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Introduction

Motivational interviewing (MI) is a talk therapy that can be used by healthcare professionals to help people change their behavior by resolving their ambivalence (Rollnick, Miller, & Butler, 2008). MI involves arranging conversations in a way that people talk themselves into change, based on what they value and are interested in (Miller, Rollnick & Rollnick, 2013). Refugees often exhibit the following behaviors that they may want or need to change:

• Depression
• Anxiety
• Restlessness
• Insomnia
• Fear

Occupational therapists can help these individuals to change these behaviors to live more successful and secure lives.

Theory

According to Brown and Stoffel (2011), the Transtheoretical model is a vastly used theory that can aid an individual in the process of changing behavior. The major concept of the aforementioned theory describes the stages of change through five stages. The five stages are:  precontemplation, contemplation, preparation, action, and maintenance. The Transtheoretical model is a unique theory  which  acknowledges that change is cyclical in that relapsation has the possibility to occur. Nonetheless, this does not mean that the cycle has ended. On the contrary, relapsation too can teach the client a myriad of information about their individual journey and specific ways to aid him/her in the cycle of change. Additionally, the Transtheoretical model allows a therapist to meet a client at their particular stage of change, while aiding them in to their successive stage.

Evidence

A study found that there is a significant need for mental health services for individuals in the Latino culture. It is known that motivational interviewing is particularly effective in inspiring change in individuals, however, it remains to be underutilized in the Latino culture due to lack of cultural competence. Añez, Silva, Paris, and Bedregal (2008), suggests adopting the values of respeto (respect and mutual deference), confianza (trust and intimacy in a relationship), and personalismo (a style of communication that indicates a preference for developing relationships with individuals rather than with institutions) when taking a motivational interviewing approach to promote a better outcome.

Case Study

Gloria Vasquez is a 60 year old housekeeper. She came to the United States 15 years ago from Venezuela to live with and help her daughter care for her family. Gloria loves her grandchildren and going to church with her family. She currently works cleaning motels in Hialeah, FL but has been experiencing anxiety and depression due to a fall. She is completely healed and back to work but the fall has had some lasting mental effects. Gloria enjoys her job and was always hailed as one of the best workers. However, after her injury, she has not been able to be as fast and efficient as she used to be. Due to these issues, she has been experiencing depression and anxiety about her work status, worried her boss will fire her. She has only worked as a housekeeper and needs the money from her job in order to help her family, but the depression she is experiencing from her work conditions is taking its toll.

Intervention Plan

Problem Statement

Client’s work performance is being hindered due to her depression and anxiety about her recent fall.

Long Term Goal

1. Client will implement one activity that she recognized reduces her anxiety at least once a week to promote successful work performance by discharge.

Short Term Goals

1. Client will identify what is inhibiting her from working effectively by the first session.
2. Client will identify activities that she recognizes that reduce her anxiety while at work by the second session.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist individually at the FIU NeighborhoodHELP for 30 minutes 2x/week for 4 weeks.

Supplies

None

Agenda

• Meet Gloria and develop a rapport to establish trust (5 mins)
• Assess Gloria’s readiness for change (2 mins)
• Engage in motivational interviewing to increase her performance at work (18 mins)
  • Potential open-ended questions
    • “What is preventing you from being successful at work?
    • “Can you tell me specific ways that can help you with your anxiety at work?”
    • “Can you think of other activities that can help you?”
  • Provide affirmations
    • “It sounds like you are motivated to improve your performance at work”
    • “You are very proud of your work and are willing to get back to being the best worker”
    • “You are a determined, hard worker”
  • Provide reflections
    • “You think that if you were to listen to spiritual music as you work it would aid you in feeling more calm and happy at work?
    • “You think that if you go back to going to church every week, that would help you with your anxiety?”
  • Provide a summary of the discussion (5 min)

Documentation

S: Client expressed that her depression and anxiety are affecting her work performance and that she is worried she may fall again.

O: Client participated in a 30 minute session that focused on the client identifying what is inhibiting her from performing successfully at work. Client verbalized dissatisfaction with her work performance. Client presented with flat affect and was tearful. The therapist used motivational interviewing with the client during the session. With the permission of the client, the therapist discussed adaptive coping strategies.

A: Client is currently in the contemplation stage of change demonstrated by the awareness of her need to change. The client described how her previous fall has affected her work performance, even though she is physically healed, she still feels sad and anxious while at work. Client’s ability to identify her emotional instability and anxiety as areas that are inhibiting her ability to perform at work shows insight.

P: Client will continue with motivational interviewing OT sessions 2x/week for 4 weeks to progress to the action stage of change. Therapist will continue to evaluate the effectiveness of the coping strategies identified and reevaluate them if needed.

References

Añez, L. M., Silva, M. A., Paris, M., & Bedregal, L. E. (2008). Engaging Latinos through the integration of cultural values and motivational interviewing principles. Professional Psychology: Research and Practice, 39(2), 153-159. doi:10.1037/0735-7028.39.2.153

Brown, C., Stoffel, V., & Munoz, J. P. (2011). Occupational therapy in mental health: A vision for participation. Philadelphia: F.A. Davis

Miller, W. R., Rollnick, S., & Rollnick, S. P. (2013). Motivational interviewing : helping people change. Retrieved from https://ebookcentral.proquest.com

Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivationals Interviewing in Healthcare: Helping Patients Change Behavior. American Journal of Pharmaceutical Education (Vol. 73). http://doi.org/10.1111/j.1465-3362.2009.00073.x