Counselling and Helping in Motivational Interviewing

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Table of Contents

Introduction
Evidence showing MI works
Interventions are necessary for spreading treatment universally
MI can be useful as part of general intervention health programs
Strengths and weaknesses or limitations of the reviewed articles
Conclusion
Reference List

Introduction

Motivational interviewing (MI) upholds four principles in its attempt to give people with mental health issues a better health outcome (Miller & Rollnick 2009). The principles are the expression of empathy without arguing, developing discrepancy, going with resistance, and self-efficacy support so that a client understands the personal ability to change (Treasure 2004). This paper will look at depression as a mental issue for solving using MI approaches. The paper chooses depression because of its high prevalence in populations around the world.

Depression is an important mental health issue that affects about 20 per cent of the global population at a given time (Riper et al. 2014). As a very common mental health problem, depression should offer sufficient evidence for looking at the role of brief approaches to counselling and helping patients with this mental issue when using motivational interviewing. Depression is a mental condition that requires a combination of medication and counselling, and it only works when the right approaches are used for the two interventions (Flynn 2011). Therefore, it would be beneficial for practitioners to understand how a given approach to helping or counselling is improving their practice, and whether there are alarming components of treatment that need changes (Mason et al. 2011).

Despite the effectiveness of MI, the intervention by health care providers when initiating and implementing MI succumbs to limitations in counselling as its results are not always effective. Comparing MI to standard practices would reveal other points to consider for future applications that can help to improve outcomes and reach the goal (Mason et al. 2011). The paper presents these arguments by using results from peer-reviewed journal articles.

Evidence showing MI works

Motivational interviewing works as a counselling intervention. To prove the argument, the meta-analysis study of empirical research reports on motivational interviewing done in the last 25 years was conducted by Lundahl et al. (2010), with the main criteria for inclusion of articles being that they were covering the main principles of motivational enhancement therapy. The researchers were also careful to include studies that only had a treatment group and a comparison group to improve the validity of the findings of their meta-analysis. Lastly, their criteria for selection of articles also ensured that humans delivered interventions in the studies in all articles considered. In the analysis, the dependent variable was the outcome assessed. The outcomes were observable behaviours like alcohol use, reduction in risk-taking behaviour, and psychological well-being, as with the case of stress and depression.

Particular measurements of each outcome were multifaceted. Besides, the researchers also used potential moderators to influence their study, where they had eight categorical variables and continuous variables. They looked at the comparison group, client’s level of distress, MI type, use of a manual, role in treatment, fidelity to MI, who delivered MI, and the delivery mode. In addition, for continuous variables, which served as potential moderators, the researchers used the participants’ average age, percentages for males and females, percentages for whites, African-Americans, or Hispanics, and to a lesser extent other racial groups, number of sessions, total dosage, durability, and study rigour.

The parameters used in conducting the meta-analysis by Lundahl et al. (2010) led to the qualification of 119 studies in the final analysis, with 10 of the studies comparing two conditions of MI or two different comparison groups in the same study. The researchers noted variations in focus and presentation of MI to clients, as well as outcomes of interest in all the studies.

The Lundahl et al. (2010) meta-analysis had categorical findings as follows. On the overall magnitude of the effect of MI intervention, results showed that effects were small but statistically meaningful. The researchers explored the effects of the moderators identified in their study criteria to bring out particular moderator relations to the MI outcomes. Overall, the study shows that MI exerts a small and significant positive effect on a broad range of problem domains, but its effectiveness is pronounced in some situations compared to others. The study also notes that when looking at all effects, MI results in some negative effects. However, that did not imply that participants received any harm; rather, the comparison group was more responsive.

Lundahl et al. (2010) did not review the cost impacts of agencies adopting MI, but they indicated that most intervention in the studies reviewed took less than 100 minutes. It implies that MI can be a cost-effective intervention due to the efficient use of personnel resources. Another question answered by the study was whether MI would only be useful for substance use problems.

The answer was that MI associated positively with measures of general well-being like lower depression levels. Another question was whether MI would be successful in motivating clients to change. The results of the study supported the claim of effectiveness by showing that MI was capable of boosting client confidence about the intention to change when reviewed as a variable for the MI outcome. Another question was on whether MI was useful with very troubled customers and the average distressed clients and whether MI was as successful as other interventions. The results showed MI as useful for people with high levels of misery, as well as those with relatively low misery levels (Lovejoy 2012).

MI is also better than no treatment or weak treatment options like written materials, but it is not clearly superior to other alternative methods (Tse, Vong & Tang 2013). The study by Lundahl et al. (2010) shows the effects of MI being durable. Moreover, the use of a manual did not matter affecting the superiority of MI. Similarly, the format of MI does not matter, while the goals of using MI are similar to many change efforts. Data analyzed in the study also showed that training did not influence the success of MI, but the dosage of MI somewhat mattered. The study was unable to give a simple response to a question of whether MI worked for most clients. MI is capable of helping in many problems and domains, with data showing a mixed picture of effectiveness about race. There were few studies reviewed by Lundahl et al. (2010) showing that it would be a mistake to rely on group-delivered MI only.

Overall, Lundahl et al. (2010) support the use of MI by showing that MI has a clear and articulate theoretical frame. It uses specific techniques that are easy to transfer. Moreover, significant growth in learning material for MI has led to standardized training that focuses on the effectiveness of the training and the resultant MI interventions (Lundahl et al. 2010).

Interventions are necessary for spreading treatment universally

Brief interventions are important because they help to avail treatments in areas that would be left out of health care interventions because of social-economic challenges. Mental health care discrimination due to social challenges can be addressed adequately by an MI approach that puts the treatment and intervention stewardship on clients, rather than social workers. It would allow all health providers to serve a critical role of being intermediaries between the desired outcome and client wishes. A study by Sampson, Zayas, and Seifert (2013) indicated that the use of motivational interviewing could be useful for complying with federal mandates for screening for depression and the provision of treatment.

The study was able to show how motivational interviewing helps to bypass obstacles for seeking and accepting treatment by low-income, ethnically diverse mothers. The researchers looked at a case study of women and their children regarding the risks of untoward outcomes such as low self-efficacy and insecure infant attachment due to postpartum depression (Sampson, Zayas & Seifert 2013).

The researchers considered postpartum depression (PPD) in low-income settings. They examined its presence, predictors, and identifiers. They also looked at barriers that faced low-income and ethnically diverse mothers when considering their choice of accepting services. After the review, the study examined the social workers’ usage of MI techniques to engage the study population. The criterion for the study population was mothers showing signs of being at risk of PPD development. Before evaluating MI and PPD in the study population, the researchers looked at literature indications of barriers to PPD treatment among populations similar to their study population at the same time.

They also brought up consideration for MI intervention and treatment as presented by peer-reviewed literature. They used the evidence in the literature to argue that MI is particularly useful in the problem of PPD, and it would be very assistive in a population of marginalized mothers, especially those fitting the study sample criteria due to the four primary values of MI. In their case study, Sampson, Zayas, and Seifert (2013) used a 23-year-old mother of three children whose race was African-American, and the children were aged 4, 3 and 6 months, while the mothers were unmarried. Besides, the case revealed that the mother was not in constant communication with the father of the two children. The study report covered the process of MI for a particular case study report. It highlighted the approaches used to build rapport, the exploration of readiness and the importance of the intervention and offering information.

After presenting possible approaches for illustrating the uses of motivational interviewing techniques that would serve the interest of clients in treatment, the study showed that untreated PPD had the possibility of affecting family units negatively (Sampson, Zayas & Seifert 2013). Therefore, the intervention of MI should fit the purposes of the client, but the results are also useful for improving the conditions of a family unit’s coping abilities with depression. The study evaluated the problem from both a perspective of an ethnically diverse mother and a social worker in charge of such a client with PPD. Therefore, it offered knowledge that showed the relevance of MI interventions. It also provided guidelines that would aid the approach taken by the social worker when dealing with issues of acceptance for depression treatment in the study population (Sampson, Zayas & Seifert 2013).

The researchers attributed the success of MI in their case study to the philosophy of putting client needs first and adapting to their abilities to encourage self-efficacy. Therefore, women and families on a global scale are going to benefit most from MI related techniques used by social workers, such as the ones championed by the researchers. They include use of open-ended questions, display of empathy, and reflections for encouraging mothers to be talkative about their feelings, which should also aid in the increase of their awareness of their condition or vulnerability to the PPD condition (Sampson, Zayas & Seifert 2013). The study stresses the fact that ultimately decisions about admitting to symptoms of depression and engaging in treatment will always rest with the client.

MI can be useful as part of general intervention health programs

MI is effective in ensuring effective treatment of mental health issues like depression. It can also be used as part of other general intervention programs. It can be delivered in the form of motivational pharmacotherapy, which may safely combine with medication treatment (Balan, Moyes & Lewis-Fernandez 2013). The effective treatment of psychiatric disorders relies on treatment adherence. There have been many studies seeking to establish effective ways of ensuring that there is treatment adherence.

One such study was by Balan, Moyes, and Lewis-Fernandez (2013), who attempted to answer the question by examining an intervention for clinical and cultural characteristics of monolingual Spanish-speaking immigrants as the study population. The researchers used an experimental design being to test the reliability of MI. The experiment was done to show aspects of MI that are incorporated into pharmacotherapy. The researchers used transcriptions of interactions between psychiatrists and the clients to show the approach of MI. They explained that motivational pharmacotherapy has significant differences from standard pharmacotherapy, especially due to its option of putting clinicians and patients as equal experts.

The study ensured that interventions were feasible in agreement with a typical pharmacotherapy session. It also looked at cultural congruency of the motivation. In this regard, the study was sensitive to incorporating values, illness representations, and attitudes towards medication that have relevance in a Latino context as a precondition for sustaining the desire for a more collaborative approach to treatment by the Latinos who formed the study population (Balan, Moyes & Lewis-Fernandez 2013).

Reviewing standard pharmacotherapy and motivational pharmacotherapy allows the researchers to show that emphasis is on symptoms, side effects, and dosing adherence in the first case (Ludman et al. 2007). There is no focus on guiding the patient on achieving the desired changes. Meanwhile, the second method ensures that psychiatrists are attuned to the progression of a talk by a patient (Catley et al. 2012). They can use as a real-time result for estimating and influencing the momentum of sessions. The psychiatrist deals with obstacles to adherence and works on strategies for enhancing the intervention, with a significant bit of the practice being the trust in the use of open-ended questions and their ability to bring out significant symptoms of the patient’s condition.

In addition to studies that have directly sought to determine the effectiveness of the MI approach, other studies also concentrate on bringing up barriers to the intervention in an effort to provide practitioners with novel strategies for ensuring that objectives are met. One such study was done by Soderlund et al. (2009), which focused on the identification of barriers that nurses experience when they are dealing with motivational interviewing in counselling for overweight children. Their study looked at children population of 5 to 7-year-olds. Although it did not directly touch on depression, the problems of coping with obesity stigma related social consequences included depression.

At the same time, studying depression in isolation blinds a study on other factors that may play a significant role in creating depressive environments. For example, stress due to obesity can be one of the blinding factors. The study by Soderlund et al. (2009) showed that nurses lacked recognition of the fact that obese children have a health problem. Such could also be an indication of other problems that applications of MI face, where the mental problem being addressed is not considered a health issue.

The study by Soderlund et al. (2009) was conducted in Swedish, and it covered the application of MI among obese children. The study focused on the sessions between the children and the nurses and noted that their parents accompanied children. The study filled a gap existing in other studies that had not interviewed the nurses delivering the MI and then used the findings as part of the analysis of the actual sessions of motivational interviewing. Coming up with the study was possible by relying on five child welfare centre nurses and six school health care service nurses that had been recruited specifically for the study and were taken through two days of learning MI principles.

The nurses also spend six months practising MI in their routine work before taking part in the study. By the time the study was conducted, the nurses had at least six months of experience in using MI in counselling. The outcomes of intervention were picked according to changes in body mass indices (BMI) of the children attending the counselling sessions.

The nurses recruited for the Soderlund et al. (2009) study were the ones in charge of introducing the children to the counselling sessions. There was an interview guide used in the study, which was prepared by a multi-professional team. It indicated the number and open-ended questions used. In addition to analyzing the sessions, the research team created a focus group of ten nurses to explain their reactions, capabilities, and overall progress with concrete and general cases of counselling with the use of MI. The findings of the study revealed major issues that would affect the application of MI in ordinary healthcare facilities.

The biggest problem identified was problem denial by nurses, as they did not rely much on the scientific definitions of obesity and those prescribed in the study. Instead, nurses seemed to succumb to cultural influences on the perception of being healthy. The nurses even went ahead to discount flesh on the body of children as a normal part of growth, which was a sign of ambivalence (Soderlund et al. 2009).

On the other hand, there were notable advantages of using MI. For example, nurses recognized that MI had advantages over other counselling methods; MI served as an effective problem solver. Soderlund et al. (2009) also showed that in the case of children, parent support was critical in shaping a nurse’s perception of their ability to carry out a session with children effectively. On the other hand, nurses faced barriers when they were in denial, while clients faced obstacles when they perceived nurses or parents lacking the willingness to recognize the problem.

Strengths and weaknesses or limitations of the reviewed articles

Brief approaches to counselling with MI work because they elevate the powers of clients to determine the outcome of treatment. They also improve the interaction of treatment and clients, thereby allowing them to set the pace of progress later. This ensures that health care interventions are responsive to clients’ needs, rather than following a standardized format that can leave out many patients’ needs. The studies included in this review had presented the need for education of the primary conceptions of MI. They also looked at the application environment, as well as the client’s characteristics. In this regard, environmental conditions and notable barriers to effective MI need considerations in setting up an MI session (Baumann 2012).

Organisational commitment and setting will also come into play. Studies have reviewed the individual practice and organized practice in experimental design. Such studies include the ones by Balan, Moyes and Lewis-Fernandez (2013) and Soderlund et al. (2009). They highlight the need for seeking organizational commitment. The studies also show that when they are available, brief approaches to counselling with MI are very effective in dealing with mental health issues.

In reviewing cases that have to deal with actual depression patients, studies can have a problem with loss of energy affecting enthusiasm and cooperation in the intervention. As such, studies like the one by Balan, Moyes, and Lewis-Fernandez (2013) is an excellent example. The study used structured materials like value sort cards and lists of common obstacles in improving the outcome of their sessions. While this is an effective way of getting a uniform experiment environment, the use of such structured materials may not always fit practical sessions as clinicians do not have a desire to ensure that a typical session is used in future studies.

Therefore, the applicability of such research findings suffers when the application environment is not ideal (Chang et al. 2015). The study by Balan, Moyes, and Lewis-Fernandez (2013) also highlights a risk that MI may face, which is an early termination due to over-focusing on the symptoms. However, when introducing motivational strategies for interviewing during counselling, the psychiatrists can ensure that there is the suppression of other standard activities to provide room for their replacement with interactions, which are consistent with MI (Keeley et al. 2014; Csillik 2015).

Attitudes and perceptions of counsellors need additional evaluation. They have a high probability of affecting outcomes of MI and influencing the client’s acceptance of future sessions (Glassman et al. 2013). Given that MI relies much on client acceptance and focuses on building self-efficacy, it is important to have nurses and other health care providers ready to question their perceptions and beliefs to aid clients’ recovery (Britton, Williams & Conner 2008). Relying on a practical theory like the self-determination theory can help to internalize therapeutic change for clients and counsellors (Vansteenkiste & Sheldon 2006).

Conclusion

The paper has supported its main arguments with evidence from peer-reviewed literature about how MI works. It shows that intervention by health care providers when initiating and implementing MI succumbs to limitations in counselling. It also shows that MI is effective in dealing with a broad range of problems, and will be useful in the application of treatment for mental health issues. Brief interventions with MI are important because they spread favourable healthcare outcomes to underprivileged populations. Nevertheless, the organizational and environmental context, as well as attitudes and perceptions of caregivers, have a significant capability of affecting the results of the intervention. Various studies highlighted in the paper show that highlighting these problems before the intervention helps when addressing them, which indicates that self-determination theory is a framework that would be helpful in reviewing the matter.

Reference List

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