Dual role- Therapist abiding by the spirit of MI at the same time being on a multi-disciplinary team that confrontation is used frequently to point out substance use.
Dear John,
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Hi John!
I think, and it´s my idea, based in many years of working in teams and with substance abuse clients, that de rules of the multidisciplinary team must be followed and elicitated when it´s needed, so if you have to confrontate with the client you do it.
In the other hand, like opening a parenthesis, you go ahead wtih MI goals.
As you asume, it´s a Dual Role you have to play, one as MI Therapist, the other as part of a team.
Regards!
Diego
utilizing information derived from other team members as the backdrop to discover ambivalence can be a powerful tool for making one aware of how their actions and desires do not match up in fundamental ways. I would also recommend strategy building with other team members which can facilitate this.
Personally, I value MI but also integrate an aspect of approaches and treatment modalities; especially at the assessment stage with clients struggling with substance use/abuse. Screening one's motivation, hope scale or even question around reaching out for services rather than suggested; without their willingness to seek support tends to be a motif when it comes to working with substance dependents. Another aspect I should mention, is looking into strengths and skill sets and supports from within rather than from outside. From the person rather than referrals. However, collaboration is key when working in a multi-disciplinary team-spirited environment as well as patient-care focused.
Hi John,
This is challenging because your program appears to use an AA disease model with confrontation as one of its main interventions, whereas MI is much more supportive and collaborative.
In response to your question, I have these ideas:
- As long as your program permits the use of MI, you'd use confrontation with some clients when it's most appropriate, and use MI with others when it fits them.
- In the best interest of some of your clients, you may integrate the two approaches in a sequential manner if necessary.
Hi John
being in a dual role is a challenge however I think you have to give the client some credit here for how they respond to you. If this is a client that you have worked with for some time and established a good working alliance with, the client will know both your style of work and the philosophy of the service that you are embedded in. They will be able to cope with some difference. That way it is possible to work with someone from an alternative perspective. However you need to balance this with your responsibility to the rest of the team, if you are going to work differently with a client they are also engaged with you need to keep everyone informed of this to avoid splitting. Sometimes you have to live with ambivalence in relation to a shared philosophy. Have you an opportunity to bring this to supervision?
Gerry
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