HLTH423: Joanna's Case Study - Motivational Interviewing Analysis

This report presents a comprehensive analysis of Joanna's case study, focusing on the application of Motivational Interviewing (MI) as a therapeutic intervention. It begins with a case conceptualization, exploring Joanna's history of substance abuse, including speed and opium use, and the contributing factors such as financial problems, potential child protection concerns, suicidal ideation, and a history of childhood sexual abuse. The report identifies risk factors across various domains, including mental health, social and psychological well-being, and the impact of her relationship with Adam. The analysis then identifies counseling goals for Joanna, emphasizing abstinence, and the reduction of drug use. The report proposes a treatment plan based on these goals, outlining the implementation process and potential challenges, such as resistance to change. Two evidence-based interventions are then discussed: strengths-based case management and brief intervention (BI). The report highlights the importance of MI principles, such as empathy, developing discrepancy, and promoting self-efficacy. The community resources and support systems are also emphasized. The paper concludes by exploring strategies to overcome potential barriers and promote Joanna's recovery, including the use of assertive outreach and collaborative care approaches. References are provided to support the evidence-based interventions and theoretical frameworks discussed throughout the analysis.

Joanna’s case study

After watching the video about Joanna’s case study, I have chosen Motivational Interviewing
(MI) as an appropriate intervention. This essay devises a case articulation in relation to
Joanna based on Motivational Interviewing viewpoint. The essay will analyze possible
present and past situations related to the issue. Strategies are provided in this essay to resolve
potential barriers. Interventions are based on evidence with rationales to apply in Joanna’s
context and are supported by references. A treatment plan is formulated on counseling
objectives and framework of how these goals are implemented. The discussion identifies
potential challenges; suggest strategies and literature to overcome the obstacles towards
recovery. Defined goals during counseling and devised treatment plans via case management
are being structured to support Joanna.
Develop a case conceptualization/formulation about the case of Joanna from your
chosen theoretical perspective. Include the history of her problem(s), her current issues
or concerns, her interpersonal/life functioning. Note any risk factors you have identified
and your behavioral observations that are relevant to your formulation.
Smedslund (2019) stated that MI is a client-centered semi-directed mode of intervention. It
increases fundamental motivation to change by discovering and solving ambivalence, and this
type of intervention is widely used throughout the world to treat patients in order to change
their challenging behavior by applying MI during counseling phase. This type of intervention
is involved in the effective management of substance abuse, negligent parenting in
combination with legally established agreements governed through family drug courts
(Reading, 2010).
Hall, Gibbie, and Lubman (2012) claimed that behavioral change focuses on the significance
of inspiration, ambivalence, and refusal to accept change. MI fundamentally is a counseling
method which increases patient's (Joann’s) drive through guiding principles. The therapist
helps to rectify resistance in response, understand the patient's motivation. Active listening
and empathy are essential during the intervention process. The therapist may face resistance
from Joanna at the time of providing necessary advice. When clients are given pieces of
information to adopt a healthier lifestyle by reducing substance use or stop the harmful
behavior, such type of conduct can be expected, and a therapist can develop and able to
encourage for a healthier lifestyle. Motivating behavioral change (2011) claims that it helps

patients to identify reasons behind changes. Behavioral change is challenging, especially
overcoming substance dependence. MI is a therapeutic intervention many clinicians use to
assist patients in identifying specific purposes. MI involves the patient's participation in
physical activity, and patients abide by medical treatment. In MI, the therapist prevents
threatening, conflicts, direct attempts to disagree, motivate, or inform the patient to
accommodate positive changes. Expressing empathy, developing discrepancy, moving with
resistance, promoting self-efficacy are crucial elements and collaborative approach which are
applied to address patient’s issues like Joanna.
Bizzarri, Rucci, Vallotta, Scandolari, Zerbetto et al. (as cited in Abasi, & Mohammadkhani,
2016) noted that women who use substances are weak in psychiatric, social, and economic
domains. Quality of life declination is another significant mental health index which creates
risk in patient’s life like Josna.
Both Joanna and Adam stooped using speed and opium a couple of years ago, and they
relapsed again. Joanna complains, she feels tired. The risk factor includes financial problem
as Joanna has indicated poor financial management, unpaid bills, and rental arrears. Also,
most of the finances are spent for purchasing drugs. Child Protection involvement for the
safety and protection of children may be required due to Joanna’s parenting capacity and
parental drug abuse. Joanna has expressed suicidal ideation. However, she has no plan to do
so. There are risk factors in all domains of the family such as mental health, social and
psychological, education of the children, the relationship between Joanna and Adam,
parenting, self-care, emotional wellbeing of the children. Possible ongoing drug abuse,
historical sexual abuse (went on for many years) by Joann’s uncle (Jonna has never disclosed
this to anyone because she fears that no one is going to believe her) are the significant risk
factors.
She is identifying the reasons which are contributing to causation and maintenance of
Joanna’s issues and the role of change in her life.
Ponce, Williams & Allen (as cited in Engstrom, El-Bassel & Gilbert 2012) stated that the
association of force from family members for childhood Sexual Abuse might cause negative
impacts on values and beliefs about persons, connections and the humankind. Childhood
sexual abuse can enhance the risk of family violence experiences. These can cause to hopes

and her acknowledgment of violence in intimate connection which after another bound
women’s interest in a positive relationship and better communications with close partners.
The victims of childhood sexual assault and neglect may face numerous difficulties in
adulthood, for instance, diagnosis of mental health syndromes, addictions and bad physical
wellbeing (Bonomi et al., Cohen et. al. & Lynskey et al, as cited in Herrenkohl, Hong, Klika,
Herrenkohl, & Russo, 2013). Lynskey and Fugerson further claimed that childhood sexual
abuse is associated with depression and anxiety. Adults who faced adversities during their
childhood they have higher chances of depression in their adulthood. Stewart, Morris,
Mekkings, Komar (2006, as cited Abasi, & Mohammadkhani, 2016) stated that history of
sexual assault is related to women's substance use and patients might use this for
psychological distress that began in their history. Audrian-Mcgovern, Al Koudsi, Rodriguez
(as cited in Abasi, & Mohammadkhani, 2016) claimed that children of addicted parents are
genetically at the highest risk of becoming alcoholic and drug abusers. Also, role modeling
plays a significant contribution to substance use in children.
Temme, Fenester, and Ream (2012, as cited in Temme & Wang, 2018) stated that mood and
awareness are believed to be linked with lapse; harmful mood enhances the chance of relapse
and reduces emotive feelings and consciences. When a person like Joanna is depressed, she
may be unaware of the cues of deterioration.
Long-term childhood sexual abuse has indicated the worse mental and physical wellbeing in
adulthood. These increase the chances of dangerous actions like smoking addiction, drinking
issues, and substance abuse which may reduce the engagement with preventative health care
and premature demise ( Beitchman, Zucker, Hood, & daCosta; Felitti et al.,1998, Coles, Lee,
Taft, Mazza & Loxton, 2015). Coles, Lee, Taft, Mazza & Loxton(2015) have stated that co-
operative mode of treatment needs to be established, such as counseling facilities focusing on
child abuse, sexual violence which are predominant underlying issues. Patients may need to
access legal and protective services. Therapist and other professionals should react gently
after hearing the information about violence and its effect. Communication aptitudes, for
example, replying to patient indications are also important in these regards. The support
should enclose questions and safeguard for the safety of Joanna. Information should be
provided to enable Joanna to make her own decisions on her own time. The intervention
process needs to develop pathways to cooperate care requirement to Joanna’s ongoing
education and training.

Reisnicow et al. (2002, as cited in Scott, G. 2010) described that MI helps patients like
Joanna to recognize harmful behaviors. This mode of intervention has an impact on a
patient's management of the most serious diseases caused by lifestyle factors.
Based on your case, conceptualization, identify counseling goals for Joanna and devise a
proper treatment plan. Outline how you would implement this plan with Joanna,
identifying any challenges you may face and how you would overcome these barriers.
Developing goals is significant as it provides a connection between assessment and
intervention. Goals should be negotiated with Joanna and need to be realistic, achievable,
specific, and broken down into small stages and accepted by Joanna. Possible goals produced
by Teeson, Hall, Mewton & Grigg (2012, as cited in Graham, Farhall, Fossey 2012) are
addressing abstinence, moderate, and reduce drug-taking.
MI intersects recovery-oriented ideologies that highlight shared decision between the
therapist and a patient making respect about patient’s viewpoints and self-management of
mental sickness. MI is linked with reasonable recovery in the level of participation, hope,
empowerment, and bigger change in life. There is enough evidence that MI's vital healing
themes are an optimistic success, better relationships, feelings of security and faith, ties, to
better self-revelation. The principle healing correlation are finding aspiration and aim in life
besides obtaining a more prominent sense of personal restraint (Corigan & Ralph as cited in
Glassman, Kottsieper and Gosch, 2013).
Cordova, Lisa & Gee (2001) claimed that the strategies for MI are proposed to be convincing
and encouraging. It is believed that the demonstration of tangible evaluation should be
considered as a mode of teaching for couples like Joanna and Adam. Motivation will be given
merely by notifying in the gap to the couple's assumed principles of relationship satisfaction
and strengths. Furthermore, these authors stated the therapist could address relationship
issues between Joanna and Adam to help them rely on each other for emotional support and
wellbeing. This is a good strength because it is discovered that partners that are good in
sources of social support for each other are only happier within their relationship but healthier
and better able to cope with the stresses of daily life.
Maybery, Reupert & Goodyear (2015) sated that goal setting, and healing is essential
elements for those with mental health and addiction disorders. However, if a patient is a

parent, then the healing procedure is required to admit the parenting role for the children.
Clarke (2012, as cited in Maybery, Reupert & Goodyear, 2015) stated that goals change and
parents desire for more significant human necessitates which includes professional activities
after patients’ fundamental needs of physical health and day to day operation are met.
Recovery models usually denote patient, who has practical experiences to access mental
health services and actively engaged with those services. Mowbrary et al. (Maybery, Reupert
& Goodyear, 2015) have expressed that in order to support the recovery process in addition to
mental health services, Joanna needs parenting support and routine. These authors have
emphasized the fact that the healing process is closely associated with effective parenting.
The consciousness of indication of relapsed gives opportunities for being proactive,
abstinence, and relapse prevention to Joanna.
Describe two evidence-based interventions you would attempt with her and outline your
reasons for choosing these two. Ensure your responses are congruent with your
theoretical approach and are evidence-based and referenced.
Rapp and Goschal (2006, as cited in Meadows, Farhall & Fossey, 2012) expressed that
strengths-based Case Management emphasizes on strengths, abilities, resources, and
potentials people like Joanna. During the intervention, Joanna is linked with the community
promoting her optimism and address her mental illness. In this model intervention, the
therapist can emphasize on the person’s strengths through motivation, and the patient is
assisted via encouragement to fulfill her dreams and aspirations. The response does not focus
on patients’ shortfalls. The community is viewed as a retreat of resources. The broader
community is a source of mental health which provides a means of prospects for social
interactions, develop a sense of belonging and supports. The case management and client’s
relationship are essential, and interventions are relying on the self-determination. Actions are
taken with the patient's approval; mistakes are expected from clients, and they should learn
from them. These authors emphasized that assertive outreach is desired because it will give a
choice to meet with Joanna at her preferred location, such as a park, home, a café than seeing
her in the office. This is a good opportunity for the therapist to learn about the patient. Theses
authors added that people with mental illness endure growing, learning, and change. This
principle establishes expectations about patients’ continuing agency in their social and
everyday life. This principle can challenge and underline neurological or cognitive
impairment that is related to anticipations of psychological decline.

Treatment Improvement Protocols (1999) described that Brief Intervention (BI) for substance
abuse problems are used by many professionals such as counselors, social workers,
psychologists, physicians, and nurses. BI is an effective practice in addressing substance
abuse in patients like Joanna, who is unable or unwilling to access specialty care. BI is a
time-limited attempt process questions asked to Joanna that if she can stop by her own,
encourage her attending a self-help group. Treatment Improvement Protocols further
expressed that substance-dependent user intervention is an appropriate treatment/intervention
as it emphasizes on helping patients like Joanna to consider treatment after relapse, to
contemplate, abstinence, or returns to therapy. The objective of Joanna is optimal behavioral
change and intensity of care. Here the clinician can collaborate a change Joanna is willing to
admit and thrive ultimately towards moderation.
BI involves a range of approaches, such as structured counseling and planned therapy.
Specific goals are established with the patient, and timetable is given for the implementation
of specific positive behaviors. The purpose of BI is to decrease the risk of damage from the
persistent use of substance uses. Goals are set up and determined by Joanna’s consumption
pattern. Setting up immediate goals such as decreasing the consumption frequency of
substances, attending next meeting, doing homework assignment will help Joanna to self-
regulate and control her emotions (Chick et al., Fleming et al., Kristenson et al., Persson &
Magnusson, as cited in Treatment Improvement Protocols,1999).
Identifying any challenges, you may face in implementing these interventions and
how you would overcome these barriers.
Brehm & Brehm (1981, as cited in Hohman, 2011) has expressed reactive theory which
states that when self-governance is endangered human becomes resistance. Hepwal et al.
(2010, as cited in Hohman, 2011) strength operate as a challenge to personal growth and
change. The role of the practitioner is to reduce this difficulty via interpretation or
treatment. Miller & Rollnick (1999, as cited in Hohman, 2011) stated that communication
traps could block communication and can increase the patient's resistance. Weisner, Satre
(2016) have said that MI has robust clinical evidence of its ability. However, maintaining
obedience by the patients is a challenge for practitioners. Also, this treatment may be
costly; its success is pivotal as a suitable safeguard provider which indicates competent

delivery of MI.MI is an effective intervention for assessment, brief intervention, and
referral to a therapist for addiction in primary care, which has enormous implications for
training. Primary health clinicians have insufficient time to devote for treatment
procedure.
Bundy (2004) claimed that MI is a problematic and argumentative process. During this
course, questions are asked to Joanna how much she wants to accomplish. Arguments are
counterproductive and unfavorable. If the therapist challenges the patient, then the patient
may create disagreements and tensions for not shifting. These authors have stated that
resistance is another type of challenge presented by the patients during any interventions.
A skillful therapist can shift the patient’s viewpoint of the situation. To address the issues
of resistance, a therapist can offer perceptions/ suggestions. Also, reflection is an
influential method of handling resistance.
Bundy (2004) stated that while assessing readiness to change by asking questions about
barriers and support for change can be challenging as this can escalate discrepancy.
Investigating for a reason, willingness, and ability to change is a crucial part of the MI
procedure. Patients may be willing to change but not ready, also vice-versa happens. To
overcome the issue of readiness to change a therapist can share the reason by asking
questions to build a rapport and teaching MI skills to the patient. Dealing with
ambivalence is another challenge when a patient like Joanna may express disagreement,
arguments, demands, or ignorance. Hecht et al. (2005) revealed that MI is a client-
centered instructive method which investigates and determines ambivalence by creating
internal motivational change in patients. In the clinical setting, MI is an efficient
psychotherapeutic intervention for patients who have drinking problem. This method is
applied for enabling patients in other areas of health, for instance, patients having tobacco
addiction, eating habits, and physical activity level. Asking MI outside of the clinical
settings presented challenges concerning implementation and evaluation.
In conclusion, MI builds up the necessary motivation helps to solve ambivalence. MI is a
counseling process which drives patients like Joanna to resolve resistance. Active
listening and empathy are vital in order to establish a therapeutic relationship with the
patients. MI involves physical activity, and patients should comply with the treatment
intervention. Childhood abuse and neglect are associated with several challenges later in
adulthood, such as depression, anxiety. Children of addicted parents have a high chance

of becoming drug-addicted. MI interconnects healing-oriented principle that features
mutual understanding between therapist and the patient. The therapist should respect the
patient's perspective and self-management of mental illness. MI helps Joanna to identify
her risky behaviors. Thus, it is crucial for the therapist and Joanna to work together for
recovery.
While setting up goals, these need to collaborate with Joanna and needs to be realistic and
achievable. Strengths-based interventions, for example, case management which focuses
on Joanna’s strengths, can be useful to fulfill her aspirations. MI is a time-limited and
planned therapeutic intervention for substance use complexity. Resistance, arguments
between therapist and patient, barriers, and discrepancies are main challenges while
working with Joanna. A skilled therapist should have the ability to change the patient's
outlook. A therapist should offer advice to overcome barriers arising during the treatment
process.

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