DBs Unit 4

DB 4.1: Motivational Interviewing and Stages of Change Theory

Similarities between MI and Stages of Change Theory

Focus on Change as a Process

Both motivational interviewing (MI) and the Stages of Change Theory view behavior change as a dynamic and gradual process rather than an immediate event. For instance, in the Stages of Change Theory, individuals move through pre-contemplation, contemplation, preparation, action, and maintenance (Raihan & Cogburn, 2023). Similarly, MI acknowledges ambivalence and works to guide individuals from hesitation to commitment. For example, in human services, a caseworker helping a client struggling with substance use might use MI techniques to explore their ambivalence (e.g., “What are some things you enjoy about drinking, and what are some things you dislike?”) while aligning it with the contemplation stage: DBs Unit 4.

Client-Centered Approach

Both approaches emphasize empowering the client. MI has no forcing of change, used by listening to the client and coming to their level of understanding while the Stages of Change Theory provides clients the freedom to change at the individual pace (Yao & Kabir, 2023). For example, MI employed by a counselor who is working with a client willing to quit smoking in the preparation stage might ask questions like, “What are you prepared to do today?” Such a strategy might be considered as being in harmony with the level of the Client’s readiness for some action.

Differences

Directive versus Stage-Based

MI consciously guides the client to change utilizing reflective listening and reinforcement of motivation while the Stages of Change Theory is performing a classification of the client based on the readiness levels without indicating how to transition between them. For example, an addiction counselor using MI may motivate a client in pre-contemplation by helping them discover the want to change based on their values whereas the Stages of Change Theory will just acknowledge that the client is not yet prepared.

Theoretical Framework

The Stages of Change Theory are part of the Transtheoretical Model, a structured framework for behavior change. MI, on the other hand, is a flexible conversational style that can be adapted to various contexts without rigid stages (Tsantila et al., 2023). For instance, a therapist might use the Stages of Change Theory to assess where a client falls in readiness to quit drugs, while MI would focus on building intrinsic motivation regardless of the stage.

Combining Perspectives in Addictions Work

Building Motivation

MI can help clients in the pre-contemplation stage of the Stages of Change Theory move to contemplation by exploring their values and goals. For example, one can encourage a client to reflect on how their substance use impacts their family.

Personalized Progression

The Stages of Change Theory can help human service professionals identify a client’s stage and tailor MI techniques to match their readiness (Tsantila et al., 2023). For example, for a client in preparation, MI can help solidify their plan by emphasizing achievable actions, like attending support groups.

Avoiding Judgment

Both frameworks avoid labeling or judging clients, allowing professionals to foster trust and collaboration. For example, a caseworker might combine MI’s empathetic approach with the awareness that relapse is a normal part of the stages of change.

References

Raihan, N., & Cogburn, M. (2023, March 6). Stages of change theory. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556005/

Tsantila, F., Coppens, E., De Witte, H., Abdulla, K., Amann, B. L., Arensman, E., Aust, B., Creswell-Smith, J., D’Alessandro, L., De Winter, L., Doukani, A., Fanaj, N., Greiner, B., Griffin, E., Leduc, C., Maxwell, M., Connor, C. O., Paterson, C., Purebl, G., . . . Van Audenhove, C. (2023). Developing a framework for evaluation: A theory of change for complex workplace mental health interventions. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16092-x

Yao, L., & Kabir, R. (2023, February 9). Person-centered therapy (Rogerian therapy). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK589708/

DB 4.2: Debunking Myths about Motivational Interviewing

Motivational interviewing (MI) is a widely accepted approach in human services, but misconceptions persist. One myth is that MI is confrontational, which likely developed because traditional addiction treatment models often relied on confrontation to challenge denial. However, MI is the direct opposite of the traditional authoritarian approach that has been used in guiding patients as it focuses on collaboration and the doctor-patient rapport.

It emphasizes exerting influence on clients to help them appreciate their uncertainty and choose targets for planned change (Bischof et al., 2021). For example, instead of using confrontation where a client might be forced to accept that they have a problem, MI practitioners might use the “What are the advantages of your current actions?” approach.

Another common myth is that MI is too “soft” and ineffective for treating addiction, with critics advocating for “tough love” approaches. This probably arises from the belief that addiction requires some forceful interventions to be made on the subject. However, MI treats the client as an independent adult because research has found that this approach leads to change (Samardzic et al., 2020). When using MI a counselor might say “What are you prepared to do?” instead of telling the client what to do.

A third myth is that MI allows relapse, leading to claims that it is ineffective. Such a myth stems from the fact that relapse is considered a failure. MI accepts relapse as part of the change process and utilizes it in revising coping mechanisms (DiClemente & Crisafulli, 2022). For example, when a client has a relapse, they can look into the circumstances that brought it about as well as the practices should be taken to prevent such occurrences.

Some critics claim MI is just a fad due to its relatively recent development. However, years of research and massive experiments in healthcare and human services show its effectiveness. Fourth, it is commonly believed that MI is used only in cases of addiction because treatment by MI was initiated from this sphere. However, MI is applied for such purposes as enhancing physical health status and coping with mental disorders.

It is recommended that practitioners concerned with MI should correct these misconceptions, given that MI is based on the concept of collaboration and evidenced approach to enable clients to make a correct and sustainable change.

References

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Aerzteblatt Online, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014

DiClemente, C. C., & Crisafulli, M. A. (2022). Relapse on the road to recovery: Learning the lessons of failure on the way to successful behavior change. Journal of Health Service Psychology, 48(2), 59–68. https://doi.org/10.1007/s42843-022-00058-5

Samardzic, M., Doekhie, K. D., & Wijngaarden, J. D. H. (2020). Interventions to improve team effectiveness within health care: A systematic review of the past decade. Human Resources for Health, 18(2), 1–42. https://doi.org/10.1186/s12960-019-0411-3

DB 4.3: Roberto’s Case and Motivational Interviewing

Value of MI in Beginning Work with Roberto

In Roberto’s case, motivational interviewing (MI) provides valuable tools to build rapport and guide him toward change. Notably, because of his courteous tone together with apparent reluctance, it becomes critical to gain his trust. MI starts with modeling and accepting Roberto’s point of view and his indecisiveness without a single criticism. Beginning with questions such as “What are some things you’ve noticed about your drinking habits lately?” allows him to open up.

Reflective listening then reinforces his emotions as well as fosters exploration. For example, revising a message like, “I think you are confused about whether you have a drinking issue and are willing to discuss it”, to one like “It seems you are in the grey area regarding whether alcohol is an issue to you but you could be willing to discuss it”, also builds rapport.

Collaboration vs Confrontation: The Most Critical Factor

The most critical factor in addressing Roberto’s issues is Collaboration vs Confrontation. Intervention strengthens the alliance that was made to deliver the client in the situation without forcing him to engage (Lei et al., 2024). Confrontation, on the other hand, is likely to offend him because he does not admit that he is an alcoholic.

For instance, instead of confronting Roberto with specific allegations, a positive confrontation may include phrases such as, “You mentioned that you like having a drink now and then and that you are beginning to see some issues. What do you make of that?” This allows Roberto to hear someone else acknowledge and accept him—it makes him more ready to change.

How Change Could Happen for Roberto

First, Roberto’s ambivalence would be acknowledged by asking about his values and concerns. For instance, discussing how drinking might affect his health or independence could highlight discrepancies between his behavior and goals (Sharp, 2024). Next, Roberto could identify small, achievable steps, such as reducing alcohol intake or attending a treatment session. Lastly, ongoing support through reflective listening and encouragement would help him maintain progress.

In this case, the MI approach to the change process would major in Roberto’s motivation, capacity, and self-determination (Huang et al., 2023). This approach creates the paradigm for change for the better so that it may be sustained throughout the future.

References

Huang, M., Lv, H., Lv, A., Yang, F., Tang, Y., Li, Y., Hua, Y., Liu, H., & Ni, C. (2023). Applying self‐determination theory towards motivational factors of physical activity in people undergoing haemodialyses: A qualitative interview study. Health Expectations, 26(3), 1368–1379. https://doi.org/10.1111/hex.13757

Sharp, A. (2024, August 23). The effects of alcoholism on families: How alcoholism effects families. American Addiction Centers. https://americanaddictioncenters.org/alcohol/support-recovery/family

Lei, L. Y. C., Chew, K. S., Chai, C. S., & Chen, Y. Y. (2024). Evidence for motivational interviewing in educational settings among medical schools: A scoping review. BMC Medical Education, 24(1). https://doi.org/10.1186/s12909-024-05845-w

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DB 4.1
In reading and viewing the video assignments for this week, you were given an opportunity to learn more about the concepts of Motivational Interviewing/Enhancement. In thinking about Motivational Interviewing, please answer the following questions in your own words:

• -How is the Stages of Change Theory similar to the principles of Motivational Interviewing? Please discuss at least 2 ways and provide examples from the field of human services.
• -How is the Stages of Change Theory different to the principles of Motivational Interviewing? Please discuss at least 2 ways and provide examples from the field of human services.
• -In thinking about the clients you would like to work with in the field of addictions, how do you think that both viewpoints can be helpful? Please give at least 3 examples.

NOTE: You must make at least 1 substantial posting and 2 substantial replies to this thread. You must participate in the Unit discussion board (making postings/replies) at least 3 days per unit to qualify for full credit and also have at least 1 posting by Wednesday at midnight. You also must use APA style in your posting and replies so please use in-text references and provide a reference to give proper credit to the authors.

DB 4.2
Since Motivational Interviewing is a relatively new approach in the field of human services, there are several “myths” that have been identified but have been refuted. Please pick at least 5 myths below and provide 1) your rationale for why the myth developed, 2) your thoughts based on your reading as to why the myth is false, and 3) the “correct” viewpoint demonstrating your understanding of the myth. Please choose from the list below:

• -Motivational Interviewing (MI) is confrontational
• -MI is too “soft” – addicts need “tough love”
• -MI is part of the Transtheoretical Model
• -MI does not work because it allows people to relapse
• -MI is for treating addictions only
• -MI is just a fad
• -MI is the only approach that works
• -MI is unethical
• -There is no proof that MI works
• -MI is only available in expensive treatment centers

NOTE: You must make at least 1 substantial posting and 2 substantial replies to this thread. You must participate in the Unit discussion board (making postings/replies) at least 3 days per unit to qualify for full credit and also have at least 1 posting by Wednesday at midnight. You also must use APA style in your posting and replies so please use in-text references and provide a reference to give proper credit to the authors.

DB 4.3
Roberto is an older man in his late sixties and is a bit disheveled in appearance. He is accompanied by his landlady to the assessment. The landlady tells you that she found him earlier this evening trying to enter his apartment door. He was sweaty, his eyes where dilated, and his hands were trembling so badly that he could not get the key in the door.

He kept calling her by another name and saying he was trying to get into his office to do some work. She knows he retired years ago, has lived in her apartments for several years, and knows her real name. His blood/alcohol level is low and his speech is not slurred. He can correctly identify himself but, also appears confused.

He is unable to tell you the month or season. His nose and cheeks are red with tiny spider veins and his stomach distended and when he extends his hands out in front of him they are very tremulous. His demeanor is polite and apologetic to you and the staff. He tells you he has never had a problem with alcohol but scored high on the CAGE assessment test.

He then admits to an occasional drink every now and then. He did have a few drinks earlier today but can’t say exactly when. However, he is willing to enter treatment if really thought it was necessary.
In thinking about Roberto’s case, please answer the following questions:

• -In thinking about Motivational Interviewing, what would be valuable in the beginning of your work with Roberto? Please give specific examples.
• -Pick one of the following statements and describe why you think it is the “most” important factor in addressing Roberto’s issues. Please provide at least 2 examples as to why this is the “most” important statement (and yes, you have to pick just one):
  • Collaboration vs Confrontation
  • Autonomy vs Authority
  • Drawing out his ideas vs your ideas
• -How could “change happen” for Roberto according to MI? What would the process look like? Examples?

Readings:

• Please read White’s (2012) article on The Psychology of Addiction Recovery by viewing: https://www.chestnut.org/resources/3fbdce0f-6f4d-4196-b992-142dcf7936e8/2012-Dr.-William-Miller-v2.pdf
• Please view this short video where Dr. William Miller discusses Motivational Interviewing by clicking HERE.
• Please read Bundy’s (2005) article on Changing Behaviour: Using Motivational Interviewing Techniques by clicking HERE
• Please view a short clip demonstrating the principles of Motivational Interviewing by clicking HERE.