Motivation-Adaptive Skills-Trauma Resolution (MASTR) Therapy for Adolescents with Conduct Problems

Summary

Trauma is proposed as a key to understanding the development and persistence of adolescent conduct problems, in conjunction with other contributing factors. A trauma-focused individual therapy approach is presented as one example of how this population might be more effectively treated. This approach features motivational interviewing, self-control training (cognitive-behavioral therapy), and trauma resolution (eye movement desensitization and reprocessing). This paper reports on an open trial of six adolescents with school and conduct problems who received school-based Motivation-Adaptive Skills-Trauma Resolution (MASTR) treatment. Reductions in post-traumatic stress, related symptoms, and problem behaviors, along with improved school performance, indicate the value of further study of this treatment approach.     

A Randomized Controlled Pilot Study of Motivational Interviewing to Change Attitudes about Adherence to Medications for Asthma

The day-to-day management of asthma relies on patient self-care practices; in particular, adherent use of asthma medications is fundamental for asthma management. However, most persons with asthma do not use their medications to clinically acceptable standards. The purpose of this study was to test the efficacy of a brief educational intervention to enhance knowledge and skills relevant to asthma self-care, and the efficacy of motivational interviewing to improve attitudes toward taking medications as prescribed. Twenty-five adults with asthma were randomly assigned to receive a brief educational intervention alone, or education plus motivational interviewing. Over time, all participants improved their knowledge of asthma and skills using a metered dose inhaler. Participants who received education alone showed a decreased level of readiness to adhere with their medications over time, whereas participants who received motivational interviewing were more likely to show a stable or increased level of readiness to adhere over time. Among participants who described themselves as not consistently adhering with their medications at the first evaluation, those who received motivational interviewing endorsed more positive attitudes toward taking medications over time. The results are supportive of the utility of motivational interviewing in enhancing participants' attitudes toward adherent medication use. Future research should test if attitude change is reflected in change in medication use.     

Do motivational interviewing behaviors predict reductions in partner aggression for men and women?

Motivational interviewing is a directive, non-confrontational intervention to promote behavior change. The current study examined therapist behaviors during a successful brief motivational interviewing intervention for physically aggressive college dating couples (Woodin & O'Leary, 2010). Forty-five minute motivational interviews with each partner were videotaped and coded using the Motivational Interviewing Treatment Integrity scale (MITI; Moyers, Martin, Manuel, & Miller, 2003). Hierarchical modeling analyses demonstrated that therapist behaviors consistent with motivational interviewing competency predicted significantly greater reductions in physical aggression perpetration following the intervention. Specifically, greater reflection to question ratios by the therapists predicted reductions in aggression for both men and women, greater percentages of open versus closed questions predicted aggression reductions for women, and there was a trend for greater levels of global therapist empathy to predict aggression reductions for women. These findings provide evidence that motivational interviewing seems to have an effect on behavior change through therapist behaviors consistent with the theoretical underpinnings of motivational interviewing.     

Managing resistance in cognitive behavioural therapy: the application of motivational interviewing in mixed anxiety and depression

While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression.     

Drug awareness in adolescents attending a mental health service: analysis of longitudinal data

One of the procedures used most recently with longitudinal data is linear mixed models. In the context of health research the increasing number of studies that now use these models bears witness to the growing interest in this type of analysis. This paper describes the application of linear mixed models to a longitudinal study of a sample of Spanish adolescents attending a mental health service, the aim being to investigate their knowledge about the consumption of alcohol and other drugs. More specifically, the main objective was to compare the efficacy of a motivational interviewing programme with a standard approach to drug awareness. The models used to analyse the overall indicator of drug awareness were as follows: (a) unconditional linear growth curve model; (b) growth model with subject-associated variables; and (c) individual curve model with predictive variables. The results showed that awareness increased over time and that the variable 'schooling years' explained part of the between-subjects variation. The effect of motivational interviewing was also significant.     

A Dual-Focus Motivational Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy

Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed.     

Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men

Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.     

Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men

Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.     

Psychodynamik und Psychotherapie psychotischer St?rungen

This article gives a review of the options for psychodynamic treatment of patients with psychoses. The various settings for individual treatment as well as group and family therapy will be presented with a special emphasis on modified analytical long-term therapy. For a psychodynamic understanding, which is the basis for this treatment, the most important psychoanalytical models for psychotic disorders will be presented. In addition the current empirical results of non-explicit psychodynamic-oriented research will be referred to, which emphasize the significance of traumatic events in the early phases of life and the importance of narrative elements, whereby the psychodynamic approach experiences both complementation and confirmation.     

A cultural adaptation of motivational interviewing to address heavy drinking among Hispanics

Although the need for cultural adaptations is often noted in addiction research, there are few templates to guide the process. The rationale for a social contextual framework to culturally adapt motivational interviewing for an immigrant heavy drinking Latino population in the U.S. Northeast is presented. The aim of the pilot study was to obtain data on acceptability of this approach. Participant responses to the adaptation were examined qualitatively and quantitatively in a preliminary study. Participants recruited from the community met criteria for risky drinking (men, ≥5 drinks/occasion or ≥14 drinks/week; women, ≥4 drinks/occasion or ≥7 drinks/week). Participants (n = 25) who completed baseline assessments and a culturally adapted brief motivational interview (CAMI) were asked to complete a qualitative exit interview to give feedback on their interview experience. Participants reported being highly engaged with treatment (M = 3.58 on a scale of 1-4, SD = .50), and felt very satisfied with treatment (M = 3.58 on a scale of 1-4, SD = .93). Nearly all (95%) reported that understanding their culture was important to understanding their drinking behavior. Results support the acceptability and relevance of this adaptation from participants' perspectives.     

Motivational interviewing and smoking behaviors: a critical appraisal and literature review of selected cessation initiatives

The present paper systematically reviewed and critically appraised three different dimensions of motivational interviewing currently utilized in smoking cessation initiatives: social support, motivation, and tailored interventions. A review of four databases generated 57 primary articles, 17 of which met the inclusion criteria of an intervention study utilizing at least one dimension of motivational interviewing, adults between 18 and 64 years, no comorbidities, and a follow-up period of at least 6 weeks. More than 11,600 participants are represented in this review. The implementation of social support, motivation, and tailored interventions yielded mixed results. Furthermore, threats to validity emerged, including self-report, follow-up period, sample sizes, a priori differences in groups, and web-based and text-based interventions. Further research must ascertain the efficacy of the three dimensions of motivational interviewing indicated by the mixed results reported in terms of statistical significance of cessation rates. More empirically rigorous designs with evaluations based on stringent replicable criteria are needed.     

Reliability and Validity of a Treatment Fidelity Assessment for Motivational Interviewing Targeting Sexual Risk Behaviors in People Living with HIV/AIDS

This study psychometrically evaluates the Motivational Interviewing Treatment Integrity Code (MITI) to assess fidelity to motivational interviewing to reduce sexual risk behaviors in people living with HIV/AIDS. 74 sessions from a pilot randomized controlled trial of motivational interviewing to reduce sexual risk behaviors in people living with HIV were coded with the MITI. Participants reported sexual behavior at baseline, 3-month, and 6-months. Regarding reliability, excellent inter-rater reliability was achieved for measures of behavior frequency across the 12 sessions coded by both coders; global scales demonstrated poor intraclass correlations, but adequate percent agreement. Regarding validity, principle components analyses indicated that a two-factor model accounted for an adequate amount of variance in the data. These factors were associated with decreases in sexual risk behaviors after treatment. The MITI is a reliable and valid measurement of treatment fidelity for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS.     

Psychodynamische Diagnostik

The paper describes the development and objectives of psychoanalytic diagnostics. It shows that one of the key tasks of psychoanalytic/psychodynamic interviews is to initiate the doctor-patient relationship and that the patient’s motivation for treatment is to be examined and promoted in the interview. Different sources of information for the interview are then described; following a presentation of various systematic approaches of psychodynamic diagnostics, the principles of biographic history-taking are also explained. Modern psychodynamic diagnostics provides complex access to the patient, covering both elements of open interviewing and more exploratory approaches. Options for integrating these various methodological approaches are highlighted. Finally, more recent approaches in psychodynamic diagnostics that have a stronger relation to treatment planning are presented. These include the Structural Interview developed by Kernberg and Operationalised Psychodynamic Diagnostics (OPD).     

A view of aggression in phobic states

This article attempts to apply a theory of aggression as motivation to overcome obstacles to the understanding of phobic states and their formation. The role of aggression in the genesis of phobic conditions is discussed, and the traditional analytic view of aggression as instinctual drive is contrasted with a motivational approach. The motivational view offers the advantage of a clearer understanding of the stimulus contexts, representational connections, and both real and imaginary object connections that are lacking in the more traditional understanding of aggression as a biological drive.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.     

Post natal depression,the mother's conflict and parent – infant psychotherapy

This paper sets out to consider a psychodynamic approach to postnatal depression. In particular, it examines the advantages of psychodynamic parent?–?infant psychotherapy both as a treatment model, and also as a way of thinking that can help to formulate a theory of the postnatal period. An illustration is provided in the clinical account of the therapy of a couple and their nine-week-old infant. The author draws on this example, and on findings from psychoanalytic theory, infancy research, evolutionary biology and anthropology to suggest an integrated understanding of the postnatal state of mind and its challenges.     

Collaborative Helping: A Practice Framework for Family-Centered Services

This article offers a framework for collaborative family-centered practice that can reinvigorate our work with families who have not responded to more traditional approaches. Collaborative Helping is grounded in family-centered principles that include: striving for cultural curiosity, believing in resourcefulness, working in partnership, and making our work more accountable to the clients we serve. The article introduces collaborative inquiry as an organizing metaphor for clinical practice and offers a five-step practice framework with clinical illustrations and sample questions. The framework draws from appreciative inquiry, motivational interviewing, the signs of safety approach to child protection work, and solution-focused and narrative therapies.     

Psychodynamic counselling in an educational setting: Containing,transference and clientele

Abstract

The concepts of containing and transference, as well as the specific nature of the clientele, may, on a first approach, be used to differentiate psychodynamic counselling in an educational setting (PES) from the ‘pure gold’ of psychoanalysis. Further, it is argued that a realistic understanding of PES, given the constraints in which it operates, demands that the psychodynamic practitioner be prepared to cut her procedural cloth in accordance with the demands her clients place upon her. This makes PES a pragmatical practice rather than some lesser cousin of ‘orthodox’ psychoanalysis.     

Modular Treatment for Children and Adolescents With Problematic School Absenteeism: Development and Description of a Program in Germany

Problematic school absenteeism is defined as absence from school occurring with a clinical-level mental disorder. It represents a higher-order term for school refusal, school truancy, and the combination thereof and is associated with an increased risk for school dropout, prolonged mental disorders, and unemployment. This article describes the manualized modular treatment of problematic school absenteeism (MT) by a multiprofessional team. The manual was developed to target a broad spectrum of mental disorders characterized by internalizing but also externalizing behavior. The therapeutic focus is on the reintegration into school and on the cognitive behavioral treatment of the mental disorder. The MT is based on a multilevel model of problematic school absenteeism. The treatment is informed by an extensive case-conceptualization and addresses motivational aspects by offering a low-threshold therapeutic design and motivational interviewing. Core interventions are represented in four modules: cognitive behavioral therapy, family counseling, school counseling, and a psychoeducational physical exercise program. A case vignette provides an illustration of the treatment and the specific graduated approach for school reintegration. The current modular approach is discussed in relation to other cognitive-behavioral manuals targeting a broad spectrum of mental disorders or school refusal.