The MI Process - Research Proposal Example

 The MI Process Introduction According to Boardman (2006) the prime objective of motivational interview is directive, with the aim of eliciting self-motivational statements and subsequent behavioural change from the subjects. The report aims to examine the MI conversational approach through an evidence-based treatment to address Chelsea's deviant behaviours. The report will consist of five major sections. The report will commence with a detailed review of the literature relating to MI. The next stage will entail discussion of the MI process with regard to the subject, interviewer, and observers. The discussion stage will be followed by evaluation subject’s behavioural changes and critic of observations during the interview. The report will conclude with reflective commentary on key aspects of MI process. Objectives To gain firsthand experience and understanding of the person-centred technique of MI. The undertaking was further aimed at underpinning the role of the five key principles of MI. According to Murphy and Maiuro (2009), the five principles that underscore the effectiveness of the MI include the expression of empathy, establishment of inherent discrepancy between client's objective and their present behaviour, avoidance of argument, adjustment to subject's resistance and the enhancement of self-efficacy and optimism. The reports will further expound on how the views and needs of interviewees are likely to be influenced by information. Literature Review Miller and Rollnick (2013) defined motivational interview as both a treatment philosophy and a collection of techniques that could be employed to aid people increase intrinsic motivation through the exploration and resolution of ambivalence about their behavioural change. Amrhein et al., (2003) further reiterated that MI applications have gained momentum over the last two decades with widespread adoption in psychotherapy, public health, medicine, and addiction. According to Washton and Zweben (2011), MI is founded on the conceptualization of human motivation. Vis a vis, the mathematical equation that best describes the principle of MI is as follows: Knowledge × Motivation = Change. From the equation, it is evident that the motivation forms a pertinent integral of the behavioural change process. Wahab (2005) hence noted that the MI process entails the identification of patient-related factors that could result to motivational conflict, therefore, hindering effective progress of the behavioural change process. Subjects in MI have been observed to undergo five change stages with inherent motivational conflicts that should be addressed by the clinicians. These stages include pre-contemplation, contemplation, preparation, action and maintenance. In their argument, Hettema et al., (2005) wrote that subject’s ambivalence underlines the centrality of the MI process. Ambivalence refers to a conflicted patient state where the subjects experience opposing attitudes between the need for change and not wanting the change. Therefore, as counselling method, Moyer et al., (2002) asserted that MI techniques are pegged on the successful resolution of patient’s ambivalences by use of MI techniques to underpin patient’s willingness, ability and readiness for the behavioural change. Regarding the MI process as patient-centred process, Miller and Rollnick (2002) highlighted on five-step interview process that ensured the success of the technique. The first stage encompassed the setting of the stage for the interview process followed with the interviewer elicit of sincere concern and setting of the agenda. The third state involved enhancement of patient expression by commencing the interview with focused skills. The fourth stage encompassed the use of focused skills to comprehend the patient’s symptoms and subsequent impact on the patient’s life and experience. The final stage constitutes the evaluation of the observations through summary, briefs, and implications. On the other hand, Rosengren (2009) cautioned that the goals of MI should be consistent with subsequent stages of the process. Group Write Up Interview 1 Chelsea : Gabriel Interviewer : Neema Observers : Fay and Sarge Interview 2 Chelsea : Marie Interviewer : Gabriel Observers : Fay and Sarge Interview 3 Chelsea : Sarge Interviewer : Fay Observers : Gabriel and Marie Interviewer 4 Chelsea : Fay Interviewer : Sarge Observers : Gabriel and Marie Discussions Interview 1 The first session was characterized by pre-contemplation signs. Chelsea indicated fewer regards towards her deviant behaviours and their implications. During the first interview, the goals of the interviewer included validation of the Chelsea’s experience, encouragement of further self exploration, development of reasons for behavioural change and the enhancement of opportunity for future conversations (Douaihy, et al., 2014). Chelsea was quick to deny the claims that her behaviour had shifted since she joined the sixth form. The interviewer went ahead to highlight on incidences that had been triggered by Chelsea’s recent behaviours. However, the session mostly focused on the implications of Chelsea’s behaviour with regards to her family relationship, academic performance, and public reputation. In conclusion, Chelsea was asked to reflect on her past experiences and choose the ones that positively impacted on her future developments. She was to present her feedback during the second interview. Interview 2 The second interview was built upon Chelsea’s reflection on her past experiences. Unlike the first interview, Chelsea asserted that she was considering a change, although she was undecided on how to approach the process. On one end, she was still attached to her recent popularity at school and at home while on the other end she was alarmed of her dismal performance at school. Vis a vis, the session majorly concentrated on addressing the ambivalence of Chelsea. The discussions acknowledged Chelsea’s control of her decisions and subsequently suggested a dance academy where she could freely express herself. The session also highlighted on the prospective actions that could rebuild Chelsea’s relationship with her parents. Interview 3 Alarmingly, Chelsea had developed negativity towards the MI process. She had not looked into the dancing academy. To empathize, the interviewer offered to look for a dancing school for Chelsea. Subsequently, the interviewer resolved to identify the origin behavioural change. Chelsea was a victim of peer pressure from her new found friends. The interviewer reassured Chelsea of her control of the entire process and gave her more time to decide. During the second session of interview 3, Chelsea reaffirmed her conviction to continue with the MI. Chelsea was further impressed by the interviewer’s suggestion to take her to a youth centre. Interview 4 Chelsea had successfully completed the action stage by visiting a youth centre. The final interview was mainly geared towards undertaking of small initial steps, identification of social support, and reinforcement of behavioural change decisions and assistance of problem solving. Although Chelsea was not decided on joining the dancing academy, she maintained her visitations to the youth centre. In addition, while, at the youth centre, Chelsea inquired about swimming lessons hence indicating positive signs of socializing at the centre. The interviewer further stressed the significant role of Chelsea’s parents in sustaining her behavioural change process. Positively, Chelsea highlighted that she was already in good terms with her stepfather and was optimistic about regaining her excellent performance at school. Stages of Change Analysis of Chelsea’s MI process demonstrated the five stages of change with their respective motivational conflicts. The first interview was predominantly characterized with the pre- contemplation stage. The subject demonstrated minimal regard to her behavioural problems and thus had less consideration for behavioural change (Emmons & Rollnick, 2001). Chelsea stated that “she was the same Chelsea” even after joining her sixth form. During the first interview, Chelsea's responses were mainly punctuated with denial as she blamed her mother, stepfather and school teachers for her woes. She vehemently asserted that she was not responsible for the implications of her actions. As a result of her misplaced priority, Chelsea misdirected her anger towards her parents and the society. Nevertheless, after the interview, Chelsea agreed to contemplate on her past experiences marking her first step towards behavioural change. Interview 2 was predominantly a contemplation stage. Chelsea was profoundly ambivalent towards the MI process. Chelsea had progressed from pre- contemplation stage was now considering action plans aimed at mitigating her deviant behaviour (Miller & Rollnick, 2002). However, Chelsea was still uncertain whether she would regret initiating the process. On one hand, she felt she was being controlled hence abound with the fear of change. By underscoring the benefits of behavioural change, the interviewer employed MI techniques to motivate Chelsea to consider continuing with the action plan. In response, Chelsea became aware of her ambivalence state, thus acknowledging the benefits relating to her behavioural change. During the interview 3, Chelsea entered the pre-contemplation stage again. The subject failed to initiate the action plan and reconsidered quitting the process. The development of negativity had been triggered by external forces such as Chelsea’s peers and media. The scenario reversed MI gains that had been achieved from previous sessions. With the intervention of the interviewer, Chelsea overcame her ambivalence state and showed signs of responsibility by considering to visit a youth centre. The final interview was marked with both preparation and action stages of changes. Chelsea successfully visited a youth centre and was further willing to maintain her visitation to the centre. Subsequently, Chelsea showed preparedness through her socialization at the youth centre and her willingness to undertake swimming activities (Craig, 2005). Additionally, Chelsea commenced the action stage as she was already communicating with her stepfather and also was working to restore her grades at school. Observations Throughout the MI process, the interviewer asked for permission before she could ask questions. Rollnick et al., (1992) noted that by asking permission during MI, clinicians demonstrate the utmost respect to their clients thereby facilitating trust between the clients and the interviewers. In most cases, the interviewer phrased her questions in the form of “do you mind if we talked about your?” Additionally, the interviewer employed the MI technique of change talk to address profound discrepancies between Chelsea’s words and actions. Chelsea was often asked “what will happen if you don’t change?” As one of the core principles of MI, the interviewer was keen to express her empathy with the situation of Chelsea. The discussion was mostly hinged on open-ended questions that prompted further conversations that could be reflected upon by Chelsea (Miller & Rollnick, 2013). Through the influence of open-ended question structure, Chelsea underwent changes from being ambivalent to being aware of the implications of her actions. Chelsea's self-efficacy was also heightened by the employment of affirmations by the interviewers. The interview constantly reminded Chelsea of her academic potential and further stressed her past charismatic relationships at school and at home. Chelsea was able build rapport with the interviewer as she narrated her past success. On her part, the interviewer maintained positive nonverbal cues through the maintenance of direct eye contact, clear and slow voice tone and posturing steadily. The interviewer further sat directly facing the Chelsea thus establishing a formal interaction. Additionally, as a patient-centred process, Chelsea controlled almost every aspects of the interview such as number of breaks and the duration of the sessions. Another key aspect included the reflective listening technique. Craig (2005) noted that reflective listening encompassed careful listening to clients and intuitive guess of what they are about to say. Interviewer majorly employed the following reflective phrases, “it sounds like…, it feels as though…, and what I hear you saying…” The interviewer further provided advice through non-judgmental and neutral information in the form of feedback with regards to socialization, academic performance and relationships (Miller et al., 1992).  Reflective Commentary Based on Chelsea’s case study, it emerged that individuals have more often failed in their attempt to initiate behavioural changes. Vis a vis, in resonance with Shumaker et al., (2009) studies, the MI process underpinned the role of information and subsequent external motivation to overcome negative enduring behaviours. The examination of Chelsea’s change stages reinforced the four stages in behavioural changes that include the pre-contemplation, contemplation, the preparation, and action stages. The project also positively impacted on the individual skills of every group member. By undertaking individual research prior to the composition of the group work, members were exposed to the extensive literature on motivational interviewing. Similarly, the role play enhanced our understanding and application of MI techniques in real situations. Among the three roles, I was most impressed with the observer’s role. Although the other roles were also enlightening, as an observer, I strategically scrutinized the underlying elements of the subject and the interviewer. Unlike most members of the group, I was most challenged with role of Chelsea. I was unable to overcome my belief system and adopt Chelsea’s ambivalence state towards the MI’s action plan. Nevertheless, by working as a group, members complemented each other on the roles that best suited them. The project thus provided a comprehensive framework that critically demonstrated the concepts of MI procedure by highlighting the roles of subject, interviewer and observers. Additionally, the group work’s implications transcended the MI framework by fostering a mutual relationship between group members. Conclusion Effective motivational interview skills are essential in overcoming ambivalence among patients undergoing behavioural changes. On the other hand, the report also underlined the patient centredness of the process as evidenced by patient’s utmost control of the MI process. The discussion further underpinned five stages which clinicians should be aware of while undertaking motivational interview based groups MI process. The subsequent knowledge of these predetermined phases should further enable the determination of MI techniques to employed in the course of the procedure. Vis a vis, successful implementation of motivational interview majoly lies in the adminatrations of the five principles of MI process. These included the expression of empathy, establishment of inherent discrepancy between client's objective and their present behaviour, avoidance of argument, adjustment to subject's resistance and the enhancement of self-efficacy and optimism through a patient centred process. References  Amrhein, P., Miller, W., Yahne, C., Palmer, M., And Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcome. Journal of Consulting and Clinical Psychology. 71, 862-878 Boardman, T. (2006). Motivational interviewing: Examining the therapeutic process. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66, 6262 Craig, R. (2005). Clinical and diagnostic interviewing. Lanham, Md, Jason Aronson. Douaihy, A., Kelly, T.,And Gold, M. (2014). Motivational interviewing: a guide for medical trainees. Emmons K. And Rollnick S. (2001). Motivational Interviewing in Health Care Settings: Opportunities and Limitations. American Journal of Preventive Medicine, 20:68-74. Hettema, J., Steele, J. And Miller, W. (2005) Motivational interviewing. Annual Review of Clinical Psychology1, 91–111 Miller, W. And Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change, 2nd edn. New York, Guilford Press Miller, W. And Rollnick, S. (2013). Motivational interviewing: helping people change. New York, Guilford Press. Miller, W., Zweben, A., DiClemente, C., And Rychtarik, R. (1992).  Motivational Enhancement Therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence.  Rockville, National Institute on Alcohol Abuse and Alcoholism. Moyer, A., Finney, J. And Swearingen, C. (2002) Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment -seeking populations. Addiction 97, 279–292 Murphy, D. And Maiuro, D. R. (2009). Motivational Interviewing and Stages of Change in Intimate Partner Violence. New York, Springer Pub. Co. http://public.eblib.com/choice/publicfullrecord.aspx?p=435124. Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change in medical settings: The development of brief motivational interviewing. Journal of Mental Health, 1, 25-37. Rosengren, D. (2009). Building motivational interviewing skills: a practitioner workbook. New York, Guilford Press. Shumaker, S., Ockene, J. And Riekert, K.(2009). The handbook of health behaviour change. New York, Springer Pub. Wahab, S. (2005). Motivational Interviewing and Social Work Practice. Journal of Social Work, 5 (1), pp. 45-60. Washton, A. And Zweben, J. (2011). Treating Alcohol and Drug Problems in Psychotherapy Practice Doing What Works. New York, Guilford Publications. Read More