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Block 2 Therapeutic Interventions

Unit 5 Motivation Enhancement and Relapse Prevention Therapy

1. List down the features of MET in your own words.

Features of MET:

1. MET is a client-centred counselling approach designed to encourage internally motivated change.
2. It is brief and avoids direct persuasion.
3. The counsellor adopts a quiet and eliciting style, acting more as a partner than an expert.
4. Readiness to change is seen as fluctuating and influenced by interactions.
5. MET uses motivational strategies to mobilise the client's own resources for change, rather than providing step-by-step guidance.
6. It aims to resolve ambivalence towards change through active listening and feedback techniques.
7. The approach is founded on the assumption that the client has the capacity and responsibility for change.

2. What are the strategies used to deal with resistance?

Strategies to Deal with Resistance:

1. Simple reflection: Acknowledging the client's disagreement, emotion, or perception.
2. Amplified reflection: Reflecting back what the client has said in an exaggerated form to encourage them to reconsider their statement.
3. Shifting focus: Redirecting the client's attention away from a barrier that is blocking progress.
4. Agreement with a twist: Initially agreeing with the client, but with a slight change in direction.
5. Emphasis on choice and control: Acknowledging the client’s personal choice and control.
6. Reframing: Offering a new meaning or interpretation to the client's perceptions, using the client's own words.

3. What are the principles behind Motivation Enhancement Therapy?

Principles Behind Motivation Enhancement Therapy:

1. Expression of empathy: The counsellor shows respect and listens to the client, rather than telling them what to do.
2. Assisting the client in perceiving discrepancy: Helping the client see the difference between their current state and where they want to be.
3. Avoiding argumentation: Recognizing that arguments can evoke resistance.
4. Rolling with resistance: Not meeting resistance head on, but shifting the client's perceptions.
5. Ambivalence is viewed as normal: Openly discussing ambivalence and eliciting solutions from the client.
6. Support of self-efficacy: Enhancing the client’s belief in their ability to achieve goals.

4. Imagine that you have been eating chocolates everyday. Your dentist asks you to stop, however, you are not too convinced that you should. Prepare a decisional balance sheet for the situation.

Decisional Balance Sheet for Chocolate Consumption

• Benefits of Remaining the Same (Eating Chocolates)
• Enjoyable taste and pleasure
• Comforting and stress relief
• Quick source of energy 
• Costs of Not Changing (Eating Chocolates)
• Potential for tooth decay and cavities, weight gain, negative health impacts
• Guilt about not stopping, negative impact on dental health
• Cost of buying chocolates, habit continuation
• Possible poor health outcome due to overconsumption of sugar
• Benefits of Changing (Not Eating Chocolates)
• Healthier teeth and gums 
• Weight management
• Reduced risk of health issues and diseases
• Improved self-esteem
• Costs of Changing (Not Eating Chocolates)
• Experiencing cravings and urges
• Discomfort or irritability during abstinence
• Missing the pleasure or comfort it provides
• Difficult to break the habit

5. List down the internal and external triggers for lapse with two examples each.

Internal and External Triggers for Lapse (with two examples each):

1. Internal Triggers (within the individual):
   • Coping with negative emotions: Feelings of sadness, anger, or anxiety.
   • Coping with negative physiological states: Experiencing pain, discomfort, or withdrawal symptoms.
2. External Triggers (environmental or interpersonal):
   • Coping with interpersonal conflicts: Arguments with family members or friends.
   • Dealing with social pressure: Being pressured to use substances by peers or at social events.

6. Put the following situation in a A-B-C format. “Shiv has not been getting along well with his wife. They keep on having constant arguments about financial matters. On 3rd May, when Shiv handed the salary to his wife, she found that it was lesser than last month. Instead of asking where the money was, she started shouting at him for spending money on his Ganja. Shiv got very angry as he felt that his wife did not understand him or respect him. He also felt that all she cared about was money. In anger, he left the house and went to his friend’s place with whom he used to smoke ganja. There, he took ganja and immediately felt a sense of relief and reduction in tension.

Here is the situation in an Antecedent-Behaviour-Consequence (A-B-C) format, based on the provided text:

• A (Antecedent): Shiv and his wife have ongoing arguments about finances. On May 3rd, Shiv gives his wife his salary, and she notices it is less than the previous month. Instead of asking for an explanation, she shouts at him and accuses him of spending money on Ganja.

• B (Behaviour): Shiv feels angry because his wife does not understand or respect him and that she only cares about money. He leaves the house in anger and goes to his friend’s place, where he smokes Ganja.

• C (Consequence): Shiv immediately feels a sense of relief and a reduction in tension. This can be seen as a short term reward, which reinforces the substance use behaviour.

This A-B-C analysis shows how a stressful situation (the argument with his wife) acted as a trigger for Shiv to use ganja as a coping mechanism. The immediate relief he experiences serves to reinforce the substance use behavior. This model is used in relapse prevention therapy to understand what happens before a person has a lapse.

7. What are the stages listed in the transtheoretical model of change?

1. Pre-contemplation, 
2. Contemplation, 
3. Preparation, 
4. Action and 
5. Maintenance

8. Are these stages linear or spiral in nature?

Spiral in nature. Can lead to lapse/relapse anytime.

9. What are the different types of resistance that the counsellor can be expected to face? Give examples for each.

1. Arguing — “I have only smoked 3 cigarettes since morning. So what is your problem with that?”
2. Interrupting —“…No what I am trying to say is…”
3. Denying — “Its not my fault. I did not drink for 3 days. My wife drives me crazy. I needed a drink to keep me sane.”
4. Ignoring — Looking outside while the counsellor talks

10. Categorize the following statements as cognitive, affective or behavioural.

i. What are the potential problems that you may face when you try to quit cigarettes?

Cognitive

ii. What are the steps that you need to take if you want to leave alcohol?

Behavioural

iii. How do you feel about smoking again after being abstinent for 4 days?

Affective

11. Ramesh, who had been abstinent for several weeks, drove home from work on a night when his wife was going to be away. On the way, he turned left instead of right at an intersection, so that he could enjoy the “scenic route”. On this route, he drove past a bar he had frequented in the past. Because the weather was hot, he decided to stop for a glass of coke. However, once inside, he decided that since his problem was with the whiskey, he would have beer. After two beers, he lost control. 

i. When do you think Ramesh first got into trouble?

When he turned in the other direction than his usual one.

ii. What rationalization did he use to take the other route?

He rationalized that he wanted to experience the scenic beauty.

12. Classify the following situations into “Internal” and “External” triggers:

1. Feeling restless and irritated - Internal

2. Being thrown out of the job - External

3. Breaking up with girl-friend - External

4. Diwali - External

5. Having a splitting headache - Internal

5. “I have lots of will-power, I can control after one drink” - Internal

7. Meeting up with old friends with whom alcohol/drug was taken - External

8. Being alone at 8 PM when normally he/she used to drink - External

9. Going to a party where drinks are served - External

10. Feeling happy after a salary hike - Internal

Important Points

i. Lapse and relapse are not synonymous.

ii. A lapse may or may not lead to a relapse.

iii. The client entering treatment may already have some coping skills to deal with high risk situations.

iv. Shame and guilt regarding a lapse can lead the way to a full blown relapse.

v. If a person is motivated to quit, he may still encounter high risk situations.

vi. A lapse is always a possibility and should be treated as a warning signal rather than a failure.