NU 665 WEEK 2 DISCUSSION

Change Theory and Motivational Interviewing

Comparison of Change Theory and Motivational Interviewing Principles

Change theory provides steps of change that may encompass pre-contemplation, contemplation, preparation, action, and maintenance of motivation levels. It focuses on comprehending cognitive mechanisms of behavior change. On the other hand, motivational interviewing (MI) is a specific form of a patient-centred and directed counselling approach designed to mobilize intrinsic motivation by addressing a patient’s indecisiveness (Bischof et al., 2021). Five core principles of MI include the provision of empathy, the acceptance of the client’s resistance, the creation of a discrepancy in the target behaviour, and the enhancement of the client’s self-efficacy. While the end of both is to cause behavioural changes, Bischof et al. (2021) indicate that change theory has a more prescriptive approach compared to MI’s relational approach, where the patient is empowered to be an active participant in the process. Combining the abovementioned principles makes it possible to apply psychological intervention while personalizing it.

Therapeutic Intervention Example

In one case, I worked with a young adult experiencing anxiety and avoidance behaviors related to public speaking. Using change theory, I sought where they were and got that they were in the contemplation stage, which was admitting to the fear but not sure how to deal with it. Using motivational interviewing, I engaged them in exploring their ambivalence by asking open-ended questions, such as, “What would speaking confidently mean to you?” and reflecting on their responses empathetically. Together, we created short-term actionable objectives, such as rehearsing a presentation before a friend. I employed the change theory task structured approach to address the issue while combining motivational interviewing and patient-centred advocacy to move the patient from the contemplation stage to the action stage. Consequently, she was able to make a short presentation before an enthusiastic crowd. This was quite beneficial in boosting their self-esteem and ability to have the necessary strength to tackle such demands in future (Cybulska et al., 2020).

Application of Change Theory and Motivational Interviewing Principles to a Clinical Case

Motivational interviewing and change theory were employed to inform an intervention for a middle-aged adult with severe depressive illness. The patient in the contemplation stage realized the importance of an organized schedule but did not believe in the ability to change. Some of the challenges mentioned were explained by a lack of self-confidence and energy (Mifsud et al., 2020). To boost self-efficacy, client-centered ways of communication, like asking questions like ‘What should an ideal day in your life look like?’ were used to generate and confirm the objectives. The last example of the goal implementation was the use of a target chart starting with a 10-minute morning walk to achieve the transition to the preparation and action stages.

Navigating Challenges in Applying Principles

Navigating challenges required balancing the structured elements of change theory with the flexible, patient-centred approach of MI. One concern was doubt with the patient, unpredictability, and failure to adhere to the prescribed actions. To address this, it was important to listen to them without passing any judgment and also focus on small victories to support the concept of self-efficiencies. For example, when the patient failed to go for a walk as planned, I transformed the negative perception of walking into more of a process of checking up on goals and coming up with new specific objectives that the patient can adopt. Another problem was the general avoidance of expressing desire and other complex emotions. In line with the MI principle that involves rolling with resistance, it was easier for me to readdress other concerns while, at the same time, developing a rapport with the client. This structure aided in maintaining the intervention in congruency with the patient’s level of participation and willingness to improve. It also fostered a strong working alliance, leading to significant improvements in managing depressive symptoms.

References

Bischof, G., Bischof, A., & Rumpf, H. J. (2021). Motivational interviewing: an evidence-based approach for use in medical practice. Deutsches Ärzteblatt International, 118(7), 109.

Cybulska, A. M., Szkup, M., Schneider-Matyka, D., Skonieczna-Żydecka, K., Kaczmarczyk, M., Jurczak, A., Wieder-Huszla, S., Karakiewicz, B., & Grochans, E. (2020). Depressive Symptoms among Middle-Aged Women—Understanding the Cause. Brain Sciences, 11(1), 26. https://doi.org/10.3390/brainsci11010026

Mifsud, J. L., Galea, J., Garside, J., Stephenson, J., & Astin, F. (2020). Motivational interviewing to support modifiable risk factor change in individuals at increased risk of cardiovascular disease: A systematic review and meta-analysis. PLoS One, 15(11), e0241193. https://doi.org/10.1371/journal.pone.0241193

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NU 665 WEEK 2 DISCUSSION

Value: 100 points

Due: Create your initial post by Day 3 and reply to at least two of your peers by Day 7.

Grading Category: Discussions

Note: In this type of discussion, you will not see the responses of your classmates until after you have posted your own response to the following prompt.

Initial Post

For this discussion, compare principles of change theory and motivational interviewing and how these principles have informed a therapeutic intervention you have had with a patient (1-2 paragraphs). Apply these principles to a real or hypothetical clinical case, discussing how the principles guide therapeutic interventions in the context of the case and how you would navigate any potential challenges (1-2 paragraphs).

You will gain a greater understanding of the theoretical underpinnings of the use of change theory and motivational interviewing used across clinical practice situations and settings.

Replies

Reply to at least two of your peers. Discuss similarities and differences in your and your peer’s patient interactions. Describe one concept from your peer’s post that you could use in your own clinical practice (1-2 paragraphs).

Use APA formatting as stated in the syllabus and grading rubric.

Please refer to the Grading Rubric for details on how this activity will be graded.

The described expectations meet the passing level of 80%. You are directed to review the Discussion Grading Rubric for criteria which exceed expectations.

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NU 665 WEEK 2 DISCUSSION