Motivational Interviewing in Counseling
Substance abuse is a phenomenon that is observed worldwide which results from harmful use of drugs leading to health issues in the individuals. Substance abuse disorders are classified as mental disorders in the diagnostic and statistical manual (DSM-5) with the commonly abused substances being alcohol, cannabis, hallucinogens, opioids and tobacco. All abused substances have common health issues or outcomes. According to Wheeler (2014), the most common effect of substance abuse is impaired control. The individual fails to regulate the amount of daily substance intake leading to dependence syndrome. Social impairment and risky use are also associated with substance abuse. In the United States, alcohol abuse is the leading cause of substance abuse with over 17.6 million Americans being diagnosed with alcohol use disorder each year.
Many patients who seek mental health care suffer from alcohol abuse and alcohol withdrawal syndrome is the most common disorder managed in psychiatric units. I was part of the team that provided counseling to a client diagnosed with alcohol withdrawal syndrome, and this paper outlines the relevant history, criteria for diagnosis and the legal implications related to counseling of the client.
Description of the Client: The patient is a 48-year old male of African-American origin currently staying in Upper hill California. The client is divorced, and currently, he stays with his son. The client is employed working at the nearest factory. He is a Christian but stopped attending church services five years ago.
Presenting complain: The patient reports that “I stopped drinking alcohol three days ago because I don’t want it anymore. Ever since I have been feeling like drinking but I have managed to control the urge. However, I have been having frequent headaches since yesterday, vomiting at times and hand tremors. I have difficulties in sleeping, and whenever I do a small task, I sweat a lot.” The patient also reports that he felt confused.
Pertinent History: The patient reports that he has been drinking alcohol for more than ten years now. Six years ago, he divorced his wife because of misunderstanding related to the alcohol intake. He has been staying with his 17 years old son since the divorce, and he has had problems with uncontrolled drinking since the divorce. In 2014, the patient was hospitalized in the county hospital due to alcohol intoxication but received treatment and went back home. He reduced the amount of alcohol intake, and it seemed to help. He attended a few therapy sessions as advised by the doctor but he reports that he stopped attending the sessions because they were not helpful.
It is three days now since the patient took his last sip of alcohol. He reports that it started lack of sleep, tremors, flashbacks, and headache. The symptoms have increased, and he feels that his heart is racing and sometimes he seems confused. The patient has a history of hypertension diagnosed ten years ago, but it resided after medication use. He has been hospitalized twice due to hypertension and alcohol intoxication. There is no relevant surgical history. There is a family history of alcohol abuse disorder. He reports that his father died fifteen years ago due to chronic alcohol intake. The patient reports that he has been having drinking problems since the divorce and three days ago he decided to stop drinking to save himself from the misery.
Justification of the Diagnosis: Substance abuse disorders are classified as mental disorders in the diagnostic and statistical manual (DSM-5) with the commonly abused substances being alcohol, cannabis, hallucinogens, opioids and tobacco. According to the American Psychological Association (2013), substance use disorders occur when people use abusive substances like alcohol leading to health issues or problems at work, school or home. Alcohol withdrawal syndrome is a condition that affects heavy alcohol users when the daily intake is reduced or when the individual stops alcohol intake. The DSM gives the criterion for the diagnosis of Alcohol Withdrawal Syndrome. According to the DSM-5, the patient must show at least two of the following symptoms: Insomnia, autonomic syndromes like sweating or racing heart, increased hand tremors, nausea or vomiting, psychomotor agitation, and anxiety (American Psychiatric Association, 2013). Extreme cases of alcohol withdrawal can manifest with generalized tonic-clonic seizures and hallucinations.
A patient diagnosed with alcohol withdrawal syndrome must experience at least two of the symptoms stated above, and they must be related to reduced alcohol intake or cessation from drinking. The patient manifests with hand tremors, insomnia, restlessness, sweating and headache. The history depicts that he stopped drinking alcohol three days ago and the symptoms follow the cessation of alcohol intake. According to the DSM-5, the patient’s symptoms provide an impression of alcohol withdrawal syndrome.
Motivational Interviewing: Motivational interviewing is a behavioral approach that is used to counsel clients who have limited options in managing their addictions. It is defined as a counseling method that enables individuals to resolve ambivalent insecurities and feelings through internal motivation to change behavior. According to Morton (2015) the approach is used mainly in addiction conditions, but evidence indicates that the process is effective in the management of lifestyle conditions like diabetes, hypertension, and asthma. Motivational interviewing works through two major ways. It enables people to become motivated to change the behaviors that are preventing them from making healthier choices n life. The method also forms a baseline for other therapies because it psychologically prepares individuals (Arkowitz et al., 2015). According to research, motivational interviewing is less effective for individuals who have already started to change ad it is more useful for people with anger and hostility.
The first step in motivational interviewing is letting the client express the reasons for the change of behavior. The interviewer or therapist introduces the topic and lets the client dominate the conversation. After the conversation, the client will obviously expect a reflection of their thoughts, and the therapist reinforces the need for change. The major goal of motivational interviewing is to increase the motivation of the individual and ensure commitment to change. Carl Rogers refers to motivational interviewing as a client-centered approach that helps in counseling of people to provide solutions for difficult change processes (Copeland et al., 2015).
Motivational interviewing for Mr. JM will be effective because the patient displays the desire for change. The patient is encouraged to express a commitment to the desire for change during the interview as the motivator listens to the change process. The patient has stayed for three days without taking alcohol showing the commitment he has for change. The motivational interviewing sessions are usually minimal, and the interviewer should ensure that all the aspects required are captured. The main objective of the session with MR. JM is that by the end of the session the patient should be more motivated and committed to stopping alcohol drinking. The expected outcome is that patient should be able to display a better understanding of the need to stop drinking after the motivational interview. The motivational interview should always be followed by other methods like cognitive behavioral therapy or alcoholic group therapy sessions.
Ethical Considerations: Each professional counselor must uphold high moral standards that create trust through professional responsibility in counseling sessions. Ethical standards are developed by professional bodies to guide the behavior of professionals (Fisher, 2016). Counseling clients use the five moral principles: autonomy, justice, beneficence, nonmaleficence, and fidelity. The American Counseling Association provides ethical and legal considerations guiding professional practice, and the first one is informed consent. The patient has the right to be told the purpose, goals, procedures, limitations, and benefits of the services they are receiving. Informed consent builds trust between the therapist and the patient, and it enables the patient feel like they are part of the team providing solutions to the problem.
Confidentiality, privileged communication and privacy apply to the counseling of Mr. JM. The counselor gives a statement that promises confidentiality at all costs, and in some cases, vital information is avoided in the clinical notes (Stuart, 2014). The therapist should be keen on using technology like computers and email because information can easily be retrieved. Confidentiality improves communication and sharing between the two parties. The records of the counseling process should be kept safely in the hospital according to the Health Insurance Portability and Accountability (HIPAA) regulations. The criteria for access to the patient’s information should be outlined correctly, and individuals who disclose the patient’s information outside the clinical setup can be taken action according to the law.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
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Copeland, L., McNamara, R., Kelson, M., & Simpson, S. (2015). Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review. Patient education and counseling, 98(4), 401-411.
Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002
Morton, K., Beauchamp, M., Prothero, A., Joyce, L., Saunders, L., Spencer-Bowdage, S., … & Pedlar, C. (2015). The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health psychology review, 9(2), 205-223.
Stuart, G. W. (2014). Principles and Practice of Psychiatric Nursing-E-Book. Elsevier Health Sciences.
Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.