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Introduction

It is approximated that 10-15% of Americans have a serious eating disorder (“Mirasol Eating Disorder Recovery Centers”, 2017). Motivational interviewing (MI) is a type of intervention that intends to inspire clients to move from a state of ambivalence regarding change to a state of empowerment through client-centered counseling (Miller & Rollnick, 2013). Some behaviors that individuals with eating disorders may be concerned with changing are:

• Excessive exercise
• Unhealthy caloric intake
• Purging
• Lack of leisure activities

Occupational therapists are skilled in providing motivational interviewing to clients with eating disorders that are interested in changing the aforementioned behaviors.

Theory

The transtheoretical model suggests that health-related behavior changes involve a state of intentional progress through six stages; precontemplation, contemplation, preparation, action, maintenance, and termination (Prochaska & Velicer, 1997).

Evidence

MI was shown to increase treatment adherence and patient motivation within an eating disorder inpatient program. Early discharge rates increased in a one year span compared to when MI was not being included into treatment sessions (Dray, et al., 2014).

Case Study

Ellen is a 20 year old female who was diagnosed with bulimia nervosa. She was admitted to a group home due to concerns of binging followed by excessive exercise. Ellen’s parents are concerned with her lack of leisure activities and social participation. Ellen has not been able to enroll in college as a result of anxiety and obsessive behavior regarding food and exercise. Her physician referred her to an occupational therapist.

Intervention Plan

Problem Statement

Client is unable to engage in social participation due to excessive concerns of caloric intake and exercise.

Long Term Goals

• Ellen will participate in 2 leisure activities of choice to enhance social participation within 4 weeks.
• Ellen will implement 3 adaptive coping skills to engage in social participation within 4 weeks.

Short Term Goals

• Ellen will identify 3 leisure activities of interest in order to increase social participation within 2 weeks.
• Ellen will identify 2 alternative activities, when feeling anxious about her caloric intake, to enable her to engage in social participation within 1 week.
• Client will decrease the time that she spends exercising by 25% to support her engagement in social participation within 2 weeks.

Intervention Format

Individual

Setting

Client was referred to an inpatient and residential treatment center for eating disorders. She will individually meet with an occupational therapist 3x a week for 30 minutes.

Supplies

None

Agenda

• Meet Ellen & develop rapport (5 min)
• Assess Ellen’s readiness for change (2 min)
• Engaging in motivational interviewing about exercising habits (18 minutes)
  •  Potential open-ended questions
    • “What would you like to change about your exercising habits?”
    • “Tell me about your exercising habits?”
    • “What is preventing you from changing your exercising habits?”
  • o Provide affirmations
    • “It sounds like you are aware that you should change your exercising habits”
    • “You are willing to change your exercising habits”
    • “You are a persistent and strong willed person”
    • “It sounds like you are not satisfied with your eating habits”
  •  Provide reflections
    • “It seems like your current exercising habits are not aligned with your goals”
    • “You think with the proper guidance you are capable of changing your eating and exercise habits”
  • Provide summary of the discussion (5 minutes)

Documentation

S: “I’m here because my parents think I exercise too much and don’t eat enough. I haven’t been able to see my friends in a few months because they always want to go out to eat and that really bothers me. I know I should be trying to have fun with my friends but I don’t think I’ll be happy if I gain weight. I also want to enroll into my local college to help me get a job in the future but then I won’t have enough time to exercise.”

O: Client engaged in occupational therapy session for 30 minutes. The session focused on identifying problem behaviors using a motivational interviewing approach. Client mentioned exercising more than 6 hours a day, 7 days a week. Client feels her time spent exercising interferes with her social participation. Client shows interest in changing behaviors. Client was able to identify 2 alternative activities to engage in when feeling anxious.

A: Client presents with an excessive exercise schedule resulting in the inability to participate in social outings. She is currently contemplating behavior change in that she is beginning to have concerns with her bruises on her body. Client feels anxious when she is not participating in exercising activities, therefore discouraging her from applying to college.Client will benefit from skilled occupational therapy to assist in proceeding to the next transtheoretical stage in order to increase her social participation.

P: Client will continue occupational therapy services 3 times a week for 30 minutes. Sessions will focus on moving the client from the contemplating stage to the preparation stage by identifying healthy habits and different resources.

References

Dray, J., Gilchrist, P., Singh, D., Cheesman, G., & Wade, T. D. (2014). Training mental health nurses to provide motivational interviewing on an inpatient eating disorder unit. Journal of Psychiatric and Mental Health Nursing, 21(7), 652-657. doi:http://dx.doi.org.ezproxy.fiu.edu/10.1111/jpm.12163

Jakubowska, A., Woolgar, M. J., Haselton, P. A., & Jones, A. (2013). Review of staff and

client experiences of a motivational group intervention: Meeting the needs of contemplators. Eating Disorders, 21(1), 16-25. doi:http://dx.doi.org.ezproxy.fiuedu/10.1080/10640266.2013.741965

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing, Third Edition : Helping

People Change. New York, NY: The Guilford Press. ISBN 978-1-60918-227-4

Mirasol Eating Disorder Recovery Centers . (n.d.). Retrieved January 17, 2018, from

https://www.mirasol.net/learning-center/eating-disorder-statistics.php

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American journal of health promotion, 12(1), 38-48.