Motivational Interviewing and Cognitive Behavioural Therapy - Essay Example

Comparison of Two Psychiatric Interventions Name Institution Lecturer Date Abstract Schizophrenia which is a Greek word which means a split - mind, and is a psychiatric diagnosis of a mental disorder which under normal circumstances is characterized by abnormal perception of reality. It is mainly noticeable through disorganized speech and thinking, paranoia and delusions and, or hallucinations. Such symptoms start to manifest themselves at young adulthood and around 0.4 percent of the population is affected. (Beck, J. S., 1995) Introduction According to Prochaska, J. O., & DiClemente, et al, (1992), some of the important factors that contribute to the onset of schizophrenia are: neurobiology, psychological and social processes, genetics and early environment; though some recreational or otherwise prescribed drugs could worsen the situation. Due to the nature of the disorder and the manner in which it displays a large number of symptoms, Eugen Bleuler termed the disease as a number of discrete syndromes hence the name the schizophrenias. Schizophrenia shouldn’t however be confused with disassociative identity disorder, which was also known as split personality disorder or multiple personality, despite its etymology. Schizophrenic individuals experience increased dopamine activity in their brain especially in the mesolimbic pathway. Hence, antipsychotic treatment which is the main treatment offered, suppresses the dopamine activity, and their doses today, are lower than in their early years of use. Where the patient can pose as a risk to the society and to their own self, they are involuntarily granted hospitalization and just like antipsychotic medication, the stays are also shorter today as compared to the earlier years. Also according to Prochaska, J. O., & DiClemente, et al, (1992), schizophrenia contributes to chronic depression and emotional and behavioral problems apart from affecting cognition. Also, people suffering from schizophrenia are likely to have some other conditions such as anxiety disorders and major depression, social problems which include homelessness and unemployment, and substance abuse. Consequently, the life expectancy of people with schizophrenia is around 10 to 12 years less than those without due to a higher suicide rate. Study appraisal In this study, we will look at two types of psychiatric interventions or in other words emergency psychiatry. These are cognitive behavioral therapy and motivational interviewing. Psychiatric interventions is the application clinically of psychiatry in emergency settings which include, substance abuse, attempted suicide, depression, violence and other drastic changes in behavior. Due to the mental state of the patients, staff working at emergency service setting are usually at a high risk of falling victim to the violence that is projected by the patients. Such patients may come to such centers of their own free will or involuntarily, and their care includes the stabilization of the life threatening conditions which symptoms are associated with mental disorders. Main functions of psychiatric intervention is to assess the problems faced by the patients’ and the putting in action of a short - term plan sort of treatment that ensures that the patient can be treated within that brief period. In the case of Cleo, the schizophrenic patient admitted at a psychiatric emergency care centre, we will look at both the motivational interviewing and cognitive behavioral therapy and critically assess the level to which either of them will aim at achieving the goal of ensuring the safety of the staff at the medical centre, and at the same time to reduce the symptoms associated with the disorder. Motivational interviewing Motivational interviewing is a counseling approach which was developed in collaboration by two clinical psychologists Miller and Rollnick. This method is aimed at engaging the client semi-directively to change behavior by resolving uncertainty within the patient and developing divergence. In comparison to other non - directive forms of counseling, motivational interviewing is much more goal directed and focused, with the counselor in pursuit of a certain goal. According to Rollnick, S. & Miller, W. R. (1995), motivational interviewing clients go for help when they are ready to change their behavior and they often do so at different levels of willingness, though if the counseling is mandatory, they would never have gone by themselves in the first place while others might have thought of it but never took the initiative to go through with it, while others have simply been trying it unsuccessfully for a couple of years. According to Rollnick, S. & Miller, W. R. (1995) motivational interviewing should be aimed at being non-adversarial, shouldn’t be judgmental and equally should not be confrontational; rather it should aim at increasing the awareness in the client of the problems caused, the consequences and the risks faced as a result of the clients behavior. All in all Barber continues to say that, the client should be helped to hope for a brighter future with motivation for her to achieve this goal and, what is to be gained by the client should there be change in behavior. The four general principles of motivational therapy can be applied to the case of Cleo, who is a patient who has schizophrenia and having assaulted a neighbor was admitted at a psychiatric hospital for treatment. First off, the therapist should show some empathy to Cleo, as this will guide the therapist to understand and share in the better understanding of Cleo’s perspective. Secondly, the therapist should roll with resistance which Cleo might project and this will assist the therapist to accept the reluctance of Cleo to change as a natural phenomenon rather than a pathological one. Thirdly, the therapist should develop discrepancy, as this will assist the therapist to be able to appreciate the difference between what Cleo wants her life to be, versus how her life really is at the present moment. Lastly, the therapist should support self efficacy, as this will guide the therapist to embrace the autonomy of Cleo even if she chooses not to change and help her to do so successfully and in the most confident way possible. According to Moyers, T. B. & Rollnick, S. (2002), motivational interviewing should be aimed at changing the client in which our case is Cleo, without imposing by use of coercion, threats, persuasion or even confrontation, but rather stimulating growth through understanding of Cleo’s goals and values thus stimulating behavior change. It is also up to Cleo and not the counselor, to resolve the presence of any ambivalence, which is restraint versus violence. Though it may seem helpful to try and persuade Cleo to change due to the benefits that come with change such as freedom from the medical institution, it isn’t right since, it might just increase her resistance and even diminish the probability of change in her. Bottom line is that motivational change is not geared towards changing Cleo’s behavior, but to allow her to argue for her own change. Cognitive behavioral therapy This is both a psychological and a social form of therapy that assumes that cognitive patterns cause emotional responses. Its treatment involves the changing of ones thoughts to fix personality, psychological and social problems. It is also goal oriented with an aim of ensuring that emotional and behavioral disorders are treated as maladaptive learned responses which are meant to be replaced with healthier behavior through the use of appropriate training. Such unhealthy behavior can be eliminated or rather, changed through cognitive restructuring and behavior therapy techniques. Though it should be noted that individuals with a cognitive impairments such as brain injury, might not respond as expected to cognitive behavioral therapy just as equally as it may not be effective in patients who are not willing to take up an active role and participate in the treatment process. (Beck, J. S., 1995) In the case of Cleo, the therapist could work with her to figure out the thoughts or the root cause of the distress, and put into action behavioral therapy techniques that will ultimately alter Cleo’s behavior. Cleo might have some core beliefs (schemas) which are wrong are in the long run have a negative impact on her behavior and functioning. In the case of Cleo, she might have undergone some sort of stressful experience that was possible life threatening and violent, which made her attack her neighbor in rage. The therapist could test this assumption by asking her if there has been any violence in her life that was threatening to her or any family and friends that love and care for her. After the therapist has established that, he / she could reinforce a new model of thought for Cleo, such as letting her know that she can be a polite, loving and caring person, who would opt for dialogue as opposed to violence. Such a technique which is known as conditioning involves the use of both positive and negative reinforcements to bring out a desired change in behavior. Some of the techniques that the therapists use in the application of cognitive behavioral therapy include validity testing, where the therapist may ask the client to defend his or her thoughts and views of which if the patient is unable to support his or her assumptions, the faulty nature of it is exposed. Cognitive rehearsal is another method where the therapist asks the patient to describe a situation in which he / she was in a challenging position, and then practice how to deal with it, and consequently, let the patient rehearse how to deal when presented with a similar situation in the future and manage it himself or herself. The patient can also keep a journal and enter the everyday happening of her life, then after a given time they can go through the journal both patient and therapist to discover the maladaptive thought patterns and how they affect behavior. (Beck, J. S., 1995) The role of family, caregiver and community Proof abounds that the participation of the family in the recovery of a member with mental disorder like schizophrenia or any similar serious illness is an important factor. Aside from the material and financial needs, there is that longing for love and understanding which the blood relatives or home companions can best share. Emotional support is a cure in itself as it revives or builds confidence, develops the sense of survival and existence, and restores the imagination of a dreamed future. So also, family members sometimes become advocates themselves for the cause of the mentally troubled. Along that line, the sense of belonging becomes more poignant and intact. (Rollnick & Miller, 2002) In the case of the attending caregiver, the same longing for a wholesome rapport is inculcated in the mind of the patient as the team accomplishes the commitments and undertakings of the therapy. Caregivers, along with family members, perform significant roles in the caring for patients with mental health problems. Aside from the support founded on compassion, they usually act as observers and monitoring agents by providing necessary information for clinical assessment purposes. (Brown, 2006) The community on the other hand could give support to the patients, by allowing them to participate in the daily happenings around the society, without excluding them. This should make the patients feel loved and cared for, thus diverting the need for violent behavior. Comparisons between the motivational interview and cognitive behavioral therapy This paper in relation to the case of Cleo should at the end be able to determine to what extent the principles of these two approaches overlap. The motivational interviewing was initially developed to deal and solve the problem of heavy drinkers and since then has been used in various health related disorders. Cognitive behavioral therapy has been proven to be effective in the treatment of mental disorders, though not all patients have successfully been treated at the initial attempt. One of the main challenges of cognitive behavioral therapy is therefore the challenge of convincing the patient to adhere to the strict demands of the treatment. Motivational interviewing on the other hand has been relatively successful, especially in the patients with drug and alcohol problems, to help them get actively involve in the reduction of substance abuse. (Beck, J. S., 1995) Despite such advantages of motivational interviewing over cognitive behavioral therapy, some therapists still tend to prefer the cognitive behavioral therapy over motivational interviewing, due to the discontinuity between chemical dependency and mental health. The two approaches are therefore different and their comparison is more of a problem due to their nature, as one is a therapeutic approach while another is a form of treatment. Despite this difference, the two approaches involve the exchange of information to develop the difference between the patient’s behavior problem and his or her personal values. Conclusion It is worthwhile to consider adding motivational interviewing to the cognitive behavioral therapy, to cater to Cleo’s condition, as this will increase the efficiency of the treatment of both the approaches are used. Apart from motivating Cleo to change and the effects that come with such change, not mentioning the benefits and considering that she has nothing to lose coupled with giving her a new mindset and convincing her that violence is not the key, then I believe it would be more effective than just one approach. Bottom line is application of both approaches could cut on the demerits and be more fruitful and advantageous, or even cost effective in the long-run. The most important thing to note is that it is important that the patient initiates the change in her, rather than for the therapist to initiate it. It is only through this way that the patient will be truly reformed and healed of the mental disorder that she is undergoing. References Albano, M., & Kearney C. (2000). When children refuse school: a cognitive behavioral therapy approach: Therapist guide. Psychological Corporation. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press. Brown, L. S.(2006). Counseling Victims of Violence: A Handbook for Helping Professionals. New York: Hunter house. Burns, D. (1999). Feeling Good: The New Mood Therapy (Revised Edition). Avon. ISBN 0-380-81033-6 Bentall, Richard (2003). Madness explained: psychosis and human nature. London: Allen Lane. ISBN 0-7139-9249-2.  Barber, C. (2008). Comfortably numb: how psychiatry is medicating a nation. New York: Pantheon Books. Cooper, Mick (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. SAGE Publications. ISBN 9781847870421. Dryden, W. (1994). 'Ten Steps to Positive Living'. Sheldon Press Dalby, J. Thomas (1996). Mental disease in history: a selection of translated readings. Bern: Peter Lang. ISBN 0-8204-3056-0.  Deblinger, E. & Heflin, A. (1996) . Treating sexually abused children and their non-offending parents: a cognitive behavioral approach. Thousand Oaks, CA: Sage Publication. Ellis, A. (2001). Overcoming Destructive Beliefs, Feelings, and Behaviors: New Directions for Rational Emotive Behavior Therapy. Prometheus Books. ISBN 978-1573928793 Fallon, James H. (2003). "The Neuroanatomy of Schizophrenia: Circuitry and Neurotransmitter Systems". Clinical Neuroscience Research 3: 77–107. doi:10.1016/S1566-2772(03)00022-7.  French, Abe.(2007). Thinking Matters Facilitator Manual. Fleck, Stephen; Theodore Lidz and Alice Cornelison (1985). Schizophrenia and the family. New York: International Universities Press. ISBN 0-8236-6001-X.  Lee, Donald T (1995). "Professional underutilization of Recovery, Inc.". Psychiatric Rehabilitation Journal 19 (1): 63–71. Leahy, R.L. and Holland, S.J. (2000). Treatment Plans and Interventions for Depression and Anxiety Disorders. New York: Guilford Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press. Moyers, T. B. & Rollnick, S. (2002). A motivational interviewing perspective on resistance in psychotherapy. Psychotherapy in Practice, 58 (2), 185-193. McCullough, J.P. (2003). Treatment for Chronic Depression: Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Guilford Press. ISBN 1-57230-965-2 Prochaska, J. O., & DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102-1114. Rollnick, S. & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334. Szasz, Thomas Stephen (1976). Schizophrenia: the sacred symbol of psychiatry. New York: Basic Books. ISBN 0-465-07222-4. Tanner, S., & Ball, J. (2001). Beating the Blues: A Self-help Approach to Overcoming Depression. ISBN 0-646-36622-X Willson, R., & Branch, R. (2006). Cognitive Behavioural Therapy for Dummies. For Dummies. Yochelson, S., & Samenow, S. (1976). The Criminal Personality: A profile for change. New York: Aronson. Read More

Study appraisal In this study, we will look at two types of psychiatric interventions or in other words emergency psychiatry. These are cognitive behavioral therapy and motivational interviewing. Psychiatric interventions is the application clinically of psychiatry in emergency settings which include, substance abuse, attempted suicide, depression, violence and other drastic changes in behavior. Due to the mental state of the patients, staff working at emergency service setting are usually at a high risk of falling victim to the violence that is projected by the patients.

Such patients may come to such centers of their own free will or involuntarily, and their care includes the stabilization of the life threatening conditions which symptoms are associated with mental disorders. Main functions of psychiatric intervention is to assess the problems faced by the patients’ and the putting in action of a short - term plan sort of treatment that ensures that the patient can be treated within that brief period. In the case of Cleo, the schizophrenic patient admitted at a psychiatric emergency care centre, we will look at both the motivational interviewing and cognitive behavioral therapy and critically assess the level to which either of them will aim at achieving the goal of ensuring the safety of the staff at the medical centre, and at the same time to reduce the symptoms associated with the disorder.

Motivational interviewing Motivational interviewing is a counseling approach which was developed in collaboration by two clinical psychologists Miller and Rollnick. This method is aimed at engaging the client semi-directively to change behavior by resolving uncertainty within the patient and developing divergence. In comparison to other non - directive forms of counseling, motivational interviewing is much more goal directed and focused, with the counselor in pursuit of a certain goal. According to Rollnick, S.

& Miller, W. R. (1995), motivational interviewing clients go for help when they are ready to change their behavior and they often do so at different levels of willingness, though if the counseling is mandatory, they would never have gone by themselves in the first place while others might have thought of it but never took the initiative to go through with it, while others have simply been trying it unsuccessfully for a couple of years. According to Rollnick, S. & Miller, W. R. (1995) motivational interviewing should be aimed at being non-adversarial, shouldn’t be judgmental and equally should not be confrontational; rather it should aim at increasing the awareness in the client of the problems caused, the consequences and the risks faced as a result of the clients behavior.

All in all Barber continues to say that, the client should be helped to hope for a brighter future with motivation for her to achieve this goal and, what is to be gained by the client should there be change in behavior. The four general principles of motivational therapy can be applied to the case of Cleo, who is a patient who has schizophrenia and having assaulted a neighbor was admitted at a psychiatric hospital for treatment. First off, the therapist should show some empathy to Cleo, as this will guide the therapist to understand and share in the better understanding of Cleo’s perspective.

Secondly, the therapist should roll with resistance which Cleo might project and this will assist the therapist to accept the reluctance of Cleo to change as a natural phenomenon rather than a pathological one. Thirdly, the therapist should develop discrepancy, as this will assist the therapist to be able to appreciate the difference between what Cleo wants her life to be, versus how her life really is at the present moment. Lastly, the therapist should support self efficacy, as this will guide the therapist to embrace the autonomy of Cleo even if she chooses not to change and help her to do so successfully and in the most confident way possible.

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