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Introduction

Motivational interviewing is a counseling method that helps people resolve ambivalent feelings to find the internal motivation they need to change their behavior. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes. (Hettema, Steel, Miller, 2005).

Occupational therapists use motivational interviewing to address the management of physical and mental health conditions such as addiction behaviors and mood disorders.

Theory

The transtheoretical model of behavior change is relevant to mood disorder in that it highlights steps in a non-linear fashion that address change.  The transtheoretical model of behavior change plays an integrative role in therapy to help assess an individual’s readiness to act upon healthier behaviors. The strategies, and or processes of change in the transtheoretical model aim to guide the individual in pursuing and maintaining lasting change in the course of treatment as they progress through lifestyle modifications.

Evidence

A randomized clinical trial by Evers et al. (2016) looking at a stress-management program based on the transtheoretical model included a national sample of 1,085 individuals participated. Random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this the transtheoretical model population-based stress-management intervention.

Case Study

Jessica is a 28-year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past.

For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days, she stays in bed all day, watching TV or sleeping.

At home, Jessica’s husband has noticed changes as well. She’s shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which has him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”.

Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of lately.

Intervention Plan

Problem Statement

Jessica’s poor stress management skills impede the quality of her work performance.

Long Term Goals

1. Jessica will demonstrate correct use of self chosen coping mechanisms 5/5 times to reduce stress during work-related tasks by d/c.
2. Jessica will incorporate at least 1 leisure activity of her choosing into her weekly routine to create a better work-leisure balance for stress reduction by d/c.

Short Term Goals

1. Jessica will identify 4 strategies for managing stress by the 3rd therapy session.
2. Jessica will research 2 leisure activities of interest within 1 week.
3. Jessica will create a weekly schedule to include 1 of her chosen leisure activities within 2 weeks.

Intervention Format

Individual

Setting

Jessica will meet with the occupational therapist at the outpatient clinic for 30 minute sessions twice a week.

Supplies

None

Agenda

• Meet Jessica & develop rapport (5 min)
• Assess Jessica’s readiness for change (2 min)
• Engaging in motivational interviewing of study habits (18 minutes)
  • Potential open-ended questions
    • “Describe your typical day at work.”
    • “What do you feel is the most stressful aspect of your work?”
    • “What coping mechanisms are you currently employing?”
  • Provide affirmations
    • “It sounds like you are very dedicated to the medical profession and will make a great medical professional.”
    • “It looks like you are familiar with some coping strategies and tried implementing some of them. It shows me that you are motivated.”
    • “You are a strong person and have all the resources for success.”
  • Provide reflections
    • “So you feel that you are not performing as well as you did in the past.”
    • “You value your role as a wife and you want to improve your relationship with your husband.”
  • Provide a summary of the discussion (5 min)

Documentation

S: Client stated that she feels ashamed due to her inability to function productively at work and home.

O: Client participated in a 30 minute session focusing on exploring the causes of her depression. Using motivational interviewing she was able to identify her inability to handle work stresses as a main reason for feeling frustrated and unproductive. Client reported feeling withdrawn and unusually fatigued. With the permission of the client, the importance of having occupational balance in daily life as well as the use of adaptive coping strategies were discussed. Client was able to verbalize 3 stress management strategies and agreed to implement at least 1 by next session.

A: Client initially arrived in contemplation phase with willingness to engage in an active approach to developing coping strategies but with no plans on how to initiate a list of coping strategies. With a cooperative effort, the client brainstormed on ways to reduce stress, showing transition from contemplation to preparation phase. The ability to follow through with instructed coping strategies while demonstrating and reciting techniques with minimal verbal cues shows increased ability to maintain and carryout instructed techniques as prescribed. Hence, client’s positive coping strategies shows increased motivation to facilitate coping strategies under stressful situations at home and at work.  Progress in today’s session and motivation for change indicate excellent therapy potential. Client would benefit from reassessment of skilled intervention in stress management.

P: Client will be seen for 3 more 30 min sessions to assess coping strategies to increase motivation for improved stress management and to maintain participation in valued and meaningful roles and occupations. Session will focus on skilled instruction and use of safe breathing techniques and lifestyle modification techniques, resources for stress management

References

Hettema J, Steel, J, Miller WR (2005). Motivational interviewing. Annu Rev Clin Psychol.

Evers, K. E., Prochaska, J. O., Johnson, J. L., Mauriello, L. M., Padula, J. A., & Prochaska, J. M. (2006). A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention. Health Psychology, 25(4), 521-529. doi:http://dx.doi.org.ezproxy.fiu.edu/10.1037/0278-6133.25.4.521