar her from pursuing her goals. There are many social and economic problems that face Asma , which affect her psychologically and compel her to engage in unhealthy activities in order to escape from reality. It is evident that she wants to continue with her studies but cannot tell her parents about it because of cultural barriers. From the interview, Somali culture does not allow children to engage in arguments or structured discussion with their parents. She does not have time to make friends and interact with them because she is always taking care of her siblings. As a social human being and a female who is still growing up, social interaction is essential because it promotes social health of an individual and enhances social intelligence when dealing with different groups of people. By staying mostly at home, she developed a social hole that needed to be filled. Her home area is a mixed race area and so she is always vulnerable to discrimination within the society. As a result of the problems that she faces in life, she engages in substance abuse. Asma’s drug taking habits were influenced by her friends who had similar problems. She got the drugs from her neighbourhood. She started taking cannabis but since she wanted to take something stronger, she started using heroine. From the interview, she noticed that substance abuse was bad and wanted to stop it but her environment and difficulties in life were the major barriers against her wishes. From Asma’s drug habit, it is evident that substance abuse is a behavioural condition that is caused by many triggers. The main triggers in Asma’s case are the problems at home and peer pressure. Her quest to stop substance abuse is a clear indication that people who are addicted to drugs intend to leave the habit but in most cases, there is no appropriate assistance that can enable them to fight the vice or the method employed to assist them in changing the behaviour is not efficient enough to elicit an appropriate and permanent change of behaviour. When Asma’s profile is taken into consideration, an intervention technique needs to look at the problems that led to her habit, how she was going to change her behaviour and how the causative factors of her habit were to be handled. In addition, the changing behaviour approach should seek ways of changing her ways of thinking, reinforce her desire of behavioural change and enable her to be the central figure in her behavioural change attempts (Flora,2007). Time line 24/10/12- A group of four people was formed. The members of the group are Fadumo, Glyn, Sharon, and Perpetua. We had our first informal meeting and as aspiring counsellors, we discussed the common social problems that affect the society in general. During our discussion, we came to know about each other, how to relate to one another, our likes and dislikes, how to work with each other considering the fact that we come from different family backgrounds and how we would cooperate in case of difficult situations. On the same day, we decided on the topic that we would handle in our behavioural therapy theme, the motivational interviewing. We decided to choose a fictitious mixed neighbourhood where we would get a character from a minority group. The character was a lady from Somali minority group and the problem that we were to handle in our motivational interviewing task was substance abuse.On the same day, the first formal motivational interviewing of the client was conducted. Glyn was the interviewer while Fadumo was the observer. After the interview, a brief discussion about the session was conducted. The issues raised in the interview included the questions being many and not helpful in understanding the problem. In addition, it was not easy to really know which help the client was to be given and there was no body language such as gesture, eye contacts and movements. 29/10/201-The motivation interview took place after the client came to attend the counselling session. The interviewer was Sharon while Glyn and Fadumo were the observers. From this interview, the client was more open and wanted to expand on what she wanted but could not manage to do so. She had started talking to the teachers in order to get extra help. From the positive development, it is clear that the motivational interview had started making a positive impact on her will to change. She had positive thoughts of becoming the role model of her sibling and started developing self responsibility by trying to get out of her situation but she kept blaming her parents for her situation. The interviewer was leading but Asma was being defensive, which showed that much effort needed to be applied in order to assist her in attaining behavioural change. Other anticipated changes had not been achieved as the client continued taking drugs as a way of escaping from her problems .After the interview, a brief analysis was conducted and it was noted that the interviewer were trying to force the client to change but the client was still adamant . 5/11/2012-The interview showed that Asma went to school for 2 days but she found it difficult to keep up with school. The interviewer encourages her to talk to her teachers. Asma does not know the help she needs but it is clear that she does not want her parents to get involved. She agrees with her interviewer’s advice of talking to her teachers. When the interviewer used eye contact, she keeps by her self and folds her arms, a clear indication that she was not open enough for counselling. She feels trapped by her school, siblings and parents and she did not want her parents and siblings to know about her problems and therapy. Asma feels that she can try and solve her own problems but she was not comfortable to talk about the problems. After the interview, there was a brief discussion and it was discovered that the question were closed instead of open ended questions. In addition, the interviewers needed to allow the client to give her own ideas and expend on them. 7/11/2012-The interviewer was Fadumo. According to the interview, Asma was talking with teachers and still had a positive will of becoming a teacher. She stated that she was still taking drugs although she was willing to stop the habit. After the interview and a brief analysis, it was noted that Asma needed to positively reinforce the support that she was getting. She maintained eye contact, which showed that she was open and was willing to get help. 14/11/2012-The interviewer was Sharon while Fadumo and Perpertua were observers. The interview has started to display positive results. Asma is positive about her school work as she constantly attends her school and doing her homework. According to the interview, she had stopped taking drugs because of her school homework that kept her busy. It was noticed that her teacher managed to get in touch with a drug counsellor who assisted her in stopping drugs. The only fear that she had was drug relapse. After the interview, we conducted brief analysis which showed that Asma was getting well and was still positive with assistance on drugs. She had become more open, still continued to pursue her dreams of becoming a teacher, and was getting a lot of help from her drugs counsellor. Reflection by group members Since each member had a turn of interviewing and observing, all members gave a reflection on what they learned and how the interview was beneficial to the practice of counselling and their career in general. They discovered that through motivational interviewing, a client centred behavioural change approach, a client was able to understand his or her behaviours and develop his or her own solutions that would elicit positive change(Miller &Rollnick,1991). Fadumo’s reflection The motivational interviewing was chosen because it is directive and client centred. The client was Asma who sought help on how she would eradicate her substance abuse menace. From the interviewing process, it was easy to establish the main causes of her drug problem as family issues and identity problem. In order to start assisting the client, the starting point of the session was the main problem that faced her. While interviewing Asma, the interviewer applied the principles of motivation by relating to the client in a respectful manner and showed empathy to the client’s situation. This was intended to create trust and an open and honest communication, given the fact that the client was adamant to participate in open discussion. Her body language showed that she was under uncertainty and needed a lot of help although she did not know which kind of help she really wanted. By creating a positive therapist-client relationship, a mutual trust was developed and played a key role in the client’s opening up to the issues that were facing her (Flora,2007). Asma may have considered seeking help but she was not sure about the type of help she needed. She feared telling her parents and teachers about the drugs problems but with motivation interview, she managed to change and opened up to her teacher. From Asma’s case, it can be noted that motivational interviewing is the most appropriate method when handling situations that one may need to make difficult behavioural change decisions. The interview is client centred and when one feels as part of the process, he or she develops a positive attitude towards counselling and so getting a solution becomes easier (Miller &Rollnick,1991). Glyn’s reflection From Asma’s condition, the interview was essential because it opened up the input of other helpers who were vital for her behaviour change. It is evident that the interviews motivated her to seek help from her teacher who in turn sought a drug counsellor to assist her in her drug problem. In addition, motivational interviewing enabled her to develop a positive social attitude towards others, as proven by her ability to interact freely and play with her siblings. Her self esteem was enhanced as she felt that she was capable of joining a university and become a teacher and so she took her studies serious and concentrated on her homework. Perpertua Reflection Asma’s case is a practical example that motivational interviewing is the best option for an individual who has problems with adopting healthy behaviours or eradicating unhealthy behaviours. Asma had problems that had both psychological and behavioural effects on her but after the sessions of motivational interviewing, she managed to overcome her problems and developed a positive attitude towards life. Motivational interviewing, which increases client awareness of the problem caused, the effects experienced, and the risk brought about by the specified behaviour, creates a good communication pathway between the interviewer and the client as they seek an appropriate remedy to a specified problem. A positive result can be obtained if the ambivalence barriers are broken (Cummings, Cassie &Cooper,2009). Asma is hesitant to change her behaviour. Although she feels she is doing wrong by talking drugs and would need help, she finds it difficult to face her parents and teacher. One way in which she breaks her ambivalence is telling her teacher about her problems. Her decision to break the silence and inform her teacher about her problem was vital in changing her behaviour because her teacher organized for a drug counselling session. During the interview, the interviewers express good listening skills and empathy. This enables the client to feel part of the session and one can be able to contribute well in looking for a solution to the problem. From the interview, Asma is the one who decides to talk about her problems to her teacher, which is a clear indication that the motivational interviewing enabled her to take full control of the solutions to her problems (Martin & Pear, 2007). Sharon reflection Motivational interviewing promotes an equal and two way communication system that is essential when creating a free and open dialogue between the interviewer and the client. Unlike other forms of behavioural therapies where the counsellors control of the whole process and the client remains as an observer, motivational interviewing enables the client to take control of the whole counselling process and develop his or her own remedies to the problem that he or she is facing. In this case, the role of the interviewer is to assist the client to look for his or her own solutions to the problems facing him or her (Hanson & Gutheil, 2004). From the interview, Asma knew she had problems with drug abuse and wanted to change her behaviour but was not sure how to do it. Through the six stages of behavioural changes that involve preparation, action, relapse, contemplation, maintenance and pre- contemplation, she managed to curb her drug abuse problems (Ruben,2001). Conclusion Motivational interviewing involves four main principle .These are empathy, rolling with resistance, developing of discrepancy, and support of self efficacy. Empathy involves wearing client’s shoes and then assisting the client from that perspective. Although it seemed difficult, the group had to put itself in the client’s situation and empathised with the situation, which enabled the client to feel that the interviewers were understanding .As a result, it was easier for her to open up and became free in the interview session. In developing discrepancy, we strove to assist the client to appreciate the value of change than maintain her unhealthy behaviours. We applied this principle by encouraging her to continue pursuing her goals of becoming a teacher, seeking help to stop the habit of drug abuse and put more emphasis on her education. This was achieved when she stopped taking drugs and started to concentrate on her homework .The principle of rolling with client’s resistance enabled the interviewers to avoid being argumentative whenever a client showed signs of resistance. This was essential because it enabled Asma to develop solutions to the problems that she had defined herself. The principle of enhancing self efficacy was essential because it offered the client an opportunity of embracing her own autonomy, which resulted in her gaining confidence that was vital in embracing solution based approaches. As a result of respecting her autonomy and in her own will, Asma told her teacher about her problems and a solution to it was found when a drug counsellor was engaged (Freedman & Coombs,1996). References Blackledge, J.T. (2003). An Introduction to Relational Frame Theory: Basics and Applications. The Behavior Analyst Today, 3(4), 421–42 Block, J.A. & Wulfert, E. 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