PS375 Unit 7 Counseling Approaches Paper Example

Which Counseling Fits a Mechanic Who Hates Talking: A PS375 Unit 7 Treatment Approaches Paper

[Student Name]

Purdue University Global

PS375: Psychology of Addiction

Unit 7 Treatment Approaches Paper

[Instructor Name]

[Date]

The writer, the program, the clients and every detail are composite and illustrative; the sources cited are real.

Dale's Choice

Dale, fifty-two, began outpatient treatment at our Tulsa program in September after his second DUI. His diagnosis was severe alcohol use disorder. At his treatment planning session, his counselor described the program's options, and Dale said, "I'd rather fix ten engines than sit in a circle talking about my feelings." As intake coordinator, I schedule clients into groups and individual sessions, and I sat in on the planning session with Dale's permission.

The counselor's task was to find an approach supported by evidence that Dale would actually attend.

A Conversation Between Partners

In the account by Miller and Rollnick (2013), the counselor and client talk as partners, and the conversation is steered toward strengthening the client's own motivation and commitment to a change the client has chosen. The counselor avoids arguing or lecturing, using open questions and reflective listening to bring out the client's own arguments for change, which practitioners call change talk. The approach is designed for people who are ambivalent, wanting change and not wanting it at the same time.

Dale was ambivalent. He wanted to keep his license and his marriage, and he did not want to give up the beers that ended every shift. In the planning session, the counselor used motivational interviewing to ask what Dale wanted his life to look like in a year. He said, "Driving my own truck, and my granddaughter not scared of me when I've been drinking." That sentence became the first goal in his plan.

Project MATCH

Project MATCH tested whether matching clients with alcohol use disorders to particular treatments based on their characteristics would improve outcomes (Project MATCH Research Group, 1997). Clients were randomly assigned to one of three individual treatments: cognitive-behavioral coping skills therapy, which teaches skills for managing high-risk situations and cravings; motivational enhancement therapy, a four-session approach based on motivational interviewing; and twelve-step facilitation, which encourages involvement in Alcoholics Anonymous. All three approaches produced substantial reductions in drinking, the outcomes of the three were broadly similar, and few of the predicted matching effects appeared.

The largest trial of its kind found three good roads and little reason to force anyone onto a particular one.

The trial's practical message for Dale was that several evidence-based approaches work about equally well on average, so his preferences could reasonably guide the choice. He disliked groups and talking about feelings, but he liked practical problem-solving. Cognitive-behavioral coping skills, delivered individually and framed around specific situations like the end of a shift, suited him. He declined twelve-step meetings at first but agreed to attend one with his brother-in-law, who has been sober for eight years.

Contingency Management

Prendergast et al. (2006) pooled studies of contingency management, in which clients earn concrete rewards, often vouchers or prize draws, for verified abstinence or for meeting treatment goals. Across studies, contingency management was effective in reducing substance use during treatment, with effects varying by substance and by how rewards were delivered, and stronger effects when rewards were larger and delivered promptly.

Our program uses contingency management mainly for clients with stimulant and opioid use disorders, offering prize draws for negative urine tests. Kayla, in treatment for opioid use disorder, earns draws for negative tests and for attending counseling. For Dale, the counselor considered it but chose another approach; the program's funding for prizes was limited, and his breath alcohol monitor, required by the court, already provided daily verification and consequences.

The Plan

Dale's plan combines three elements. Weekly individual sessions use cognitive-behavioral coping skills, focused on the hour after his shift, when he drank most, with a plan for what to do instead and who to call. The counselor uses motivational interviewing throughout, especially when Dale wavers. And Dale agreed to attend one twelve-step meeting a week with his brother-in-law for a month and then decide. His physician is also considering medication for alcohol use disorder, discussed further in a later unit.

What the Coping Skills Sessions Looked Like

The cognitive-behavioral sessions were concrete, which suited Dale. In the first session, he and his counselor mapped a typical evening: the shift ends at 4:30, the crew gathers by the trucks, someone opens a cooler, and by 6:00 he has had four beers and is deciding whether to drive. They identified the moment of highest risk, the cooler opening, and three things he could do instead: leave before the cooler opened, keep a cold soda in his own truck, and call his wife on the drive home. In later sessions they practiced refusing a beer from his foreman, who did not know he was in treatment, using short scripts Dale wrote himself. He said the scripts felt silly until the first time he used one and the foreman just shrugged.

Weighing the Evidence for Each Approach

The three approaches rest on different kinds of evidence. Motivational interviewing is supported mainly as a way of increasing engagement and readiness, and it is often combined with other treatments. Cognitive-behavioral approaches and twelve-step facilitation each performed well in Project MATCH, a large randomized trial. Contingency management has strong meta-analytic support for reducing use during treatment, though its effects can fade after rewards end. No single approach was clearly best for Dale on evidence alone, which is why fit and preference reasonably guided the choice.

Early Progress

In the first six weeks, Dale attended every individual session and four of six meetings. His breath monitor recorded no alcohol for five of six weeks. He said the coping skills sessions felt "like a repair manual," which he meant as high praise from a man who repairs engines for a living.

Matching in Everyday Practice

Project MATCH found little support for matching by client characteristics, but programs still match clients informally by preference, schedule and setting. That kind of matching may matter for attendance even if it does not change outcomes among those who attend. For Dale, an approach he found tolerable kept him coming, and keeping him coming was the first goal.

Conclusion

Miller and Rollnick's motivational interviewing helped Dale name his own reasons for change. Project MATCH showed that cognitive-behavioral, motivational and twelve-step approaches produce broadly similar results, which allowed Dale's preferences to guide the choice, and Prendergast and colleagues' meta-analysis supports contingency management for other clients in the program. His plan combines evidence and fit.

References

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.

Prendergast, M., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Contingency management for treatment of substance use disorders: A meta-analysis. Addiction, 101(11), 1546-1560. https://doi.org/10.1111/j.1360-0443.2006.01581.x

Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58(1), 7-29. https://doi.org/10.15288/jsa.1997.58.7