Introduction
Psychiatric nursing involves one of the techniques, which is motivational interviewing, used by therapists, and counselors. The technique has been considered adequate for creating positive change in behaviours among people positively, and is beneficial for patients suffering from psychosocial issues like anxiety, behavioral disorders, disorders, depression, paranoia, etc (Mullen et al., 2020). Clients play an essential role in this motivational interviewing, as they are engaged in the process. In this interviewing, the clients are involved by the nurses to develop therapeutic relationships. Therefore, planning is vital for the nurses to integrate strategic motivational interviewing interventions. In this case, a client, a 43-year-old man with substance use disorder, was chosen, based on which the motivational interviewing should be used (Wong et al., 2019).
Discussion
The client or consumer is a 43-year-old man, Peter, diagnosed with substance use disorder. Due to his addiction to substances, there have been issues in his family. His wife left with the children, leaving him alone. It was because of his activities under substance addiction. However, as days passed by, he started feeling lonely and depressed. Gradually, there were signs of mental health disorders noticed by one of his friends. While talking, the friend saw that Peter was absent-minded and did not reply (Miller & Rollnick, 2013). It was then discovered that Peter was drinking to shed off his depression. At once, the friend contacted the mental healthcare services.
The motivational interviewing technique has been selected for Peter as a process of engagement, as it could help him change his behavior from substance abuse disorder and lead a clean life. Motivation from the psychiatric nurses, counselors, and therapists, whoever might be indulged in working with him, has been established and maintained for Peter to quit his addiction to alcohol and smoking habits even. Miller and Rollnick, (2012) stated that motivational interviewing, as a therapy, could also help Peter share his feelings, which he might not have been able to narrate to others, building an effective relationship with the caregiver. Interviewing Peter through motivation, in the form of therapy or counseling, could be beneficial in gaining insights into the circumstances while forcing him to become addicted to substances. During the interview, there would be communication, which would help the psychiatric nurses understand Peter's mindset regarding substance use (Geller & Greenberg, 2012).
The motivational interviewing technique could be justified if the psychiatric nurses, counselors, and therapists trigger determination among Peter to change his behavior, encouraging him to adopt healthy lifestyle choices while preventing substance abuse. Therefore, motivational interviewing has been selected for dealing with clients like Peter, as he could be engaged in the conversation on the change needed for reuniting with his family and restoring normalcy in leading life as he had before.
According to Geller and Greenberg (2012), Motivational interviewing in psychiatry nursing is an effective technique used to inspire or motivate patients with a certain level of enthusiasm for change and to move towards improvements that could improve their lives. The primary purpose of the MI has been to move the patients from the position of complexity or issues experienced to the formation of a personal desire to change. The Motivational interviewing technique has also helped in allowing the psychiatrist to engage and strive to induce the recognition of the patient of the desirability to change (Cho & Lee, 2018). The various techniques related to the problem of alcohol dependence, which is considered a substance use disorder here. The MI in psychiatry nursing is a platform for collaboration in which the psychiatrist induces some change in behaviors among the patient, thus, gaining the desire to change (Watson & Wiseman, H. (2021). The engagement process is a significant motivational interviewing process, allowing the clinician to attend to clients' engagement during the treatment or intervention. The engagement process involves establishing a proper therapeutic relationship, which lays the foundation for MI. In such situations, qualities like empathy, acceptance, focus on the client's strengths, and mutual respect are crucial (Magill et al., 2018).
To establish a process of engagement with the client, i.e., Peter, it would be essential to interact with him appropriately, with calmness, and carefully listen to any queries appropriately. Asking open-ended and probing questions helps while acknowledging their responses also could help in making them feel valued. It creates a sense of trust and should make the patient feel that his needs and preferences are adequately cared for. Also, reflective listening and summarizing the problems experienced by Peter, such as alcohol dependence and its effects on his physical and mental health, could be helpful (Frey et al., 2021). Establishing this engagement could help develop a working alliance with the clients and create a safe and comfortable environment for them to discuss their concerns and issues. As a therapist, a person-centered approach be helpful for evaluating the problems experienced by clients, and the objectives to be achieved. Magill and Hallgren, (2019) also stated that therapeutic engagement further promotes encouragement, providing support and options for recovery along the way of treatment intervention managed for treating the patient. Therapeutic relationships, as stated by Fortune et al., (2019), have been the cornerstone of mental health nursing, and to maintain those, it would also be necessary for the counselor or therapist to remain patient while listening to what Peter wants to speak, such as what might be the causes of alcohol dependence and what led to both physical and mental issues. Expressing empathy and using reflective listening also supports noting the concerns about the degree to which there is a need to engage with the consumers in such environments (Cho & Lee, 2018).
There is a need to use the chosen motivational interviewing intervention by collecting patient history in the initial stage. After gaining information on his condition of Peter, a meeting session was scheduled with the physician dealing with Peter (Frost et al., 2018). After collecting his response, interventions were assessed, which could be used to treat his mental health condition. It was then the motivational interview technique was found to be effective for use to deal with such situations. After the selection, integrating the arguments of Steindl, Kirby & Tellegan, (2018), it was also found that the technique is suitable for Peter's condition, as it could create a sense of motivation and change behaviors. It could thus be concluded that the technique is efficient, as it would follow four processes of engaging, focusing, evoking, and planning toward changing behavior of Peter. As a sequential step, the Five Stage Model of change has been used as well, which helped the interviewer to assess the technique's impact on Peter. After the final evaluation, the strategy of motivational interviewing has been implemented within the psychiatric nursing intervention (Navidian, Sedghy & Yoosefi, 2020).
In the initial stages, the challenges were encountered in the form of inadequate responses from Peter. It was reflected in the instance that he did not give consent to participate in the process of motivational interviewing (Westra & Norouzian, 2018). T was a major challenge in terms of implementing the intervention. There is a need to manage various ethical considerations such as not forcing the client regarding anything against his consent. It must be thought about and considered from the clients' perspective. The interviewer needs to assess how Peter feels about alcohol dependence and what could be the resultant mental condition. Based on intense research about substance use disorder, a proper understanding was gained to understand the issue. To gain insights into the client's case, there is a need to convince Peter's family first so that they could approve the use of intervention, provided it is done ethically. (Marker & Norton, 2018).
When Peter consented to be a part of the motivational interview, the interviewer should also think of developing a questionnaire, which does not involve any personal questions but only the ones needed to control his alcohol dependence. It is important to use the Data Protection Act to ensure that his private responses are used only for record purposes and not for commercial purposes. This assurance could be adequate in terms of ensuring positive outcomes. This consent from Peter helped in proceeding with the counseling therapy treatments under motivational techniques (Beckwith & Beckwith, 2020). Measurability of this lies in Peter's positive response to motivational interviewing, counseling, and other therapies. Through this recovery, he would be motivated not to be alcohol dependent anymore and lead a healthy lifestyle. The impact of recovery has been exemplary, as the motivational interviewing therapy not only helped reduce alcohol and drug abuse but also improved the adherence to treatment and medication properly. Moreover, he has become much more active and has learned to adopt healthy lifestyle choices and behaviors, improving his health and making him live longer (Mullen et al., 2020).
To develop skills in motivational interviewing, my communication skills have been useful at the initial stage. This has been possible through practicing oral presentation in front of others and writing analyses of the cases. This type of analysis broadened my perspectives. Regarding the arguments of Westra and Norouzian (2018), it is important to ensure that others could understand my word selection, tone, and communication style. In my practice, it offered me affirmations, thus increasing my ability to create confidence among clients like Peter. My active listening skills also improved with careful consideration of what he wanted to speak. All these preparations helped me to influence clients like Peter. I asked him open-ended questions, which helped me to analyze his mindset from his responses in the format of yes, and no.
Working in partnership with other individuals could allow tracking the patient's condition and share the necessary information with them, which could result in better treatment. Considering the arguments of Watson and Wiseman (2021), it would be important to motivate the patient by talking with him calmly and making him understand how substance abuse and how it might even lead to problems in his personal life. Providing him with knowledge and information about participating in other activities, being physically active, and adopting healthier choices could lead to a better life for him in the future. From the consumer perspective, it could be believed that the patient has felt much better sharing his concerns with me, which allowed me to provide the appropriate treatment (Wong-Anuchit et al., 2018). Also, the consumer seems to have gained positive perceptions, as he has never been pressured; instead, he and his family members have been informed about his health status and the treatment that should be provided. It has allowed him to provide his informed consent while acquiring trust in me to deliver the best possible treatment for a speedy recovery.
Practicing this motivational interview with other clients could improve my skills and abilities in providing person-centric care for psychiatric nursing. The practice could also be effective for dealing with other types of clients from other sociocultural backgrounds who are challenging to handle due to communication gaps (Magill et al., 2018). In the future, I plan to engage in cross-cultural communication training and get admitted to six months foreign language course. This could be effective for dealing with clients suffering from psychiatric disorders like alcohol dependence and depression in Peter.
Conclusion on Therapeutic Engagements and Psychosocial Interventions:
Throughout the course, various essential aspects have been learned of psychiatric nursing. From this topic, motivational interviewing has been selected for reflective observation of own performance development as a therapist and interviewer. While evaluating the case histories of the patients shortlisted, Peter has been selected for a motivational interview, as he showed positive signs of recovery compared to others who needed more counseling. Various preparations were managed for conducting motivational interviewing of Peter in the form of developing oral communication, writing, analysis, reflective listening, and observational skills. The planned approach could help in improving my practice as a therapist, and with further guidance, it would be helpful for indulging in training sessions as well. A continuous improvement would help me develop my performance and skills while implementing this intervention effectively.
References
Beckwith, V., & Beckwith, J. (2020). Motivational Interviewing: A Communication Tool to Promote Positive Behavior Change and Optimal Health Outcomes. NASN School Nurse, 35(6), 344-351. [https://doi.org/10.1177/1942602x20915715]
Cho, J., & Lee, K. (2018). Effects of motivation interviewing using a group art therapy program on negative symptoms of schizophrenia. Archives Of Psychiatric Nursing, 32(6), 878-884. [https://doi.org/10.1016/j.apnu.2018.07.002]
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R., Dombrowski, S., & Williams, B. et al. (2018). Effectiveness of Motivational Interviewing on adult behavior change in health and social care settings: A systematic review of reviews. PLOS ONE, 13(10), e0204890. [https://doi.org/10.1371/journal.pone.0204890]
Fortune, J., Breckon, J., Norris, M., Eva, G., & Frater, T. (2019). Motivational interviewing training for physiotherapy and occupational therapy students: Effect on confidence, knowledge and skills. Patient Education And Counseling, 102(4), 694-700. [https://doi.org/10.1016/j.pec.2018.11.014]
Frey, A., Lee, J., Small, J., Sibley, M., Owens, J., & Skidmore, B. et al. (2022). Mechanisms of Motivational Interviewing: a Conceptual Framework to Guide Practice and Research. Retrieved 18 July 2022, from. [10.1007/s11121-020-01139-x]
Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association. [ISBN: 9781433810602]
Geller, S., & Greenberg, L. (2012). Empirical research on therapeutic presence. In Therapeutic presence: a mindful approach to effective therapy (pp. 37–49). American Psychological Association. [ISBN: 9781433810602]
Magill, M., & Hallgren, K. (2019). Mechanisms of behavior change in motivational interviewing: do we understand how MI works?. Current Opinion In Psychology, 30, 1-5. [https://doi.org/10.1016/j.copsyc.2018.12.010]
Magill, M., Apodaca, T., Borsari, B., Gaume, J., Hoadley, A., & Gordon, R. et al. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal Of Consulting And Clinical Psychology, 86(2), 140-157. [https://doi.org/10.1037/ccp0000250]
Marker, I., & Norton, P. (2018). The efficacy of incorporating motivational interviewing to cognitive behavior therapy for anxiety disorders: A review and meta-analysis. Clinical Psychology Review, 62, 1-10. https://doi.org/10.1016/j.cpr.2018.04.004
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press. [https://books.google.co.in/books?hl=en&lr=&id=o1-ZpM7QqVQC&oi=fnd&pg=PP1&dq=Miller,+W.+R.+(2012).+What+is+motivational+interviewing%3F+In+Motivational+Interviewing+:+Helping+People+Change+(pp.+1%E2%80%9336).+Guilford+Publications.+ISBN:+9781462507566+&ots=c1FjbPfhKY&sig=ORbWJ7OHhNX9vsf3DMLIX2G22oM#v=onepage&q&f=false]
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (applications of motivational interviewing). Guilford Press. [https://psycnet.apa.org/record/2012-17300-000]
Mullen, A., Isobel, S., Flanagan, K., Key, K., Dunbar, A., Bell, A., & Lewin, T. (2020). Motivational Interviewing: Reconciling Recovery-Focused Care and Mental Health Nursing Practice. Issues In Mental Health Nursing, 41(9), 807-814. [https://doi.org/10.1080/01612840.2020.1731891]
Navidian, A., Sedghy, Z., & Yoosefi, N. (2020). The effect of motivational interviewing-based training on the rate of using mental health services and intensity of suicidal ideation in individuals with suicide attempt admitted to the emergency department. Journal Of Education And Health Promotion, 9(1), 247. [https://doi.org/10.4103/jehp.jehp_344_20]
Steindl, S., Kirby, J., & Tellegan, C. (2018). Motivational interviewing in compassion‐based interventions: Theory and practical applications. Clinical Psychologist, 22(3), 265-279. [https://doi.org/10.1111/cp.12146]
Watson, J. C., & Wiseman, H. (2021). The responsive psychotherapist: attuning to clients at the moment. American Psychological Association. [ISBN: 9781433834011]
Westra, H., & Norouzian, N. (2017). Using Motivational Interviewing to Manage Process Markers of Ambivalence and Resistance in Cognitive Behavioral Therapy. Cognitive Therapy And Research, 42(2), 193-203. [https://doi.org/10.1007/s10608-017-9857-6]
Wong-Anuchit, C., Chantamit-o-pas, C., Schneider, J., & Mills, A. (2018). Motivational Interviewing–Based Compliance/Adherence Therapy Interventions to Improve Psychiatric Symptoms of People With Severe Mental Illness: Meta-Analysis. Journal Of The American Psychiatric Nurses Association, 25(2), 122-133. [https://doi.org/10.1177/1078390318761790]
