Harm Reduction Discuss the viability of harm reduction as a treatment approach from an evidence-based perspective. MOTIVATIONAL INTERVIEWINGIt would be extremely satisfying if we could simply tell our clients that one key thing that would make them see why they should stop unhealthy behaviors and then have the clients actually do whatever it is were suggesting. People often respond poorly to being told what to do, though. Even if they dont actively tune out, most people are unlikely to change behaviors just because someone points out the reasons to stop doing unhealthy things or start doing healthy things. People who need to make lifestyle changes will be at different levels of readiness. A persons ability to enact change will depend on what stage of change the person is in, the amount of ambivalence the person feels toward changing, and the motivation a person has for changing. Motivational Interviewing is a client centered approach that takes a non-judgmental, non-confrontational and non-adversarial approach to help a person explore change. Building on the stages of change, Motivational Interviewing helps a person see the gap between their current behavior and their identified goals. MI does not necessarily take a person through each stage. In fact, you can undo the work you and your client have done if, for example, you push the client toward planning a change strategy too soon. Precontemplation:Raise doubt, increase the clients perception of risks and problems with current behaviors Contemplation:Tip the decisional balance, evoke reasons for change, risks of not changing; Strengthen clients self-efficacy for change of current behavior Preparation:Help the client to determine the best course of action to take in seeking change. Develop a plan. Action:Help the client implement the plan, use skills, problem solve, and support self-efficacy. Maintenance:Help the client identify and use strategies to prevent relapse, resolve associated problems. Relapse:Help the client recycle through the stages of contemplation, preparation, and action, without becoming stuck or demoralizing because of relapse. There are four elements of Motivational Interviewing that differentiate it from other counseling approaches. These are: the need to express empathy with the client, the need to highlight the dissonance between the clients stated values or desires and the behavior in question, the ability to roll with resistance and allow the client to work through ambivalence, the need to promote the clients ability to enact change if she or he wants to. Lets see how what it might look like to apply motivational interviewing to a specific issue. Bear in mind, an actual interview would have much, much more dialogue than the points that well be making in this presentation. Ted is meeting with a substance abuse and addiction counselor. He has been referred to counseling because he came up positive for marijuana in a random drug test conducted at his place of employment. Erik says, Before we start, I want to explain that what we say here doesnt go back to your employer. But, Ive been asked to talk with you and see if I can be helpful to you. As you can see, Erik tries to establish a respectful and trustworthy environment. Notice how Erik demonstrates empathy with Ted. He is not claiming to agree with Teds position, but he hears it non-judgmentally and can show Ted that hes been heard. Ted: It really ticks me off that my company is getting involved with my private life. This is something I do in my own time. It doesnt affect I mean, I dont smoke at work. Ever. Or come to work stoned. Id never do that. Erik: So, as far as youre concerned, this is something apart from your work performance. Its something you do on your own time and the company has no reason to be concerned. Here Erik tries to amplify the disconnect between Teds drug use and his feelings that it is under control and not something that bothers him. Erik is also rolling with Teds resistance by reflecting the disconnect back to Ted in a question. Erik allows Ted to be an expert on his feelings and values and in doing so, allows Ted to explore the juncture between goals and action. Ted: Well, every once in a while well, one of my friends from high school started doing cocaine and even though that wasnt something Id ever really thought about doing, I thought Id try it. But its not something I consider myself doing routinely. Erik: Yeah. Whats your own reflection on that? In high school, you said you werent into cocaine; marijuana was there, thats kind of continued, and now you find yourself using cocaine and speed, and some other things. As you step back and look at yourself here and youre saying where am I going in my life? What have you thought about that? Erik reinforces Teds sense of self-efficacy. As you can see, Ted is moving away from resistance talk toward change talk. Erik: I hear confidence in the way you say that if you were to decide that you need to make a changeif you were having a baby, for example, that you could make that change. You feel pretty confident that youve got that ability within you and its more that you havent seen the need in doing that yet. Ted: Right. Erik: And in some ways, you dont want to see that this is the time, because youd be letting go of something you think makes you who you are. Ted: Thats really it, because one fear I have is about that is that everybody wants to tell me that Ive got to completely radically change my whole life, and that if I even look at a beer, Im just a big druggie drunk. So, in a sense, Im kind of afraid of what changes Im going to need to make but still stay who I am. Bill Miller, one of the developers of Motivational Interviewing, tells us that if the therapist makes the argument for change, it is natural to argue against it and become entrenched in maintaining the original behavior. However, when we make our own argument for change, hear our own voice, we talk ourselves into what we need to do. Here, Erik is helping Ted take that step. Erik: It sounds, though, like you are considering making some changes. On a scale of 1 to 10, now important do you think it is for you to stop using pot and other drugs? Ted: Thats a tough question. I guess Id have to say that its about a seven. Erik: Thats a lot. How come it isnt around a two or a three? CONCLUSIONChange is a dynamic process and it is important when using motivational interviewing not to be prescriptive, but instead to help elicit behavior change by helping clients to explore and resolve ambivalence. CREDITSSubject Matter Expert:Lynn K. JonesInteractive Design:Christina DiMeo, Patrick LapinskiInstructional Design:Felicity PearsonProject Management:Julie GreunkeTalent:Jason Herder, Pat Lapinski, Brent BerheimLicensed under aCreative Commons Attribution 3.0 License.Evidence-Based Interventions Readings Use the Internet to complete the following: Read Evidence-Based Approaches to Drug Addiction Treatment in the National Institute on Drug Abuses 2012 guidePrinciples of Drug Addiction Treatment. Use the Capella library to complete the following: Read Rowan et al.s 2013 article, What Is Valued in Gay and Lesbian Specific Alcohol and Other Drug Treatment?, fromJournal of Gay
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