Motivational Interviewing Treatment Integrity - Research Paper Example

Running head: Motivational Interviewing Motivational Interviewing: Student name: Course: Subject: Student advisor: Introduction Adolescence is the period of physical and psychological development from the onset of puberty to complete growth and maturity (Cuijpers, 2002). This is a critical stage of development which is characterised with a lot of peer pressure, low self esteem and a lot of discoveries and trials. Drug abuse is a common phenomenon at this stage and impacts individual physical health, mental health and personal and social wellbeing. Substance use is excessive consumption of an addictive substance that has a significant effect in modifying the functioning of the body like nicotine, alcohol or chemical abuse (Lisha et al., in press). This article describes how Motivational Interviewing (MI) can be applied as a booster programming to lower the rate of substance abuse by the youth. MI intervention can be possibly applied in a school based setup as a prevention program to reduce substance abuse. The study brings out MI as an intervention that increase individual confidence and establishes exposure of a client to MI unless otherwise result to change in habitual character, analyses changes in psychology that associated to MI from the program participants and relate anthropometrical with physiological achievements after the intervention and those before the onset of the course. This topic describes how MI can possibly be used as a booster in a prevention program on adolescents to control substance abuse (Barnett et al., 2012)’. Definitions MI is a counseling approach which is client centered developed by (Miller & Rollnick, 2002), clinical psychologist. It seeks to promote inherent incentive to change behavior and habits by examining and exploring hesitance towards changing behavior and habits (Miller & Rollnick, 2002). Motivational Interviewing Treatment Integrity (MITI) is a coding system that aims at finding out whether the counselor adhered to the practice (Miller & Rollnick, 2002). Motivational interviewing Skill Code (MISC) is a coding system that is used to assess the adherence of the counselor and the counselee to MI, reason, ability, and desire from the information given and commitment to change behavior (Miller & Rollnick, 2002). Booster programming is any activity that is applied in a program to enhance its effects (Cuijpers, 2002). Background The purposes of this essay is to summaries and give critiques on the article titled “Boosting a teen substance use prevention program with motivational interviewing” (Barnett et al., 2012, Pg.418). The article is organized into, introduction, ways and procedures of collecting data, the actual collecting of the data and analyzing the findings. The article used an academic approach to the problem on drug use and misuse by being published in a peer reviewed respected journal, “Substance use and Misuse”. Materials and methods Design and study sample Raw data was collected from a sample of teenagers chosen from 24 continuation high schools with the involvement of their teachers. The students’ participation in the research was voluntary. The mean age of the final sample was 16.8 percent; 40.3 percent accrued from of 573 adolescents information arrived using stratified sampling method was used. The participants were randomly placed in three possible conditions namely standard care control TND classroom program only with no interviews but class motivation sessions, or TND + MI. TND + MI involved class motivational sessions plus individual interview sessions. One teacher was given the mandate as a contact for the TND project at each school (Miller & Rollnick, 2002). All participants were required to sign consent forms, and for the underage, their parents were consulted. Since participation in the study was voluntary, attendance to the interviews sessions varied. Following a number of challenges, the research settled for fewer sessions and combined both one-on-one sessions with telephone interviews Lisha et al., (in press). The intervention structure comprised of steps “an opening, finding target behavior, exploring ambivalence, summarizing, asking a key or transitional question, action planning, and closing” (Barnett et al., 2012, p. 420) each with specific tasks. The interventionist recorded critical information with the research themes kept in mind. As such, the data had to be recorded in an appropriate manner. For this reason, the interventionists had to be qualified counselors, have excellent listening skills and exemplary record keepers. The 15 interventionists that were hired were trained on the research specifics and inducted (Miller & Rollnick, 2002). During the interviews, the interventionists were required to identify a particular behavior and Complete six items assessing how comfortable the interventionist felt during the call, how much rapport they felt, how engaged they believed the student to be, how helpful they found the protocol, their beliefs about the helpfulness of the call, and the likelihood that the participant would follow through with the behavior change discussed (Barnett et al., 2012, p. 421). The surveys used closed questionnaires to collect data for class sessions while interview sessions and telephone conversations were recorded. A number of coding applications such as Addictions and Motivational Interviewing Skill Code (MISC) was used in presenting the data. The data was analyzed using descriptive statistical methods (Miller & Rollnick, 2002). Description of MI targets Nearly 60% of the respondents in the TND + MI (573) were male and over 67% Latino/Hispanic. 92% of these students were contacted at least once for the MI. The drugs assessed in the research were alcohol, cigarette, drunk, marijuana and hard drugs (Miller & Rollnick, 2002). During the MI contacts, the target behaviors outcome were as follows,50% of the respondents showed interest on graduating from school and getting a job, 30% concentrated on substance use, and 9% of the conversations fell under the inter personal which involved self improvement (like stop gossiping or work on personal temper). Three percent, included target that provided other specific goals like doing technical courses, 8% was used where the target did not mention specific substance, however, in this category student mentioned behaviors like abusing drugs, loitering in town centers, trouble shouting or attending dinners(Miller & Rollnick, 2008). The MI interventions that targeted substance use behavior, however, only 19.3 self-reported to have never used any drug on the list while 43.5% self reported to using drugs (Miller & Rollnick, 2008). There was no significant relationship between ethnicity and language background about drug use and the same for family background. Discussion Results obtained from above evaluation show that MI is reliable and can be confidently applied in students in their teens for prevention programs. The procedures obtained for this particular scheme gave satisfying flexibility and arrangement for the domineering parties. MI contacts managed to inaugurate 92% of the target behaviors (Kealy et al., 2009). As from survey obtained in the coded sample, about three quarters of teens in the program were found to use at least five of the seven protocols. Face to face contact was shown to increase self-assurance and ease, after the contacts were reached over the telephone. The online communication and recording gave a room for follow up of the efforts of the interventionist and data recording (Miller, Rollnick & Butler, 2008). As per this survey, MI booster was the first to be applied among the teens in a school set up to strengthen TND toward chemical abuse in conjunction with other interpersonal factors like future plans of the targets or other drug use (Cuijpers, 2002). This study combination made the MI to remain exceptional, moreover, unlike other MI it is a motivational booster rather than opportunistic because it was administered after every few months. The aim was to act as pretreatment actions that will imposter change among the adolescent (Cuijpers, 2002). From the study, the interventions focused more on action planning since many of the contacts chose to discuss graduation and employment. Therefore, the interventionists should have been better placed to discuss what will happen of the contacts future rather than exploring change of which is emphasized in MI approach. It is, therefore, advisable to conclude, this booster programming aimed at helping the target to finish school and get jobs since chemical abuse was inconsistent with the above goals hence would not have been the primary focus targeting youth in high school (Cuijpers, 2002). Information from baseline show that more than a quarter of the participants reported not to have used any substance abuse in duration of a month. The research process followed all the necessary requirements using the latest coding applications. The interventionists were duly trained on all the research needs and requirements (Kealey et al., 2009). Nonetheless, the research faced numerous challenges and limitations in different areas. The first one is that the work schedules for the interventionists given that the whole research project took two years. While students were supposed to be contacted by the same interventionist for the whole duration, 32% of the students ended up seeing more than one interventionist. Therefore, this could have affected the expected consistence of results (Kealey et al., 2009). In addition, many students declined to keep the arranged time and date of meeting them, therefore, as much as they were reached over the phone they could not be reached physically. Another limitation is that 40% of students who reported to have use alcohol in the past 30 days only 5% chose this as behavior they thought some adjustment. Drawn from this majority of the learners did not identify alcohol use as a problematic issue and hence do not see any need to change it. Moreover, this fact may help learners to give information on other drug use that they feel is a problem to them Lisha et al., (in press). Critique MI was applied previously on different studies with focus to change the behavior of the mature people, which involved dietary modification, adherence to exercise alcohol and drug addiction. The results obtained showed that there is always difference in behavior target. However, structures involved in processes of change are neither unique nor do the basics drives of MI given value (Rollnick, Miller &Butler, 2008). Research has found that following standard treatment such as counseling and follow up has shown increased levels of behavior change. It is good to note that although MI effects change, the process by which it achieves this lacks a model to explain the driving behavior mechanism. Therefore, the relationship between self-efficacy and MI is not clear especially among the youths (Dunn, Neighbors & Larimers, 2006). Studies show that the effectiveness of MI is possible to analyse this is essential so as to explain the stages of change. For example, transtheoretical change model by Prochaska’s gives breakdown in three stages of how individual preparedness of an individual to adapt occurs. Which are: pre-contemplation-contemplation and behavior maintenance after a change is achieved. Therefore, persons do not remain in a single level of behavior adaptation, rather they are shown to go forward and backwards just like a fluid in between stages a key design of any change model just like MI (Littell & Girvin, 2002). Success by MI assumes an individual preparedness to adapt a new way of living is not static rather is variable and dynamic. To achieve success there is a need of constructive, therapeutic procedures depending on their readiness for change (Rollnick, Miller & Butler, 2008). MI is quite applicable to persons who are at early stages of change since at this stage, the target consciousness to change is raised. Moreover, MI gives an insight to people on the program to move from stage of unawareness or unwillingness to act on the problem to awareness to take action: be determined about doing something to achieve change (Treasure, 2004). In addition, most behavior changes model work with the idea that there exist two driving forces towards readiness to change conviction and self efficacy or confidence (Miller & Rollnick, 2002). Conviction is used to relate the driving forces of an individual to a different change whereas self-assurance involves belief of the person’s ability to master change. As from the article Motivation Interviewing has shown to apply this dimension in helping the target to understand the importance to adapt change through increasing confidence and efficacy (Treasure, 2004). There are two forms of resistance that are known to prevent behavior change. This are the way the contact perceive the problem and the relationship between the patient and the therapist (Rollnick, Miller & Butler, 2008). In regard to the problem, sometimes there exist a conflict between how a client perceives it depending on family ethics and society at large. For example, a contact in alcohol, abuse may not perceive it as a problem if is acceptable in the family set up, or the society and, therefore, may not see any reason to adopt behavior change. This problem can justify why many targets thought alcohol consumption is not a problem that needed action. Patient-therapist resistance is applied where parents, counselors or the authority relationships values the targets rights. Those individual prone to this two types of resistance are usually aggressive, defensive and easily angered and certainly avoid the discussion (Beutler et al., 2002) and the results of therapy are often poor. MI has been applied to such cases of both resistance and has shown a lot of effective especially to clients who are easily angered. Although Motivational Interviewing new approach to behavior change has shown to be quite productive therapeutic arena that works humanistic therapy as it looks into the individual stages of change (Prochaka, DiClemente and Norcross, 1992). MI, however, is client-centered is a directive method that enhances inherent motivation to adopt change through exploring change and by therapist helping client resolve inconsistency (Miller, & Rollnick, 2002). From the above article, this fact has been shown from the way the interventionist interacted with the contacts either in class or over the telephone. MI involves empathy as a principle which is a basic practice to all psychotherapies which takes specific form of reflective listening (Rogers, 1951). Under this principle, there should be the client-centered boldness of acceptance, where in the feeling and expression of reluctance by the client is seen as usual experience part of human rather than pernicious defensiveness or pathology. Second principle: developing discrepancy, MI moves from client centered with an aim to increase change desire streaming from the client angle. A process achieved through asking particular question that drive the client along her problem behavior. MI is purposely directive, however, the interventionist is always careful not to impose change rather let the client present reason for change. In a case, where the client resist change the therapist goes to the third principle of MI rolling with resistance using reflective listening skills. Once the client admits change the final principle is for the therapist to strengthen the confidence and built his base to battle obstacles so as succeed in embracing change (Bandura, 1997). These are the same processes that were applied in this article to ensure success towards behavior change. Conclusion Adolescence is a critical stage of development which is characterized with a lot of peer pressure, low self esteem and a lot of discoveries and trials. Motivational Interviewing is a therapy method that has been found to resolve uncertainty, boost undeveloped motivation and promote individual confidence to adapt behavior change and can be effectively applied among the youths in drug crisis (Cuijpers, 2002). MI intervention can be possibly applied in a school based setup as a prevention program to reduce substance abuse (Cuijpers, 2002). Raw data was collected from a sample of teenagers chosen from 24 continuation high schools with the involvement of their teachers. The students’ participation in the research was voluntary. Stratified sampling was applied to arrive at the final mean age of 16.8 percent and 40.3 percent obtained from 573 adolescents. Results obtained from above evaluation show that MI is reliable and can be confidently applied in students in their teens for prevention programs (Cuijpers, 2002). The procedures obtained for this particular scheme gave satisfying flexibility and arrangement of the domineering parties. MI contacts managed to inaugurate 92% of the target behaviors (Kealey et al., 2009). However, the need for MI to achieve its targets declined since there was no consistent supervisor per particular client for the whole period of study. Different authors critique the effectiveness of the MI being applied in chemical abuse rehabilitation for the adolescents. References Bandura A. (1997). Self-efficacy: the exercise of control. New York: freeman and company Cuijpers P. (2002). Effective Ingredients of School-Based Drug prevention Programs: A systematic review. Addictive Behaviors, 27(6): 1009-1023 Dunn E., Neighbors C., & Laminers M., (2006). ‘Motivational enhancement therapy and self-help treatment for binge eaters’. Psychology journal of addictive Behaviors pp.44-52 Lisha N., Sun P.,Rohrbach L., Spruijt-Metz D., Unger J.,& Sussman S. (in press). An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: Project Towards No Drug Abuse (TND). Journal of drug education Girvin H. and Littell J. (2002). Stages of change: A critique. Behavior modification 26:223-273. Doi: 10.1177/014544550202600 Miller W. R. & Rollnick S. (2002). Motivational Interviewing: Preparing People to change, 2nd ed. New York: Guilford Press Prochaska J.O., DiClemente C.C., & Norcross J.C. (1992). In search of how people change: Application to addictive behaviors. American Psychologist, 47:1102-1114 Rogers C.R. (1951). Client-centered therapy. Boston: Houghton-Mifflin Rollnick S., Miller w, & Butler. (2008). Motivational Interviewing in Health Care. NY. Sage Publications Talebi H., Moleiro C. and Beutler L. E., (2002). Resistance in Psychotherapy: what conclusions are supported by research. Journal of clinical psychology, 58:207-217 Treasure J. (2004). Motivational Interviewing. Advances in Psychiatric Treatment. Doi: 10.1192/apt. 10.5.331 Read More