A Reflection On Motivational Interviewing Essay.

• apply motivational interviewing knowledge and strategies to facilitate co- constructed constructive consumer behaviour change
• reflect on the implications that emerge from using motivational interviewing from the perspective of the learner’s specific discipline

Part 1- Review the video of the simulated Motivational Interview. Take note of what features of motivational interviewing are employed and what opportunities the interviewer had to use motivational interviewing but didn’t.

https://www.youtube.com/watch?v=0hVTGpTdeT8

Part 2- Provide a reflection on the clinical interview process. Consider what the interviewer has done well, what aspects of Motivational interviewing does the interviewer still need to focus on. Also reflect on how the simulated client responded to the MI approach and what could have been done differently to promote behaviour change in that context.

Features of Motivational Interviewing Employed in the Simulated Interview

The counseling principles of ‘Motivational Interviewing’, were formulated by reputed psychologists and practitioners, William R. Miller and Stephen Rollnick. The usage of motivational interviewing as a novel therapeutic initiative for provision of counseling, emerged as a response to the treatment procedures required for individuals engaging in chronic drinking or substance abuse (Mantler et al., 2015). The primary principle outlining the concept of motivational interviewing, is the recognition of ‘ambivalence’, or a difficulty in undertaking decisions due to a loss of understanding concerning the fulfillment of individual improvement goals and objectives. Hence, for this reason, motivational interviewing is highlighted as a counseling approach, adding emphasis to the client, who will be encouraged to recognize and accomplish personal goals for improvement and resolution of detrimental conflicts (Miller & Rose, 2015).

The following paragraphs aim to reflect on the outlines of motivational interviewing as observed from the simulated interview conducted, the leading takeaway points as well as the scope for possible improvements of the same.

Upon observation from the viewed interview, I could identify several aspects which the interviewer performed well, as well additional theoretical features of motivational interviewing, which I believe she could have improved. As outline by Miller in his book, ‘Motivational Interviewing: Helping People Change’ (2012), it is evident that the primary functioning principles of conductance of motivational interviewing, is the usage of a client-oriented approach, where the interviewee in question, will be the main focus of the interview, along with due consideration of his needs, interests, shortcoming and expectations (Miller and Rollnick, 2012). With respect to the interview as viewed the video, I believe that the interviewer did justice in focusing upon this key aspect of motivational interviewing, as she was observed to constantly ask questions to the client, in order to prompt answers and hence, give emphasis on the clients perception of shortcomings, strengths and weaknesses. In addition to the performance of motivational interviewing, there is a need to adopt a specified style of conductance of the interview, namely the ‘guiding style’ (Draxten, Flattum & Fulkerson, 2016). As outlined skillfully by Miller (2013), the guiding style has similar functions pertaining to a travel guide, where the said person not only patiently allows a traveler to explore novel surroundings, but also engages in active guidance when required (Miller & Rollnick, 2012). While observing the motivational interview, I observed that the interviewer attempted to successfully utilize this style, by patiently listening to the client, without exerting any of her personal views. She further attempted to guide the client, especially as a response to this drug addiction and financial crisis, by recommending the benefits she received upon undertaking financial training as well as handing out information pertaining to harmful implications considering the clients cocaine abuse. Another key theory pertaining to the usage of adequate motivational interviewing is the usage of a righting reflex, where the interview promptly attempts to discourage the client’s harmful behaviors through justified explanations as well as empathy (Petrova et al., 2015). As observed from the interview, I feel however, the interviewer was required to exert greater effort in execution of this theory. Though she promptly encourage the client to read the information she provided concerning the harmful effect of cocaine abuse, I believe that further reading out and explaining the information to him, would have yielded greater compliance to the righting reflex theory, rather than mere lending of data for the client to consult on his own. Motivational interviewing is based upon the presence of ambivalence, where the client outlines considerable confusion concerning undertaking the best decision for his betterment (Feldstein Ewing, Apodaca & Gaume, 2016). As evident from the interview, the client displays considerable ambivalence, concerning his desire to gain control of his occupation and life, as well the desire to be lazy and isolated. Hence, in response to this, interviewers are required to undertake a persuasive response to change conversations, involving guidance and empathy (Hardcastle et al., 2017). In the interview, the interviewer I believe, successfully conducted this practice, by gently questioning the client and encouraging him to outline his perceived notions of strengths and weaknesses, his required personal goals, his possible betterment in the future if he would follow these goals and possible hurdles to his journey, followed by encouraging  him to suggest the changes which he should undertake in his behaviors and attitudes.  

Opportunities to Use Motivational Interviewing That Were Missed

The performance of motivational interviewing is highlighted by the conductance of six key principles, which I could identify in the interview video. In accordance to the reactance theory, the interviewer must not stringently instruct the client concerning the required goal fulfillment (Lee et al., 2016). Upon observing, I believe the interviewer successfully implemented this principle, since she gently questioned the client concerning he believes he should be doing, rather than imposing her decisions. The second key principle of adopting successful motivational interviewing practices is conductance of listening (Christie & Channon, 2014), which I believe that the interviewer performed really well. She patiently listened to the client’s problems. However, I believe she could have improved on showcasing of empathy, by attempting to relate to the client’s doubts and putting herself in his shoes. Thirdly, in motivational interviewing, the key need is to allow the client to express desire for change (Morton et al., 2015). I feel the interviewer successfully incorporated this practice by avoiding her imposition of views and encouraging the client to admit to the fact that he needs to recover from his substance abuse as well as engage in greater occupational functioning. The fourth key principle to be followed for the purpose of successfully motivational interviewing, is to recognize conflict between two options, also known as ‘dissonance’ (Sayegh et al., 2017). I feel that the interviewer successfully performed this procedure, by identifying the conflicting interest of the client to engage in work, as well as to be lazy, and emphasizing the need to engage in work in response to his financial difficulties. The fifth key principle required for motivational interviewing is the attempt to encourage a sense of confidence in the client (Yakovenko et al., 2015). From the interview, I feel the interview is required to exert greater effort in this field, since by the end of the session, the client, remained a little skeptical concerning his desire to change and engage in greater occupational work and establishing healthy relationships with his family. The sixth key factor pertaining to the motivational interviewing is ambivalence (Elwyn et al., 2014), as prevalent clearly in the interview, where the client still exhibited considerable confusion concerning his acknowledgement of the need to engage in work, as well as detrimental desire to be lazy. Despite considerable attempts by the interviewer to persuade the client to undertake healthy decisions concerning work and family, I believe that there is still need to engage in greater empathetic and persuasive conversation in order to eradicate the client’s feelings of ambivalence.

Upon observation of the video of the interview, I could obtain certain key points concerning the behaviors exhibited by the client. It is clear that the client’s engagement towards cocaine usage is strong, and despite considerable awareness concerning the negative health implications of the same, there is still considerable difficulty in eradication of the problem. Hence, I believe that there is a need by the motivational interviewer, to further engage in encouraging conversations with the client, in order to enlighten him about the harmful results of cocaine abuse, rather than merely handing out the information for him to read. Further, despite impressive efforts by the client to mitigate his ambivalence, the client still requires considerable persuasion concerning the need to engage in work as well as family relationships, as evident by the client’s avoidance towards occupational stress and adherence to laziness. Hence, further sessions of motivational interviewing are required with greater empathy, listening and discussion, aiming to further direct the concerned client towards betterment of this life. This would require the motivational interviewer to firstly discuss in detail, the negative effects of drug abuse, which she can conduct gently and with empathy. Further, the client is in serious need of improvement of this financial conditions, which the interviewer promptly responded by the empathetic suggestion of financial classes which she undertook. Hence, during future sessions, she may conduct follow up sessions discussing and listening to the clients experiences, which would further encourage him to get back to his occupation. It is also evident that the client is fearful of stress and hence I believe the interviewer engage in empathetic conversation next, to highlight the positive impacts of stress and how the client can mitigate the same.

Areas Where the Interviewer Did Well

Conclusion

Hence, it can be concluded that motivational interviewing is an effective way to deal with clients suffering from various forms of substance abuse and behavioral issues. As evident from the video of the interview so conducted, the key aspects of motivational interviewing include the usage of empathy, and gentle persuasive discussion, with clear allowance of the client to discuss his own feelings and interests. It was observed that the above mentioned features of motivational interviewing were clearly highlighted in the sample interview. However, there is still need for conductance of future sessions of motivational interviewing, where the interview may be required to use greater empathy and showcase her genuine concern for the client, which may encourage him to undertake the required activities pertaining to the fulfillment of his goals and the resulting improvement of his life. Thus, I believe that with the usage of effective motivational interviewing, one can work efficiently towards the eradication of several ambivalent desires and detrimental behavioral aspects.

References

Draxten, M., Flattum, C., & Fulkerson, J. (2016). An example of how to supplement goal setting to promote behavior change for families using motivational interviewing. Health communication, 31(10), 1276-1283.

Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White, J., & Frosch, D. L. (2014). Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. The Annals of Family Medicine, 12(3), 270-275.

Feldstein Ewing, S. W., Apodaca, T. R., & Gaume, J. (2016). Ambivalence: Prerequisite for success in motivational interviewing with adolescents?. Addiction, 111(11), 1900-1907.

Hardcastle, S. J., Fortier, M., Blake, N., & Hagger, M. S. (2017). Identifying content-based and relational techniques to change behaviour in motivational interviewing. Health psychology review, 11(1), 1-16.

Lee, C. S., Colby, S. M., Magill, M., Almeida, J., Tavares, T., & Rohsenow, D. J. (2016). A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol. Contemporary clinical trials, 50, 193-200.

Mantler, T., Irwin, J. D., Morrow, D., Hall, C., & Mandich, A. (2015). Assessing motivational interviewing via co-active life coaching on selected smoking cessation outcomes. Addiction Research & Theory, 23(2), 131-142.

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press.

Miller, W. R., & Rose, G. S. (2015). Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behavioural and cognitive psychotherapy, 43(2), 129-141.

Morton, K., Beauchamp, M., Prothero, A., Joyce, L., Saunders, L., Spencer-Bowdage, S., ... & Pedlar, C. (2015). The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health psychology review, 9(2), 205-223.

Petrova, T., Kavookjian, J., Madson, M. B., Dagley, J., Shannon, D., & McDonough, S. K. (2015). Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool. Research in Social and Administrative Pharmacy, 11(5), 696-707.

Sayegh, C. S., Huey Jr, S. J., Barnett, E., & Spruijt-Metz, D. (2017). Motivational Interviewing to prevent dropout from an education and employment program for young adults: A randomized controlled trial. Journal of adolescence, 58, 1-11.

Yakovenko, I., Quigley, L., Hemmelgarn, B. R., Hodgins, D. C., & Ronksley, P. (2015). The efficacy of motivational interviewing for disordered gambling: Systematic review and meta-analysis. Addictive Behaviors, 43, 72-82.