PS511 Unit 6 Stages of Change and MI Paper Example

"I Only Drink After the Route": A PS511 Unit 6 Paper Placing a County Plow Driver in a Stage of Change and Planning Motivational Interviewing

[Student Name]

Purdue University Global

PS511: Chemical and Psychological Dependency Counseling

Unit 6 Stages of Change and Motivational Interviewing Paper

[Instructor Name]

[Date]

The client, the county, the clinic and every detail of the case are composite and illustrative; the sources cited are real.

The Client

Corey is 34 and has driven a plow truck for St. Louis County for nine years, working twelve-hour shifts during storms. In February, a random test at the start of a shift found a breath alcohol level above the county's limit for safety-sensitive work. Corey was removed from duty and referred through the employee assistance program for assessment and counseling. At our first session, Corey said, "I only drink after the route. Somebody else's mouthwash or something set that machine off."

Corey's assessment showed drinking six to ten beers most nights after shifts, more on days off, with three criteria for alcohol use disorder: drinking more than intended, continued drinking despite his girlfriend's complaints and tolerance. That is a mild disorder by DSM-5-TR counts. The test result, Corey's job and the safety of other drivers on winter roads make it a serious problem regardless of the label.

Locating Corey in the Stages of Change

Prochaska et al. (1992) describe five stages. In precontemplation no change is planned and the problem may not be admitted. Contemplation means the problem is seen and change is weighed without a decision. Preparation means a decision for the near future, sometimes with first moves already made. Action means the behavior itself has changed, and maintenance means holding that change over time. People often cycle back through stages rather than moving in a straight line. Their work also matched methods to timing: raising awareness and stirring feeling fit the early stages, while concrete behavioral tools fit the later ones.

Corey shows signs of two stages. In the first session, his explanation of the test result and his insistence that drinking never affects work point to precontemplation. In the second, he said, "I'm not saying I'm an alcoholic, but maybe I could skip it before a storm shift," which is a contemplation statement. The best placement is early contemplation: Corey sees that something might need to change but is not convinced and has not committed.

Corey is not refusing change; he is arguing with himself about it, which is where motivational interviewing does its best work.

Why Motivational Interviewing Fits

Miller and Rollnick (2013) present MI as a partnership in conversation, built so that the arguments for change come from the client rather than the counselor. It rests on partnership, acceptance, compassion and evoking the client's own reasons, rather than supplying the counselor's. The working tools are open questions, affirmations, reflective listening and summaries, and the counselor uses them to notice and build on change talk, meaning anything the client says that leans toward doing something differently. The counselor avoids arguing for change, which tends to provoke sustain talk, the client's arguments for staying the same.

Lundahl et al. (2010) reviewed 25 years of trials, covering 119 studies. Against no treatment, MI showed modest gains that held up statistically, and against other active therapies it came out roughly even while usually taking fewer meetings. Effects were found for alcohol, other drugs and health behaviors. That evidence supports MI as a reasonable choice for Corey, though not as a cure.

Planning the Sessions

Session three will focus on engaging and evoking. I will begin by asking Corey what he enjoys about drinking after a route, since acknowledging the benefits lowers defensiveness. Then I will ask what concerns him, if anything. Reflections will emphasize change talk: if Corey says, "My girlfriend hates it when I fall asleep on the couch," I might reflect, "It bothers you that it's affecting time with her." I will not mention the word alcoholic, since Corey has already said it does not fit.

A decisional balance, listing reasons to keep drinking and reasons to change, may help Corey see his own ambivalence. Miller and Rollnick (2013) caution that exploring reasons for not changing can strengthen them, so I will spend more time on the side Corey chooses to explore and on his values. His values include being a good driver; he takes pride in never having hit a car or a mailbox in nine winters. A question such as "How does drinking fit with being the driver you want to be?" connects the behavior to something he already cares about.

Session four will move toward planning only if Corey's change talk grows. If he says he wants to skip drinking before storm shifts, we will make that plan specific: how many nights, what he will do instead after a route and how he will handle storm weeks when shifts run back to back.

Responding to Resistance

If Corey returns to blaming the mouthwash, arguing about the test would invite sustain talk. A reflection such as "You feel the test didn't tell the whole story" acknowledges his view without agreeing. I can then ask what would need to happen for him to feel confident on the next test, which brings the conversation back to his own goals.

The Employer Relationship

Corey's return to duty depends on completing treatment and a follow-up test, and the county will receive attendance and test results through a signed consent. That pressure can make Corey say what he thinks I want to hear. MI's emphasis on Corey's own reasons is especially important here, so that any change belongs to him rather than to the county. I will say this to Corey directly in session three: the county needs a negative test, but what Corey does with his evenings after the route is his decision, and my job is to help him think it through.

Measures of Progress

I will track change talk and sustain talk in each session, the number of drinking days each week from Corey's own log and his readiness on a ten-point scale. If readiness rises above five and he sets a goal, we will shift to action-stage strategies such as coping plans and support from his girlfriend.

Conclusion

Corey sits in early contemplation, aware that drinking may be a problem but not committed to change. Prochaska and colleagues' model explains why action-oriented advice would likely fail now, and Miller and Rollnick's approach, supported by Lundahl and colleagues' evidence, offers a way to strengthen Corey's own reasons for change, tied to his pride as a safe driver.

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.

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114. https://doi.org/10.1037/0003-066X.47.9.1102