Week 6 Discussion Response To Classmates
Please no plagiarism and make sure you are able to access all resource on your own before you bid. Main references come from Van Wormer, K., & Davis, D. R. (2018) and/or American Psychiatric Association. (2013). You need to have scholarly support for any claim of fact or recommendation regarding treatment. I have also attached my discussion rubric so you can see how to make full points. Please respond to all 3 of my classmates separately with separate references for each response. You need to have scholarly support for any claim of fact or recommendation like peer-reviewed, professional scholarly journals. If you draw from the internet, I encourage you to use websites from the major mental health professional associations (American Counseling Association, American Psychological Association, etc.) or federal agencies (Substance Abuse and Mental Health Services Administration (SAMSHA), National Institute of Mental Health (NIMH), National Institutes of Health (NIH), etc.). I need this completed by 04/06/19 at 8am.
Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.
Read a your colleagues’ postings. Respond to your colleagues’ postings.
Respond in one or more of the following ways:
· Ask a probing question.
· Share an insight gained from having read your colleague’s posting.
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion.
· Expand on your colleague’s posting.
1. Classmate (J. Car)
Overview of Motivational Interviewing
In order to best serve my client Maurice, I have selected Motivational Interviewing (MI) as a primary treatment approach. According to Forman & Moyers (2019), after over 200 clinical trials, MI has proven effective as both a stand-alone treatment as well as post treatment method of enriching the positive elements of other therapeutic approaches. Maurice has been struggling with an addiction to heroin for 8 years, in and out of inpatient treatment three times and now worried that his family will completely abandon him after this latest incident. However, according to the Transtheoretical Model or Stages of Change, Maurice is currently moving beyond the Contemplation stage and thus MI may be a helpful strengths-based model to lead him toward the life he desires. The core tenants of MI focus on helping a client renew self-control by examining suffering and negative consequences of addiction, striving to help clients cling to an intrinsic motivation for and vow to change (Van Wormer & Davis, 2018). Additionally, Maurice may be struggling with ambivalence with regard to making big changes in his life, and MI will allow him to examine the many levels of motivation: desire, ability, reasons for change, need, and commitment to change. Examining costs and benefits of stopping the use of heroin may assist Maurice in overcoming ambivalence. Once he has established language focused on the decision to make changes, even experimenting with several small changes between sessions, he may be ready to take further steps toward treatment of his own volition.
Strengths and Weaknesses
MI may not be a strong contender for a treatment approach with a client who is resistant to or in denial of a need for change, especially if his or her addiction is contributing to significant physical health or lifestyle risks for him or herself, friends, family, and the community at large. The desire for change is a huge element in the implementation of MI, and a client who does not move past ambivalence may continue to inflict serious harm on him or herself. (Van Wormer & Davis, 2018). A strength of MI is the therapist-client relationship, focusing on creating an atmosphere of acceptance and understanding which will influence the client enough that he or she will me more likely to thoughtfully consider their problems (Forman & Moyers, 2019). In the case of Maurice, he is already feeling very isolated and fearful that not only his roommates will abandon him, but also his parents and brothers. With its focus on expressing empathy, non-confrontational approach, reflective responses, and support of self-efficacy, Maurice may begin to take ownership of his problems as opposed to the past perception that his addiction was completely out of his control.
Meeting Treatment Goals
Two goals for treatment with Maurice would be to help him attain measurable instances of self-control with regard to heroin use, as discerned by him, and to examine his levels of self-efficacy and continual comparison to his siblings, helping him to examine previously unrecognized strengths which may contribute to the life he desires and potentially the end of his addiction to heroin. MI would contribute toward meeting these goals by examining the negative addictive patterns in Maurice’s life and how social influences, biology, or emotion may have contributed to the beginning of his heroin use (Van Wormer & Davis, 2018). Examining the reason he has to change, potentially wanting to be closer with his family, may be an enormous source of hope and a catalyst in the commitment to change, which can only be achieved through the client’s own decision. Empathetically building a therapeutic alliance with Maurice will contribute to the process of uncovering what might be hindering him from making the changes to his life that he desires, and having a positive relationship with a counselor and the opportunity to hear reflected back what strengths he or she sees in him may be incredibly empowering, possibly even the first time he has heard any of them named aloud.
Benefits of Group Treatment
Though limited research has been achieved regarding group motivational interviewing (GMI), it has been associated with higher levels of Change Talk (CT) in treatment of substance disorders (Shorey, Martino, Lamb, LaRowe, & Santa Ana, 2015). Group treatment is common and highly impactful in 12-step programs such as Alcoholics Anonymous, as it provides accountability and solidarity in choosing to address addiction. GMI promotes group cohesion, a focus on hope, and renewing the client’s sense of self-respect, all of which are highly attractive factors for individuals considering therapy, resulting in a high retention rate and lowered use of substances (Shorey et al., 2015). Change Talk is a goal of both individual and group Motivational Interviewing and though GMI necessitates more empirical evidence of effectiveness, both treatment methods continue to be implemented by counselors due to the client-centered, hope-instilling qualities.
Forman, D. P., & Moyers, T. B. (2019). With odds of a single session, motivational interviewing is a good bet. Psychotherapy, 56(1), 62–66. https://doi-org.ezp.waldenulibrary.org/10.1037/pst0000199
Shorey, R. C., Martino, S., Lamb, K. E., LaRowe, S. D., & Santa Ana, E. J. (2015). Change Talk and Relatedness in Group Motivational Interviewing: A Pilot Study. Journal of Substance Abuse Treatment, 51, 75–81. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2014.11.003
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
2. Classmate (C. Ree)
The treatment approach I elected with the case study of Shanelle is Motivational Interviewing (MI). MI is a client-centered, directive therapeutic style to enhance readiness for change by helping clients explore and resolve ambivalence (Hettema & Miller, 2005). It is client centered because all the benefits and consequences of making a change are elicited from the client (Van Womer & Davis, 2018). I selected this treatment modality since Shanelle is displaying a diminished capacity for self-control over a period of time and this method strengthens a person’s own motivation and commitment to change. Shanelle has two DUI’s, she has lost a job because of the results of drinking, and her family is worried about her drinking; as well as Shanelle. Yet she remains convinced that her drinking is not so bad and has not caused problems in her life. MI seems to be a comprehensive approach to help Shanelle since it focuses on stages of change. For instance, MI understands that one can be in a state of change like having a desire, ability, reasons, need, and commitment to change. With these changes or stages in mind MI seems suitable for Shanelle’s scuffle with making a change.
One Strength and One Weakness of Motivational Interviewing
A strength that I found with Motivational Interviewing is MI combines a compassionate and empathic counseling style with a consciously directive method for resolving uncertainty in the direction of change. For instance, MI practitioners use techniques to enhance a person’s desire to change like avoiding arguing or expressing empathy (Van Womer & Davis, 2018). A weakness of MI is across a growing array of problem areas includes MI generally showing small to medium effects in improving health outcomes and Hettema and Miller (2005) discuss in their article how increased client change talk would predict behavior change and how frequency of change talk statements was unrelated to subsequent behavioral outcomes which obviously posed a serious problem for the theory of MI.
Two Treatment Goals
For Shanelle one treatment goal would be to build a framework for intrinsic motivation to change. When this goal is reached Shanelle will be able to decrease her resistance to change and increase her change talk. Another treatment goal for Shanelle would be to evoke her own motivations for, and commitment to change. MI would serve groups as well as individual. In a group setting Shanelle would benefit since she will be exposed to others and their ideas about change. In an individual setting Shanelle will be able to dialogue about reasons she is interested in changing. Also group treatment could help this client deal with feelings when they resurface. After MI for instance, Shanelle will be faced with the commit she made to discontinue the behavior. Group will give her the space she needs to be heard and to hear those who are grappling with an addition like she is. This participation could help her with relapse and continuing on the path to stay committed to overcoming her addiction.
Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annu. Rev. Clin. Psychol., 1, 91-111.
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
3. Classmate (A. Mc)
John, a 38-year-old Euro-American, has been ordered to seek counseling by his workplace after stopping at a casino during a cross-country run; he is a long-distance truck driver. Though he has a place he calls “home”, he spends most of his time on the road. Due to his work, he does not have very many friends, he has no romantic relationships, and he has alienated family members and close friends who he owes a substantial amount of money. John admits that he enjoys gambling and engages in this activity whenever he can, but he does not believe this to be problematic. He does disclose that gambling has been a causal factor in breakups and in preventing him from reaching financial goals.
Treatment Approach: Motivational Interviewing (MI)
With the information that John has provided, it is evident that, at the very least, he is on the path to a gambling disorder diagnosis. In accordance with the DSM-5, John has jeopardized or lost a significant relationship due to gambling (A.8.) and has relied on others to provide him money (A.9.) (American Psychiatric Association, 2013). These criteria account for two of the four necessary to be clinically diagnosed with the disorder. Contrary to John’s disclosures, he does not believe that his behavior is problematic and is unable to identify any motivation to do so. Therefore, motivational interviewing may be a beneficial treatment approach for this case study.
Motivational interviewing is a client-centered approach intended to be used with ambivalent clients, like John. The approach utilizes open-ended questions which seek out the client’s desire, ability, reasons, need, and commitment to change. Techniques used to enhance a client’s motivation through this approach are (1) express empathy, (2) develop discrepancy, (3) avoid argumentation, (3) roll with resistance, and (4) support self-efficacy (Van Wormer & Davis, 2018).
Strength of MI
One strength of this approach is that it is non-confrontational and client-centered. All the “change talk” comes directly from the client, not the counselor. This is especially important when dealing with ambivalence, because there would likely be a lot of resistance if the counselor were to “[try to] get the client to admit they have a problem” (p. 328), as stated in Van Wormer and Davis (2018). This approach facilitates the client’s discovery of their own motivations for discontinuing a behavior.
Weakness of MI
One weakness of this approach is that it is not as effective when there are co-occurring disorders present (American Addiction Centers, 2016). With further inquiry, John may meet the criteria for gambling disorder, however, it is also important to ask questions and use assessments to determine his level of depression, if any. John has isolated himself from other people and does not truly have a home, both of which could lead to feelings of hopelessness. Ultimately, it is difficult to find motivation in a client who has not been treated for an underlying disorder, such as depression.
One treatment goal for John might be to decrease the amount of time he spends gambling. This goal would become more specific depending on new information and disclosures. Motivational interviewing will eventually require questions which will elicit a client’s commitment to change. During this time, John and his counselor can create a reasonable and achievable goal for him to strive for, such as the amount of time per day (per week, per month) spent gambling. A second treatment goal for John might be to reconnect with those whom he owes money to. This goal can be addressed after John is able to identify why he needs to change, another step included in motivational interviewing. One reason he might need to change is to rebuild his relationships and pay his debts. Overall, the motivational interviewing process will guide John and the counselor in creating the goals and provide John with the intrinsic motivation to reach these goals.
Group versus Individual Treatment
It is important to consider whether the client’s counseling process should include individual treatment, group treatment, or both. There is not a lot of information available which discusses the motivational interviewing approach in a group setting, however, there is evidence which suggests that it can be done (Van Wormer & Davis, 2018). The counselor working with John might not suggest group treatment in the beginning, because he has been isolated from others for so long. He will probably be more open and feel safer in an individual treatment environment at first. After John has made some progress, adding group treatment might be beneficial for the same reasons—he has been isolated from his support system for awhile (Van Wormer & Davis, 2018). Group therapy will help John by supporting relapse prevention and continuum of care. In other words, working alongside other individuals with the same goal (e.g. abstinence) can add external motivation to complete the desired goal, preventing relapse. Further, individuals in group settings can become each other’s friends and motivators when group therapy has finished.
American Addiction Centers. (2016). Motivational interviewing in addiction treatment.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th
Bottom of Form
- Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.
- Chapter 8, “Strengths- and Evidence-Based Helping Strategies” (pp. 313-351)
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- “Substance-Related and Addictive Disorders” (pp. 481–589)
- Davies, G., Elison, S., Ward, J., & Laudet, A. (2015). The role of lifestyle in perpetuating substance use disorder: The Lifestyle Balance Model. Substance Abuse Treatment, Prevention, & Policy, 10(1), 1–8.
Retrieved from the Walden Library databases.
- Martin, G. W., & Rehm, J. (2012). The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: A review of the evidence. The Canadian Journal of Psychiatry, 57(6), 350–358.
Retrieved from the Walden Library databases.
- Document: Week 6 Case Studies (PDF)