PS380 Unit 5 Motivational Interviewing Skills Paper Example

Beer Helps Me Calm Down: A PS380 Unit 5 Motivational Interviewing Skills Paper

[Student Name]

Purdue University Global

PS380: Clinical Psychology

Unit 5 Motivational Interviewing Skills Paper

[Instructor Name]

[Date]

The client, the clinician and the exchange are composite; the method, protocol and studies cited are real.

The Client and the Question

Travis keeps the motors and conveyors running at an Iron Range taconite plant, and he is 34. At his intake at our clinic, described in the previous unit, Dr. Lund's working diagnosis was panic disorder. She also found that he had doubled his drinking to six to eight beers most nights since the attacks began, and his score on the Alcohol Use Disorders Identification Test was 16, in the hazardous range.

Travis came to the clinic for his heart and his nerves, not his drinking. He believes beer is helping. A clinician who told him to stop would probably meet resistance and might lose him from treatment altogether. Dr. Lund chose motivational interviewing for the second session. This paper explains the method, presents an annotated part of that conversation and evaluates the evidence for the approach.

What Motivational Interviewing Is

In the account by its founders, the method's aim is that the argument for change be voiced by Travis, not by Dr. Lund (Miller & Rollnick, 2013). They insist that it is more than technique. The clinician meets the client as an equal, respects that the decision is the client's to make, keeps the client's welfare at the center and trusts that reasons for change already exist in the client, waiting to be voiced. They call these partnership, acceptance, compassion and evocation.

A conversation of this kind passes through four stages that overlap in practice. Engaging establishes trust, focusing settles on what to talk about, evoking brings the client's own arguments for change into the open, and planning turns them into a next step. Four everyday skills carry the work: asking questions that cannot be answered with yes or no, noticing strengths out loud, mirroring back what the client means, and pulling several statements together into a summary. Practitioners shorten these to OARS.

The method pays close attention to language. Change talk is anything the client says in favor of change, such as desire, ability, reasons and need, and later commitment and steps taken. Sustain talk is what the client says in favor of keeping things as they are. The clinician tries to evoke and reflect change talk while not arguing with sustain talk, since arguing tends to make clients defend the status quo. A federal treatment protocol on enhancing motivation in substance use treatment adopts the same approach and emphasizes that ambivalence is normal, not a sign of denial (Substance Abuse and Mental Health Services Administration [SAMHSA], 2019).

In motivational interviewing, the client should be the one making the case for change, because people tend to believe what they hear themselves say.

An Annotated Exchange

The following exchange, condensed and with identifying details changed, comes from the middle of the second session, after Dr. Lund had spent twenty minutes engaging Travis about his panic attacks.

Dr. Lund: You mentioned last time that a few beers help you settle down in the evening. Tell me how that works for you.

This is an open question that invites Travis to describe drinking in his own terms, without judgment. It follows his lead rather than raising alcohol as a problem.

Travis: After work I'm wound up. I keep waiting for the next attack. A couple of beers and I can finally sit on the couch with my daughter.

Dr. Lund: So beer is one of the few things that has given you relief, and it lets you be with your daughter in the evening.

This reflection captures the benefit Travis sees. Reflecting the positive side of drinking may seem strange, but it shows Dr. Lund understands his reasons, which lowers the need to defend them.

Travis: Yeah. Though it's not a couple anymore. It's more like six or seven. And I wake up at four with my heart going.

Here Travis offers change talk on his own: a concern about how much he drinks and a link to his early-morning symptoms.

Dr. Lund: You've noticed the amount creeping up, and you're wondering whether those four o'clock wake-ups have something to do with it.

Dr. Lund reflects the change talk and slightly extends it, naming the connection he hinted at without asserting it.

Travis: Maybe. But I'm not an alcoholic. My dad was.

This is sustain talk, with a hint of discord. Dr. Lund later said that her first impulse was to explain that he did not need to be an alcoholic to have a problem. That would have been an argument.

Dr. Lund: You're not like your dad, and that matters a lot to you.

Instead she reflected the value behind his statement. Travis relaxed visibly and went on to describe his father's drinking and his own fear of becoming like him.

Dr. Lund: You've been dealing with panic attacks for seven months, still going to work every day, still taking care of your daughter. That takes a lot.

This affirmation recognizes his effort and strength, not just his problems.

Near the end, Dr. Lund summarized: on one hand, beer helps him wind down and be with his daughter; on the other, the amount has crept up, he wakes at four with a racing heart, and he does not want to follow his father's path. She asked what he made of that. Travis said he could try stopping at three on weeknights and see whether the four o'clock wake-ups changed.

What the Exchange Shows

The exchange followed the four processes. Engaging came first, through attention to his panic. Focusing occurred when Dr. Lund asked about the role of beer. Evoking produced his own concerns and the link to his father. Planning began with a small, specific step he proposed himself. Dr. Lund never told him to cut down, and the plan he made was smaller than a clinician might have recommended. In motivational interviewing, a plan the client owns is often worth more than a better one he rejects.

The Evidence

Lundahl et al. (2010) pooled 119 studies covering alcohol, other drugs, tobacco and health behaviors. Against waitlists and minimal-contact controls, motivational interviewing produced small but statistically reliable gains; against established treatments it held its own, usually with fewer contact hours. Effects were strongest for substance use. The results suggest it is a useful, efficient approach but not a powerful one on its own, and that it works best as a starting point for further treatment.

For Travis, that is the right role. Motivational interviewing did not treat his panic disorder, but it kept him engaged, made his drinking something he wanted to address and set up a plan that can be tested. Cognitive behavioral therapy for panic, discussed in the next unit, will require him to face the sensations he fears, and that will be easier if he is not using alcohol to escape them.

Conclusion

Motivational interviewing is a set of skills grounded in a spirit of partnership and respect for autonomy. In Travis's second session, a handful of well-placed questions, reflections and one affirmation drew out his own concerns about drinking and led to a plan he proposed himself. The research supports modest but reliable benefits, especially as a bridge to further treatment.

References

Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137-160. https://doi.org/10.1177/1049731509347850

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

Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment (Treatment Improvement Protocol [TIP] Series No. 35, SAMHSA Publication No. PEP19-02-01-003).