Stages of Change A Case Study Applying Motivational Interviewing

If an individual's treatment process consists of passing through stages, the psychiatric rehabilitation professional's task becomes helping the individual move from one treatment stage to the next. In short, the professional helps the individual accomplish the tasks of the stage he or she is currently in and encourages movement to the next stage. A specific strategy to accomplish this, motivational interviewing, has been developed by Miller and Rollnick (2002).

Defined as "a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (Miller & Rollnick, 2002, p. 25), motivational interviewing is an empathic communication method. According to this strategy, rather than imposing change, the practitioner using motivational interviewing is nurturing the individual's intrinsic motivation to change by assisting the person to see discrepancies between her behavior and her personal goals.

Effective motivational interviewing is based on four principles: (1) express empathy, (2) develop discrepancy, (3) roll with resistance, and (4) support self-efficacy (Miller & Rollnick, 2002, p. 36). In expressing empathy the practitioner is communicating acceptance and an understanding of the person's behavior from the person's perspective. First, the practitioner assists the person in identifying his own goals and values. Then the practitioner helps the individual examine whether there is any discrepancy between his goals and his behavior. The practitioner does not argue for change when met with resistance, but rather accepts ambivalence as natural and assists the person in recognizing the discrepancy between his stated goals and behavior. The practitioner expresses belief in the person's ability to change.

Motivational interviewing is an especially good fit with the values and principles of psychiatric rehabilitation (PsyR). It can be an effective strategy for helping individuals in nearly every aspect of PsyR from complying with their medication regimen to getting a job. Many of the evidence-based practices described in this text call for practitioners to employ motivational interviewing with their clients.

Consider, John, who has been working with his counselor and has identified obtaining employment as his most important goal. In reviewing John's work history, his counselor learns that John has attempted several jobs in the past and has lost each of them because he missed too many days of work. His missed days always followed nights out drinking with his friends. John's counselor asks if John thinks his drinking is an obstacle to reaching his goal of employment. John does not think so but admits it sometimes gets him into trouble.

Rather than confronting John's perspective (e.g., "It seems to me that your drinking is a problem. You've lost several jobs because of it and you've been arrested twice for public

A licensed clinical psychologist and professor of psychiatry at Dartmouth Medical School, through his extensive research and writing, Kim T. Mueser, Ph.D., has added immeasurably to the psychiatric rehabilitation knowledge base. Dr. Mueser effectively combines keen insights from his clinical practice with an ability to design and carry out highly relevant research. A prolific scholar, he has published books and articles on a wide range of topics within psychiatric rehabilitation, some of which include social skills training, dual diagnosis, behavioral family training, coping with schizophrenia, and cognitive approaches. Dr. Mueser is also a highly sought after speaker for gatherings of psychiatric rehabilitation professionals worldwide.

Dr. Mueser has actively participated in the identification, development, and dissemination of evidence-based practices in psychiatric rehabilitation. He continues to work with state systems and professional groups to ensure that consumers reap the benefits of these advances. He is a strong advocate of the integrated treatment of persons with dual diagnosis.

intoxication. I don't see how you can hold a job until you get control of your drinking problem."), using motivational interviewing the counselor engages John in a review of past work experiences and in an exploration of what would need to be different in order to make this next employment attempt successful. The counselor might ask John to list the benefits and costs of using alcohol. In this way the counselor could help John find alternative ways of getting the benefits (e.g., socializing with friends, feeling relaxed) while also examining the costs (e.g., missing work and other appointments, feeling ill, losing money) and helping John to see the discrepancy between his goals and his behavior.

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Alcohol No More

Alcohol No More

Do you love a drink from time to time? A lot of us do, often when socializing with acquaintances and loved ones. Drinking may be beneficial or harmful, depending upon your age and health status, and, naturally, how much you drink.

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