What are the best practices for using MI to help clients with co-occurring disorders?

Working with those who are incarcerated, autonomy is unknown and learned helplessness is the popular mindset. Allowing this population to discover their own strengths and ideas through MI is a wonderful way to watch "the light come on" inside individuals. I am so grateful to be a part of this process.

Working with any vulnerable population, a non judgmental approach and establishing trust in the relationship is cliché yet often times a crucial component that is missed. Navigating through the stages of change with the person is effective when the focus is on empathy for the person's perceived situation and not rushing into getting the person to see their situation as problematic and therfore needing to change. The person has to trust the relationship to be safe...so the therapist can then proceed with open-ended style MI in order to elicit more genuine responses from the person.

🌟 Recently, I worked with a client battling addiction and depression. Using MI, we focused on empathy, reframing their narrative from self-doubt to self-empowerment. 🔄🗣️ This approach helped them recognize their own ability to change, leading to significant progress in therapy. It's about finding that spark of hope and fanning it into a flame! 🔥

I have had the opportunity to work with individuals in the early stages of their recovery journey, encompassing precontemplation, contemplation, preparation, and action. When it comes to assessing the needs of those who are utilizing harm reduction strategies, it is crucial to consider a holistic approach. It is not solely about their willingness or confidence, but also their ability and realistic beliefs. Various factors can influence a person's readiness, and there are diverse ways in which readiness can be achieved. As a clinician, our most valuable asset is our professional knowledge and understanding, which serves as a powerful tool in guiding and supporting our clients.

Encountering a disowned ED patient living in dire conditions with maggot-infested leg ulcers was a stark reminder of the impact of unaddressed mental health issues. By employing compassionate, open-ended inquiries, I unraveled the underlying thread of low self-worth. Addressing this crucial aspect became the catalyst for breaking the cycle of alcohol abuse and neglect, offering a chance at meaningful recovery.

I think it’s really important to unpack where the client is at and meet them there. Something else to consider is that a client may be desiring change, but something like unresolved trauma can be holding them back, because trauma is something from the past that we experience in the present. MI is great in that it is easy to incorporate other therapies based on the clients needs, so we don’t have to feel tied to one approach. Ultimately, everyone wants to feel better, but may not have found the way to do that yet, or in the case of addiction, a way that will promote overall well-being rather than having the shame that can be tied to the use of substances or other unwanted/unhealthy behaviours.

In terms of working with clients with co occurring disorders, it’s important to recognize that their readiness to change may fluctuate due to the multitude of contributing factors. It’s important to stay attuned to fluctuations of emotional states, which, in turn, influence readiness to change. Leading with compassion can help enhance the therapeutic relationship, thereby,moving the client along the stages of change. Self compassion enhances client efficacy and helps the them feel empowered.

Unconditional Positive Regard. Creation of connection allows the vital two-way channel of vulnerability where truths and solutions can be communicated. Demonstrating to the client that you respect and accept them regardless of what they do or don’t do. Think about the value of feeling seen, heard, and understood. It is medicine and the secret sauce to helping others.

In my particular population, I have worked with clients in the pre-recovery stages; a combination of precontemplation, contemplation, preparation, and action. How do you assess needs for those utilizing harm reduction stradegies? Balancing decisions need to be based not just on willingness or confidence, but also on ability, and realistic belief. There are many things that may play a part in a persons readiness, but there are also, different forms of how readiness may be attained. This is a clinicians most powerful tool, the tool of professional knowledge and understanding.

Utilizar a entrevista motivacional no cliente é funcional e trará resultados a partir do momento que ele esteja disposto e aberto a modificaçoes. Caso contrário o trabalho será desperdicado

If I ever use MI again, I really want to focus on the motivation part. My question to the individual should be “why are you not these…” Not “so you are… Let’s get motivated.” The client should acknowledge an accurate diagnosis momentarily. Acknowledgment of one’s diagnosis does not promote recovery. acknowledgment, cripples, motivation. Acknowledgment, signals defeat. And agreeable client does not signal a recovering client. A client who is willing to tell me why they are not their diagnosis signals in motivated client. Our clients need to know that we hear their voice. our clients need to be able to tell us we are wrong. Not everyone who is treated for SUDS is truly a substance abuser who is labeled a failure for future moderate use.

One thing i have found helpful is: Explore Ambivalence: Co-occurring disorders often involve ambivalence about change. Use MI techniques to explore the client’s conflicting feelings and motivations related to both disorders. Understanding their readiness to change.

Participant ambivalence has since been referred to as a counselor issue of not being able to fully connect with a participant. Now, this may be half or so true. But the reality is, anyone that does not see eye to eye in terms of goals and personal motivations, will experience ambivalence. If I want my participant to stop harmful drug using behavior, but that is not really a first and foremost issue on their mind, well than what is an issue? How can I engage them within their own self-interests?

Everything starts with a relationship. If you cannot build a rapport with a client, it doesn’t matter what else comes next. Really understanding what they are facing is key, and the only way to do that is by regulating and recognizing your own parameters.

When I think of interview between an interviewer and an interviewee, I don’t naturally take all the nuance that goes into both presenters participation. Much like a news interview, or celebrity interview, With MI , A counselor and participant both need to work collaboratively in effort to best utilize MI to it’s fullest. MI is not just a tool for the counselor, and not just a ‘do it all yourself’ method for the participant. It is a method in which both participant, and counselor equally, explore concepts of motivation.

Conforme explanei anteriormente é necessário parceria e disposição por parte do cliente para uma adequação, implantação e melhor aproveitamento da entrevista motivacional com ferramenta.

While collaboration is a core principle of MI, I have witnessed poorly executed MI technique that ends of feeling like a schmoozey sales pitch for what the therapist thinks the client should be doing, vs. actually being collaborative and getting to the core of the client's values and why they may or may not want to make a change. As the therapist, keeping your own motives and values in awareness so that does not happen is key.

In my experience, It has to be a team effort. Autonomy should be emphasized throughout treatment. All their concerns are valid, and the client is the expert.

Supporting a clients change builds upon strengths that the client already had, but has now chosen to fully evolve. This is strength based motivation! This emphasizes that the participant always had these skills, and now with the fully equipped skills being utilized, the participant gains such motivation by having this affirmed!

Principalmente em processos de mudanças profundas que impactem na cultura e procedimentos da empresa, é necessário acompanhar o cliente suportando-o durante todo o processo.

What you learn is repeated several times in order to understand what results from it. At the moment you can't handle an AI like you would a Lego kit to present what has been built. Let's discuss deeper insights into the world of psyche, conversation and action. Only then can we determine the first characteristics. What do you think?