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Introduction

Motivational interviewing is a conversation that allows a person to discover their own commitment to change (Miller & Rollnick, 2013, p. 3-13). Utilizing motivational interviewing can address multiple behaviors with people with Autism. These behaviors include: social challenges, communication difficulties, and repetitive behaviors (Autismspeaks.org, n.d.). These social challenges can impact an individual’s ability to build relationships with others. Occupational therapists can implement motivational interviewing to allow people with Autism to recognize their own strengths and weaknesses and give them an opportunity to make any changes they feel are necessary.

Theory

The transtheoretical model describes certain steps an individual takes in order to make a change. This model is backed by over 35 years of scientific research and interventions (Prochange.com, n.d.). Each step involves its own process, challenging an individual to be motivated and willing to advance to the next step. By utilizing motivational interviewing, an occupational therapist will be able to determine which stage of the transtheoretical model an individual is in and gives them the skills and knowledge needed to advance to the next stage to make a change to better themselves.

Evidence

There is limited evidence to support the use of motivational interviewing with those with developmental disabilities. This can be used to infer that it may not be the most appropriate intervention for this population as it is usually accompanied by cognitive deficits, making it difficult to carry a motivational interview. However it can still be applied in higher functioning individuals as described in the case study.

Case Study

Sam is an 18-year-old boy who is diagnosed with autism spectrum disorder. He is currently a freshman at a local college studying marine biology. He lives at home with mom, dad, and sister. Sam is struggling with getting a girlfriend. Sam has gone on a few dates, however, they did not go well. He has an impulsive personality and makes blunt remarks which attributes to his struggle with dating. Sam was referred to occupational therapy services to work on acquiring and maintaining a romantic relationship.

Intervention Plan

Problem Statement

Sam demonstrates frustration with inability to maintain a romantic relationship due to a lack of knowledge about appropriate social and communication skills used in dating.

Long term goals

1-  Sam will create a personal action plan for dealing with difficulties that may occur on dates by discharge.

2- Sam will move from the contemplation stage to maintenance related to appropriate dating skills to maintain a romantic relationship within 4 weeks.

Short term goals

1- Sam will identify two aspects of his date that he felt he would like to change to enhance his ability to acquire a romantic relationship within 2 weeks.

2-  Sam will identify two strategies that he would be able to implement on a date to enhance his ability to acquire a romantic relationship within 2 weeks.

3-Sam will move from the contemplation stage to preparation in developing appropriate dating skills in order to maintain a romantic relationship within 2 weeks.

Intervention format

Individual

Setting

The occupational therapist will visit Sam in his home for two, 45-minute one-on-one sessions for four weeks.

Supplies

None

Agenda & description

• Meeting with Sam to follow-up on his date last week (5 min)
• Ask Sam, from his perspective, how he thought his date went (10 minutes)
• Engaging in Motivational Interviewing to assess Sam’s perception of his previous date (25) minutes)
  • Potential Open-Ended Questions
    • “How did your date go?”
    • “How do you think she felt the date went”- Theory of Mind
    • “How you do know that the date did not go well”
    • “What do you think you could have done for the date to have been more successful?’
    • “What do you think went well on your date?”
  • Provide Affirmations
    • You did a really good job of identifying what went well and what didn’t go well during your date.
    • “Great! It seems like your motivated to start dating!”
    • “It is very mature of you to be able to talk about different aspects of your date
    • “You’re a great catch!”
  • Provide Reflections
    • “It sounds like you are motivated to learn new strategies to implement on your dates.”
    • “It seems to me that you realized that one of the reasons the date did not go well was because of the comment you made to your date about her dress.”
  • Provide a summary of discussion (5 minutes)

Documentation

S- Sam seemed calmed and comfortable speaking to the OT. “ I really hate that my date didn’t go well because I liked the girl a lot”

O- Sam engaged in a 45 minute session focused on his dating experience using a motivational interviewing approach. Sam identified 4 aspects of the date that he was not happy with and 2 aspects he felt went well. He reported being blunt and not catching on to his date’s jokes. He expressed wanting to learn about understanding sarcasm and how to appropriately compliment a girl. After being given permission from Sam, the OT provided examples of appropriate and inappropriate ways to speak to a girl.

A- Sam presents difficulties with demonstrating appropriate social and communication skills affecting his dating life. Sam began in the contemplation phase during this interview but appeared ready to change into the preparation phase as he identified what he would like to change about his dating life. Sam demonstrated good insight by identifying where he lacks strength such as understanding sarcasm.   Sam will benefit from skilled OT services to help him to continue his readiness to implement a plan of action for being more successful in dating.

P- The therapist will continue with motivational interviewing approach to identify how to apply appropriate social and communication skills during dates. OT will continue to guide Sam through dating life. He will benefit from OT services 2x/week for one month, 45 minutes each.

References in APA format

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

People Change. New York, NY: The Guilford Press.

Symptoms. (2013, March 20). Retrieved January 19, 2018, from

https://www.autismspeaks.org/what-autism/symptoms

Transtheoretical Model (or Stages of Change) – Health Behavior Change. (n.d.). Retrieved

January 19, 2018, from https://www.prochange.com/transtheoretical-model-of-behavior-change