Reading Assignment
Miller, W. & Rollnick, S. (2013). Motivational interviewing: Helping people changeChapters 19-26 (PART V & VI)Myers & SaltChapter 7
Reading Assignment
Miller, W. & Rollnick, S. (2013). Motivational interviewing: Helping people changeChapters 19-26 (PART V & VI)Myers & SaltChapter 7
MI Demonstration Skills Series – Decisional Balance
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link to open resource.
MI Demonstration Skills Series: Using Pros and Cons
The Irish use the term Craic for “fun, gossip, entertainment.” It does not imply Crack Cocaine.
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link to open resource.
MI Demonstration Skills Series: Using Pros and ConsThe Irish use the term Craic for “fun, gossip, entertainment.” It does not imply Crack Cocaine.
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SWK 681 Substance Use Disorder: Key Assignment Instructions
Assignment: Motivational Interviewing Skills Demonstration Paper & Video Directions
Key Competencies: 1.2, 2.1, 6.1, 6.4, 7.1, 7.2, 8.2
PURPOSE: This assignment is designed to provide you with the opportunity to practice and
demonstrate beginning Motivational Interviewing (MI). Through your video taped session, you
will demonstrate Competency A1.2 of professional and ethical social work conduct, apply
assessment strategy, demonstrate the influence of theory on practice. You will also demonstrate
Competency A2.1 and A6.4 of a culturally centered practice that recognizes the impact of
diversity factors, to include trauma experiences and responses at the micro, mezzo and macro
levels.
ASSIGNMENT: Motivational Skills Demonstration Video (VoiceThread works through
Chrome not Google nor Internet Explorer). Contact VoiceThread IT for assistance as your
instructor will be unable to assist. Please do not wait until the last minute to start or upload this
assignment, it can be a very SLOW process to upload.
DESCRIPTION: Students will demonstrate beginning Motivational Interviewing through a
role-play with a mock client. The student will be provided with a storyline to build upon. This
interview must be a video recorded and uploaded according to provided directions. The video
should demonstrate Competencies A6.1 and A7.2 through establishing a relationally based
process that encourages individuals, families to be equal participants and apply an assessment
strategy to assess individuals, families and groups within a complimentary theoretical model. As
part of the mock interview, students should demonstrate Competency A8.2 through
implementing effective intervention strategies to work with individual and families. The video
must be a minimum of 12 minutes and a maximum of 15 minutes in length. Students must also
submit a brief written description (APA) of the role-play and identify each skill/strategy used
within the video. All four skills demonstrated in the video must be clearly explained and
highlighted in the paper. Timestamps may also be referenced in the paper to pinpoint an
accurate location of the MI skill in the video.
REQUIREMENTS: Students are required to upload their paper and the video to VoiceThread
separately to get full credit for the assignment.
Case Study Catalina
Catalina is a 42-year old Hispanic female who recently retired from the military. She received
multiple evaluations as part of her retirement, from both medical and mental health providers.
She has frequent nightmares and flashbacks related to combat and carries a diagnosis of PostTraumatic Stress Disorder. She has been seen in Primary Care for physical health issues. She is
currently prescribed medication for high blood pressure, high cholesterol, and lower back/joint
pain. Catalina is working to improve her health through diet and exercise, though these issues
conflict with her personal identity (e.g., able bodied, strong combat veteran,
etc.)
In addition to retirement, Catalina is newly remarried after dating for about a year. The family
home is slightly cramped as her new wife still has two teenage children living at home. The
adjustments to space and finances are manageable, though Catalina disagrees with her new
wife’s parenting style, as it is quite different from her two children whom are sophomores in
college out of state.. The main problem at home is Catalina has increased the volume of alcohol
she consumes during an average drinking session. Her wife sought professional assistance, as
she was concerned about the frequency and volume of her drinking. Catalina reports drinking
approximately one fifth of vodka per evening. She has entered your care, as she is seeking
support however, she remains “on the fence because I believe my drinking is under control, I am
retired and I have always had a high tolerance.”
Catalina’s wife has expressed a holistic approach to recovery that emphasizes spiritual, cultural,
and connectedness as important in her Hispanic community and would be necessary for the
intervention to succeed. She has emphasized the need for a multi-level intervention targeting
individuals, families, and the community as a whole.
Make sure to use four different MI strategies (e.g. develop discrepancy, express empathy,
OARS, amplify ambivalence, roll with resistance, support self-efficacy, etc.) to illustrate your
understanding and implementation of this approach. You must demonstrate the clinical style of
motivational interviewing (MI). Additionally, be mindful to integrate trauma-informed principles
of engagement (e.g., trauma awareness; emphasis on safety and trustworthiness; opportunity for
choice, collaboration, and connection; and/or strengths-based approaches and skills building).
Chapter 7
Family
Objectives
(1 of 2)
By the end of this chapter, students will be able to:
1. Describe the roles of status, power, and authority
in the family system.
2. Define the terms enmeshment and disengagement
as used in family therapy.
3. Describe the dysfunctional patterns of
communication found in addicted families.
4. Describe at least four irrational belief systems in
families with an addicted member.
Objectives
(2 of 2)
5. Describe the roles played by children and
spouses of active addicts.
6. Describe a minimum of four major sober living
tasks of a family in recovery.
7. Contrast the three major approaches to
intervening with a family with a substance
abuser: Al-Anon/Nar-Anon, the Vernon Johnson
Intervention Model, and CRAFT.
Family in Addictions Counseling
• Family therapy is a separate field and discipline
from addiction counseling.
• Unless there are trained family therapists, an
addiction treatment program should not declare
itself a family treatment program.
• However, programs can do family interventions
and family education.
Reasons to Work with Families
1. Family members can help increase motivation
for treatment.
2. It helps families understand that the whole family
is affected by substance use disorders.
3. Working with families can change patterns of
behavior or interfere or work against recovery.
4. It is useful to help families prepare for what
occurs in early recovery.
5. It encourages family members to support longterm recovery.
Who Makes Up a Family?
• Members of your immediate family (e.g.,
parents, siblings, partner, children)
• Extended family
• Friends
• Colleagues from work
• Mentors
• Anyone who will support recovery
Family Therapy
• Family therapy is often based on family systems
theory, which sees families as a “living
organism” greater than the sum of the individual
members.
• A family systems therapist tries to understand
family members from their positions and roles in
the family rather than fix a specific member. This
is done through “joining.”
Family Counseling Usually Focuses
on a Systems Model
• Systems have elements (e.g., persons) that play
a role in the system.
– The elements of systems (persons) influence
each other.
– Systems tend to strive for balance and to
maintain the status quo.
• Like group, family counseling focuses on
process.
Topics of Concern for
Addicted Families
• Status, power, and authority
• Elements of the system
• Definitions of relationships
• Conflict—hidden and open
• Styles of communication
• Family belief systems
• Harm to nonaddicted family members
• Expectations of treatment
• Concepts of privacy and boundaries
Two Important Systems
Model Concerns
• Enmeshment: Excessive or intrusive involvement
where there is no personal space, autonomy, or
sense of personal competence
– Synonymous with the term fused.
• Disengagement: Abnormal lack of involvement,
communication, loyalty, and sense of belonging
Intervening in Enmeshment
• Pointing out when a family member:
– Speaks about, rather than to, another person
who is present
– Speaks for others, instead of letting them speak
for themselves
– Sends nonverbal cues to influence or stop
another person from speaking
Restructuring
• After rapport is developed, a family therapist
often will intervene by “restructuring.”
• This is a deliberate attempt to unbalance the
homeostasis.
• By shifting patterns (e.g., changing seating
arrangements, creating new boundaries or rules,
contracting for new behaviors, changing the
power alignments)
Addictive Families Promote a
Certain Lifestyle
• A survival style is recurring patterns that occur
which are common to addicted families.
Dynamics
• The inability to separate from the drinking/drug
problem
– Either energy is spent changing the person or
dealing with the results of the drinking/drug use
• Tension and anxiety are present most of the time
related to the unpredictability of the alcoholic/addict.
• Communication is stilted. Little is out in the open;
there is very little direct, open communication.
Messages (Rules) and
Irrational Beliefs
1. Everyone is out to help the alcoholic/addict—to
enable the alcoholic/addict to feel less pain and
consequences.
2. Members don’t talk to each other about what is
going on in their family—or to others.
3. There is a message that something is wrong or
someone is responsible for the problem—
scapegoats are found.
4. If we stop enabling, something terrible will happen.
5. Keep the status quo at all times.
6. Things will get better when . . .
Behaviors
• There are a lot of excusing, lying, and other
enabling behaviors.
• Isolation and withdrawal
• Members take on more/unusual roles and
responsibilities. These are done in order to survive,
not because they are desired or shared.
• Members usually act inconsistently toward the
alcoholic/addict.
– Attacks, cries, screams, threatens, questions,
nags, bails out, overreacts, lies, leaves, and
returns
Scapegoat
• Major emotional state: HURT
• Other feelings: angry, sullen, fearful, rejected
• Behaviors: defiant, acts out, rebellious
• Provides focus
Other Roles in SUD Families
• Rescuer
• Caretaker
• Long suffering Martyr and Saint
• Overextended super-responsible
• Chief enabler
• Hypochondriac
• Joiner in addiction
• Blamer
• Battler
• Disengaged and hostile
Consequences of Use Behaviors
that Lead Toward Use
• A significant other (e.g., spouse, parent) may
unwittingly supply positive consequences of
drinking or drug use by:
– Taking care of the intoxicated member
– Pampering him or her when sick from drinking or
using too much
– Protecting the user from negative consequences
at work
Antecedent Patterns that Reinforce
Continued Use
• Avoidance and withdrawal behaviors: Lead
toward continued use, while assertive and
engaging behaviors lead toward reduction of use
• Demand withdrawal interactions: One partner
pursues and demands, and the other distances,
defends, and withdraws.
• Expressive emotion: Consists of hostility,
criticism, and emotional over-involvement
Al-Anon/Nar-Anon
• Founded in 1951 by Lois W. and Anne B., wives
of the founders of AA
• The spouse should not try to influence or force
the spouse to stop drinking or drugging.
• Stop enabling behaviors.
• Learn to lovingly detach.
• A support group helping the spouse should not
enable but maintain autonomy and identity.
Johnson Institute Model of Intervention
• Most widely known; involves 3 or 4 educational and
rehearsal sessions with family and significant others.
– List incidents and behaviors
– Rehearse written-out specific events and
upsetting experiences the client committed while
intoxicated
– Done with love and concern and control of
emotions
– Has agreed upon treatment options to offer
substance user
– Has agreed upon consequences if the substance
user refuses to go to treatment.
Community Reinforcement and Family
Training Approach (CRAFT)
• Works directly with family members to learn effective
ways to encourage the substance abusers to seek
treatment
• Teaches how to use positive reinforcement and
negative consequences, such as:
– Engaging in pleasant activities when the user is
not using (going to movies, going out to eat)
– Withholding any reinforcements when the user
uses, explaining why and ignoring the user during
period of intoxication
Charting Families
• Using family maps or genograms can be a very
helpful treatment. Maps outline immediate
dynamics in the family. A genogram is a family
tree that includes data on the relationships among
family members across the span of several
generations.
• Various symbols are used to indicate female,
male, marriage, divorce, addiction, alcoholism,
being enmeshed, being estranged, unmarried
partners, etc.
Benefits of Family Involvement
in Treatment
• Participation by family members is associated
with better treatment compliance and outcome.
• Family members gain a clearer understanding of
recovery.
• Family members and the person in recovery
understand their respective roles and goals.
• Family members and the person in recovery get
support in the recovery process.
Families in Recovery
• The recovery process can be turbulent.
– Short-term adjustments
– Long-term peace
• Al-Anon and Alateen can be invaluable.
• Family treatment is about assessing family
systems and dynamics, helping resolve
problems, and encouraging commitment to
ongoing recovery for all members.
Conflict + Alcohol and/or Drugs
Can Lead to Violence
• Violence in alcoholic homes is not an isolated
phenomena.
• Child abuse is often related to partner abuse
and can occur in any class.
• An abuser may have emotional problems
beyond the drug use.
• A counselor has an obligation to report child or
elder abuse.
Family Education
• Families need to learn:
– How addiction develops over time (process)
– How alcohol and drugs affect a person’s brain
– How addiction becomes a brain disease
– How addiction progresses
– How addiction affects thinking, feeling, and
behaving
– How recovery is possible
– How recovery is a process
– What they can do to support recovery
Factors that Promote
Resiliency in Children
• Family continues to function
• Support available within the family and external
resources
• Structuring activities on behalf of the child to
make his or her life less disruptive
• Active church affiliation
• Skills such as academic or athletic ability
Recovering Family Tasks
(1 of 2)
• Build healthy communication.
• Develop sober relationships.
• Stay in the here and now.
• Learn appropriate parenting skills.
• Children learn or relearn how to be children.
• Adapt to the new personality of a recovering
member.
Recovering Family Tasks
(2 of 2)
• Adapt to a new family structure.
• Create new healthy and sober family activities.
• Learn to express anger and sexuality in healthy
ways.
• Continue to be involved in new support systems.
• Build trust.
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