Brief Interventions for Psychosis by Basant Pradhan Narsimha Pinninti & Shanaya Rathod

Author:Basant Pradhan, Narsimha Pinninti & Shanaya Rathod
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

7.6 Clinical Examples

This author has selected examples of some of these questions within each process (Miller and Rollnick 2013, pg. 32) and believes that these are helpful for working with client/service users with a psychotic disorder. They include engagement (“How comfortable is this person talking to me?” and “do I understand this person’s perspective and concerns?” and “does this feel like a collaborative partnership?”), focusing (“What goals for change does this person really have?” and “are we working together with a common purpose?” and “do I have a clear sense of what we are doing?”), evoking (“What are this person’s own reasons for change?” and “is the reluctance more about confidence or importance of change?” and “am I steering too far or too fast in a particular direction?”), and planning (“What would be a reasonable next step toward change?” and “what would help this person move forward?” and “am I retaining a sense of quiet curiosity about what will work best for this person?”). These specific questions reflect the sometimes challenging experience with the client/service user with psychotic disorders and the difficulty in developing working relationships, trust, specific areas to focus treatment, motivation to work on these areas, and actual efforts and developing treatment plans toward this end. These four central processes of engaging, focusing, evoking, and planning, though, highlight what is needed in working with client/service users with psychotic disorder; they emphasize respect for the patient; they highlight the importance of developing an accurately empathic connection; they emphasize strong collaboration with the patient that facilitates the allowance of a patient-led uncovering of areas to address in treatment and they acknowledge the patient’s own well of potential resources to address these areas of concern.

In this treatment approach, clarifying values and goals is another element of Motivational Interviewing and is a process that should be ongoing throughout the clinical work. This is another area in working with client/service users with psychotic disorders which can be challenging, but quite therapeutically rewarding, in the process. Attempting to ascertain what the patient you are working with “values” in their life is extremely important and an area vital for exploration. Sometimes, working with individuals with psychotic disorders, it can be difficult as a clinician to understand what these areas are and this might not always be clear, depending on the current nature and state of their disorder and how impaired reality testing and judgment are. However, even when reality testing and judgment are compromised, the clinician is encouraged to listen closely to the content that the patient is sharing, which may reveal both subtle and not so subtle elements in their life of what they feel are important to them. Understanding what your patient values also helps to get a clearer picture of the goals that they have established in their life. From a Motivational Interviewing standpoint, it is not about the clinician establishing their goals for treatment, but more about helping the patient to unearth their goals in their life and where their behavior might be discrepant from what they value and what their goals are.

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