The Initial Contact and Rapport Building

Discuss about the Psychoactive substance and mental health.

There are different tools when assessing for substance use disorder and mental health symptoms. Screening and assessment is necessary as there is evidence from recent and old literature that people with substance use disorder are at risk of developing other disorders. It is known as co-occurring disorder and it is imperative to recognise early. With early recognition most effective treatment can be developed (Krill, Johnson and Albert 2016). The essay deals with the critique of the substance-use interview video, “sensitive questioning to detect co-occurring mental health questionnaires” by Logan (2018). The video demonstrates the use of Sensitive questioning strategies in an interview to detect the mental health substance use. The essay critiques the sensitive questioning approach of the interviewer during the initial contact with the client, building rapport, assessment of the interviewee, and identification of the impact of substance abuse, identification of stressors and overall engagement. The critique of the interview will be supported with the recent literature.

The initial contact of the interviewer with the patient was positive and the communication process involved effective use of verbal and non-verbal skills. The initial contact showed that the interviewer was attuned to client, attending, was open and honest. The interviewer maintained the clarity of services offered and that it would be assessment process of one hour. The initial contact appeared to follow the “SOLER” approach as mentioned by Stickley (2011). It includes squarely facing the client, maintaing open posture, leaning towards client to show involvement, covey messages through eye-contact and use of relaxed body language.

The interviewer was respectful towards the client and to build rapport systematically moved from less personal to more personal questions. The interviewer demonstrated understanding of the illness experienced by the patient using active listening skills. The communication was effective in fostering the egalitarian relationship with patients. The interviewer had built rapport with the client by taking client’s perspective on issues with the alcohol.  The sensitive questioning involved questions that allowed the client to fully explore the relevant issues of his life. The questions were asked cautiously, with empathy and centered on relevant and important issues associated with alcohol. According to Chapman (2012) active listening without judgment and development of empathy are key communication skills to build rapport with the client.

The interviewer conducted the assessment of readiness to change by questioning interviewee about his perceptions on issues with alcohol, and the amount taken. The questions were sensitive to detect the current problem due to alcohol. For instance the interviewer asked “what do you think” on issues with alcohol, where the client answered, “not like it’s a problem”. It helped interviewer to gauge the motivation and readiness of client to engage in change (Nuno and John 2015). These open ended questions are effective to identify if the client is receptive to treatment (Gutierrez et al., 2018). It is an important dimension to change among people with substance abuse disorder. At the end of interview the client requested to help with getting his children back. However, he showed no interest in seeking treatment for alcohol addiction as he has no insight of his illness.

Assessment of the Interviewee

To identify the impact of alcohol on health the interviewer directly asked about the health issues where the client said he had waking troubles and lack of sufficient sleep.  The interviewer questioned about increase in drinking alcohol before and after separation with wife, affect on sleep, and appetitite. Further, questioning led to identification of poor appetite. The interview was successful in identifying the impact of alcohol use on both physical and mental health. Eventual it helped the client recognise the impact of alcohol on his health, although at the beginning he considered no problems associated with substance abuse.  Sensitive questioning was affective in making client perceive his illness (Miller 2014).

It was justified for counsellor to ask if the client attempt to end life or has such thoughts earlier. When the client confessed about taking sleeping pills, the counsellor questioned if it was taken with intention of not waking up. According to Yuodelis?Flores and Ries (2015) addiction patients are frequently found with suicide behaviour and hence the questions were well framed.  Taking the history of suicide if any among family members further gave insights into patients vulnerability and risk of injury due to sleeping pills. This phase of interview aligns with the research that highlights history of suicide in family as risk factor for suicide in people (Law 2016)

The interviewer did ask several questions earlier on work life and amount of time spent in pub. Further, the interviewer questioned if income and pay was satisfactory. To identify the impact of alcohol on lifestyle, the interviewer asked questions if partner complained of alcohol earlier. The interviewee then revealed that he had “couple of blues” with his partner and that she moved away taking his kids. These questions were effective in recognise the impact of alcohol on personal and social life. It was observed in the interview that questioning eventually progressed towards assessing any source of mental support. These questions were effective as per Smith et al. (2014) because negative impact of alcohol abuse is manifested in relationship problems, failure to meet social obligations, legal problems (license issue in client). Further, the interviewer did identify the problem of recurring the substance throughout the day. It was evident from client’s response in spending more time at pub. In addition, emotional and psychological difficulty is significantly observed in people addicted to alcohol. Therefore, sensitive questioning helped recognise these signs of chemical dependence and its impact on overall lifestyle (Sommers-Flanagan and Sommers-Flanagan 2015).

Identification of the Impact of Substance Abuse

The interviewer summarised the factors that may be the cause of stress for the interviewee. It includes not working of license, lack of sound income earning, and separation with wife and kids.  It resembles an important element of counselling called, “summaries”. In this process the counsellor attends to verbal and nonverbal messages and pulls the key portion of the extended communication (Geldard and Geldard 2012). In the concerned interview the counsellor based on the identification of impact of alcohol health and lifestyle had figured out the stressors. Followed this interviewer emphasised that the events can “still be stressful”. These questioning was effective as alcohol use exacerbate symptoms of mental illness, such as anxiety and depression, which in run trigger alcohol dependency to relive symptoms of mental illness (Lehman and Dixon 2016). At this phase of interview, the term dual diagnosis can be considered as the interview led to successful identification of both stress disorder and alcohol affecting the individual (Tirado-Munoz et al., 2018).

The overall engagement showed the clear goals of the interviewer in mind and indicates interactive communication skills. The interviewer maintained the objectivity without allowing the patient’s beliefs, attitudes and prejudices to influence thinking as also highlighted by Deng et al. (2016). Therefore, it helped to grasp the big picture of the client needs. The interviewer did not jump to the conclusion without hearing all the facts and demonstrated empathy. The conversation did shift from one subject to other when each subject has been followed through, which is the strength of interview process. It was affective in removing the client’s defensiveness (Ehret et al., 2015).

Using both verbal and non-verbal skills a therapeutic alliance was built that allowed meeting mutually understood goals of therapy. Each question was framed in manner that it sequentially led to detection of physical, social, mental, emotional and psychological problems in client. Asking the questions in step-by-step fashion, considering the relationship with new client, eventually led the client to recognise the severity of alcohol addiction and its linkage with health issues and poor lifestyle (Lewis, Dana and Blevins 2014). At the end of the interview the counsellor recommended to get the client an appointment with the mental health clinician.  Referral was made at the end of the interview where the client was in agreement with alcohol impact on his life, health and co-occurring stress and was ready to restore his normal functioning.

The interview was overall effective as no recommendations were made during the informations-gathering phases. Further, interview met the ethical obligation by taking informed consent for meeting mental health clinicians (Lewis et al., 2014).

Overall Engagement

Conclusion

In conclusion the critique of the substance-use interview video has been useful in developing valuable insight into interpersonal skills required to interview patient with substance abuse disorder. It helped learn the technique of framing questions logically to lead towards identification of any co-occurring disorder in addition to alcohol addiction. The interview and its critique helped in learning the concept of sensitive questioning as part of dual diagnosis in counselling. The method of sensitive questioning teaches about technique to start from less sensitive to more sensitive questions during interview. The communications strategy to move from less personal to more personal issues during counselling ensures client’s assertiveness. It allowed the dialogue between the both to be honest and open.

References

Chapman, J., 2012. Interviewing & Counselling. Routledge. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=gHvjezRiXX4C&oi=fnd&pg=PT12&dq=Chapman,+J.,+2012.+Interviewing+%26+Counselling.+Routledge.&ots=-r_3Tnr8Vu&sig=CobG4kfUg-vywpZxSK3BH1F4Iwg#v=onepage&q&f=false

Deng, J., Qian, M., Gan, Y., Hu, S., Gao, J., Huang, Z. and Zhang, L., 2016. Emerging practices of counseling and psychotherapy in China: Ethical dilemmas in dual relationships. Ethics & Behavior, 26(1), pp.63-86.

Ehret, P.J., LaBrie, J.W., Santerre, C. and Sherman, D.K., 2015. Self-affirmation and motivational interviewing: integrating perspectives to reduce resistance and increase efficacy of alcohol interventions. Health psychology review, 9(1), pp.83-102.

Geldard, K. and Geldard, D., 2012. Personal Counselling Skills: An Integrative Approach.(Rev. Charles C Thomas Publisher.

Gutierrez, D., Fox, J., Jones, K. and Fallon, E., 2018. The Treatment Planning of Experienced Counselors: A Qualitative Examination. Journal of Counseling & Development, 96(1), pp.86-96.

Krill, P.R., Johnson, R. and Albert, L., 2016. The prevalence of substance use and other mental health concerns among American attorneys. Journal of addiction medicine, 10(1), p.46.

Law, C., 2016. The factors influencing suicide within Chinese culture. British Journal of Mental Health Nursing, 5(4), pp.154-158.

Lehman, A.F. and Dixon, L. eds., 2016. Double jeopardy: Chronic mental illness and substance use disorders. Routledge.

Lewis, J.A., Dana, R.Q. and Blevins, G.A., 2014. Substance abuse counseling. Cengage Learning.

Logan, G. (2018). Sensitive Questioning to detect co-occurring mental health concerns. [online] YouTube. Available at: https://www.youtube.com/watch?v=0pXFY3xWbl4 [Accessed 19 Mar. 2018].

Miller, G., 2014. Learning the language of addiction counseling. John Wiley & Sons.

Nuno, A. and John, F.A.S., 2015. How to ask sensitive questions in conservation: A review of specialized questioning techniques. Biological Conservation, 189, pp.5-15.

Smith, N., Hill, R., Marshall, J., Keaney, F. and Wanigaratne, S., 2014. Sleep related beliefs and their association with alcohol relapse following residential alcohol detoxification treatment. Behavioural and cognitive psychotherapy, 42(5), pp.593-604.

Sommers-Flanagan, J. and Sommers-Flanagan, R., 2015. Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. John Wiley & Sons.

Stickley, T., 2011. From SOLER to SURETY for effective non-verbal communication. Nurse education in practice, 11(6), pp.395-398.

Tirado-Munoz, J., Farre, A., Mestre-Pinto, J., Szerman, N. and Torrens, M., 2018. Dual diagnosis in Depression: treatment recommendations. Adicciones, 30(1).

Weger Jr, H., Castle, G.R. and Emmett, M.C., 2010. Active listening in peer interviews: The influence of message paraphrasing on perceptions of listening skill. The Intl. Journal of Listening, 24(1), pp.34-49.

Yuodelis?Flores, C. and Ries, R.K., 2015. Addiction and suicide: a review. The American journal on addictions, 24(2), pp.98-104.

Yuodelis?Flores, C. and Ries, R.K., 2015. Addiction and suicide: a review. The American journal on addictions, 24(2), pp.98-104.