PS521 Unit 7 Group Motivation Paper Example

Three Who Want to Quit, Three Who Want to Cut Back and Three Who Want to Go Home: A PS521 Unit 7 Paper on Motivation in a Mixed-Readiness Group

[Student Name]

Purdue University Global

PS521: Group Counseling

Unit 7 Group Motivation Paper

[Instructor Name]

[Date]

The writer, the program, the group members and every detail of the sessions are composite and illustrative; the sources cited are real.

The Group

The program's January cohort included more court-referred members than usual: five of nine were attending as a condition of probation or a deferred sentence. At the first session, the senior counselor asked each member what they hoped to get from the twelve weeks. Three said they wanted to stop drinking or using for good. Three said they wanted to "get it under control" and keep drinking on weekends. Three said, in various ways, that they wanted their paperwork signed. One of them, Rudy, a 33-year-old warehouse supervisor, said, "No offense, but I'm here because a judge said so."

A group like this risks splitting into the motivated and the resistant, with the resistant members pulling the group toward cynicism and the motivated ones withdrawing.

Motivation as Something That Happens Between People

Miller and Rollnick (2013) treat motivation as something shaped in conversation rather than a fixed trait. A counselor who argues for change tends to provoke the client's arguments against it, which they call sustain talk, while a counselor who draws out the client's own reasons tends to strengthen change talk. They describe the spirit of motivational interviewing as partnership, acceptance, compassion and evocation, and its core skills as open questions, affirmations, reflections and summaries.

In a group, those dynamics multiply. Each member's sustain talk can encourage others' sustain talk, and change talk can spread too. The leader's task is to steer the conversation toward members' own reasons for change without singling out the least ready members or pressuring them.

Evidence for Motivational Interviewing in Groups

One randomized trial offered group motivational interviewing to 101 hospitalized psychiatric patients, each of whom also had a drug or alcohol problem. All patients received standard care, and they were assigned either to group motivational interviewing sessions or to a control group that received the same amount of therapist attention without the motivational approach. Among those who attended aftercare and used alcohol or drugs, patients who had received group motivational interviewing attended more aftercare sessions, drank less and binge drank less at follow-up. Differences in complete abstinence and aftercare attendance overall were not significant, possibly because the sample was small (Santa Ana et al., 2007).

The study supports trying group motivational interviewing with a mixed and partly reluctant group like ours, while showing that its effects are modest and uncertain.

The Plan for the First Four Sessions

The federal treatment protocol on group therapy recommends motivational approaches in early sessions with members who are ambivalent, and it advises leaders to avoid confrontation that increases resistance (Center for Substance Abuse Treatment, 2005). Following that guidance and Miller and Rollnick's principles, we planned the first four sessions around three activities.

The first is a values exercise. Each member chooses three values from a deck of cards, such as family, freedom, health or respect, and describes how drinking or using affects each one. The exercise invites members to compare their behavior with their own values, which draws out reasons for change without the leader supplying them. When Rudy chose freedom, the senior counselor reflected, "Freedom matters a lot to you, and right now a judge is deciding a lot of your schedule." Rudy said, "Yeah. I'd like that to end."

The second is a decisional balance done in pairs, mixing members of different readiness. Each pair lists what they like about drinking and what concerns them. The leaders spend more of the group discussion on the concerns, following Miller and Rollnick's caution against strengthening the reasons not to change.

Rudy came to group to satisfy a judge, but his own word, freedom, gave the group a reason for change that was his.

The third is a readiness ruler. At the end of each session, members mark on a scale from zero to ten how important change is to them and how confident they feel. Leaders ask follow-up questions in the style motivational interviewing recommends: "Why a four and not a two?" That question invites members to explain what already matters to them, rather than defend why they are not higher.

Managing Sustain Talk in the Group

When sustain talk builds, as it did in session two when three members agreed that the court system was rigged, leaders do not argue. The senior counselor reflected the frustration, then asked the group, "Given all that, what would make these twelve weeks worth your time?" Members who were further along answered first, and their answers, such as "Keeping my license" and "My kid not being scared of me," changed the tone.

We also gave the members who wanted to quit roles that did not require them to persuade others, such as describing what their first sober month had been like when asked. The protocol warns that pressure from motivated members can feel like another form of confrontation.

Measuring Progress

We track readiness ruler scores each week and record the balance of change talk and sustain talk in each session's notes. By session four, the average importance score had risen from five to seven, and two of the three paperwork members had set goals of their own.

What the Leaders Watched for in Themselves

Motivational work in a group puts pressure on the leaders as well as the members. Both of us noticed a pull to argue with Rudy in the first session and to praise the three members who wanted to quit, which would have sorted the group into good and bad members within an hour. We agreed to check each other at the break: had either of us lectured, and had either of us let one member's sustain talk go unanswered for long? Keeping that check honest was part of keeping the group's tone collaborative.

Limits

Santa Ana and colleagues studied inpatients with co-occurring disorders, not court-referred outpatients, and their sample was small. Readiness scores in a group can be influenced by what members think the leaders want to hear.

Conclusion

A group split three ways by readiness can still move together if leaders follow Miller and Rollnick's approach, drawing out members' own reasons and avoiding argument. Santa Ana and colleagues' trial gives modest support for group motivational interviewing, and the federal protocol supports motivational work in early sessions. In this cohort, a values exercise, mixed-readiness pairs and a readiness ruler turned a judge's order into a starting point.

References

Center for Substance Abuse Treatment. (2005). Substance abuse treatment: Group therapy (Treatment Improvement Protocol Series, No. 41; HHS Publication No. SMA 05-3991). Substance Abuse and Mental Health Services Administration.

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

Santa Ana, E. J., Wulfert, E., & Nietert, P. J. (2007). Efficacy of group motivational interviewing (GMI) for psychiatric inpatients with chemical dependence. Journal of Consulting and Clinical Psychology, 75(5), 816-822. https://doi.org/10.1037/0022-006X.75.5.816