Cognitive behavioral interviewing for adult disorders : a practical handbook

This is a guidebook for clinicians on how to conduct assessment interviews with patients presenting with common psychological disorders. The orientation is behavioural and cognitive; so the book has wide applicability, as most clinicians explicitly or implicitly accept this combination of models as a useful basis for assessing and treating these problems. The problem areas covered are: fear and anxiety problems; depression, obesity; interpersonal problems; sexual dysfunction; insomnia; headache; and substance abuse.

Gifted young adolescents and email : developing a personal language of self

This paper reports on the use of email as a means to access the self-constructions of gifted young adolescents. Australian research shows that gifted young adolescents may feel more lonely and misunderstood than their same-age counterparts, yet they are seldom asked about their lives. Emerging use of online methods as a means of access to individual lives and perceptions has demonstrated the potential offered by the creation of digital texts as narrative data. Details are given of a qualitative study that engaged twelve children aged between 10 and 14 years, who were screened for giftedness, in a project involving the generation of emailed journal entries sent over a period of 6 months. With emphasis on participatory principles, individual young adolescents produced self-managed journal entries that were written and sent to the researcher from personal computers outside the school setting. Drawing from a theoretical understanding of self as constructed within dialogic relationships, the digital setting of email is proposed as a narrative space that fosters healthy self-disclosure. This paper outlines the benefits of using email as a means to explore emotions, promote reflective accounts of self and support the development of a personal language for self-expression. Individual excerpts will be presented to show that the harnessing of personal narratives within an email context has potential to yield valuable insights into the emotions, personal realities and experiences of gifted young adolescents. Findings will be presented to show that the co-construction of self-expressive and explanatory narratives supported by a facilitative adult listener promoted healthy self-awareness amongst participants. This paper contributes to appreciative conversations about using online methods as a flexible and practical avenue for conducting educational research. Furthermore, digital writing in email form will be presented as having distinct advantages over face-to-face methods when utilised with gifted young adolescents who may be unwilling to disclose information within school-based settings.

Motivational interviewing

Co-existing mental health and drug and alcohol problems occur frequently in primary care and clinical settings. Despite this, health professionals rarely receive training in how to detect, assess and formulate interventions for co-existing problems and few clinical guidelines exist. This Handbook provides an exciting and highly useful addition to this area. Leading clinicians from the UK, the US and Australia provide practical descriptions of assessments and interventions for co-existing problems. These will enable professionals working with co-existing problems to understand best practice and ensure that people with co-existing problems receive optimal treatment. A range of overarching approaches are covered, including: • working within a cognitive behavioural framework; • provision of consultation-liaison services, training and supervision; • individual, group and family interventions; and • working with rurally isolated populations. The contributors also provide detailed descriptions of assessments and treatments for a range of disorders when accompanied by drug and alcohol problems, including anxiety, depression, schizophrenia, bipolar disorder and learning difficulties. The Clinical Handbook of Co-existing Mental Health and Drug and Alcohol Problems will enhance clinicians’ confidence in working with people with co-existing problems. It will prove a valuable resource for all psychologists, psychiatrists, counsellors, social workers and all those working in both primary and secondary care health settings.

The novice researcher : interviewing young children

Being a novice researcher undertaking research interviews with young children requires understandings of the interview process. By investigating the interaction between a novice researcher undertaking her first interview and a child participant, we attend to theoretical principles, such as the competence of young children as informants, and highlight practical matters when interviewing young children. A conversation analysis approach examines the talk preceding and following a sticker task. By highlighting the conversational features of a research interview, researchers can better understand the co-constructed nature of the interview. This paper provides insights into how to prepare for the interview and manage the interview context to recognize the active participation of child participants, and the value of artifacts to promote interaction. These insights make more transparent the interactional process of a research interview and become part of the researcher’s collection of devices to manage the conduct of research interviews.

Brief motivational interviewing for depression and anxiety

Motivational interviewing (MI)can be applied as a brief, low intensity (LI) intervention of 1-4 individualised sessions (typically 45-60 minutes in duration), including screening, assessment feedback, and psycho-education. MI is a client-centred, directive therapeutic style that enhances readiness for change by helping clients explore and resolve ambivalence (Miller and Rollnick 2002). A summary of the key components of brief MI interventions is provided in Table 16.1. There is a well-established evidence base for MI in the treatment of substance misuse (particularly alcohol misuse; Moyer et al. 2002), as well as a growing evidence for the use of MI in the treatment of other mental disorders (e.g. depression, PTSD, OCD), as well as suicidality and physical health problems (Hettema et al. 2005). Brief MI intervention can be delivered as a standalone treatment or as a motivational prelude to pharmacological and/or other psychological treatments (Hettema et al. 2005). MI has been used as an accompaniment to cognitive behavioural therapy (CBT) in the treatment of both depression and anxiety for resolving ambivalence about change and developing strategies for responding to resistance (e.g. treatment attendance, homework/medication compliance; Arkowitz et al. 2008a, 2008b). This chapter will describe how to apply brief MI interventions to the treatment of depression and anxiety as applied to the case of Megan (see Box 16.1) along with some of the challenges and potential solutions to applying MI in practice.

Motivational Interviewing changes the treatment trajectory of group Cognitive-Behavioural Therapy for anxiety

Anxiety disorders have been viewed as manifestations of broad underlying predisposing personality constructs such as neuroticism combined with more specific individual differences of unhelpful information processing styles. Given the high prevalence of anxiety and the significant impairment that it causes, there is an important need to continue to explore successful treatments for this disorder. Research indicates that there is still room for significantly improving attrition rates and treatment adherence. Traditionally Motivational Interviewing (MI) has been used to facilitate health behaviour change. Recently MI has been applied to psychotherapy and has been shown to improve the outcome of CBT. However, these studies have been limited to only considering pre- and post-treatment measures and neglected to consider when changes occur along the course of therapy. This leaves the unanswered question of what is the impact of pre-treatment MI on the treatment trajectory of therapy. This study provides preliminary research into answering this question by tracking changes on a weekly basis along the course of group CBT. Prior to group CBT, 40 individuals with a principal anxiety disorder diagnosis were randomly assigned to receive either 3 individual sessions of MI or placed on a waitlist control group. All participants then received the same dosage of 10 weekly 2 hour sessions of group CBT. Tracking treatment outcome trajectory over the course of CBT, the pre-treatment MI group, compared to the control group, experienced a greater improvement early on in the course of therapy in their symptom distress, interpersonal relationships and quality of life. This early advantage over the control group was then maintained throughout therapy. These results not only demonstrate the value of adding MI to CBT, but also highlight the immediacy of MI effects. Further research is needed to determine the robustness of these effects to inform clinical implications of how to best apply MI to improve treatment adherence to CBT for anxiety disorders.

Gimmelife : listening for dialogic voices in the email self-narratives of gifted young adolescents

The art of listening for voices within narrative research is a positive endeavour that has specific value within research design and subsequent approaches to analysis. This paper details an investigation into the dialogic nature of voices among gifted young adolescents who engaged in the co-construction of email-generated self-narratives. Data are drawn from a study involving ten adolescents, aged between ten and fourteen years, diagnosed as gifted according to Australian guidelines. Individual participants were asked to produce self-managed journal entries written and sent as asynchronous emails to the researcher who was the sole recipient and respondent. Within this approach, specific techniques of listening were used to examine a series of multi-vocal narratives generated over a period of six months. This paper proposes that an adaptation of the everyday convenience of email with the traditional journal format as a self-report mechanism creates a synergy that fosters self-disclosure. Individual excerpts are presented to show that the harnessing of personal narratives within an email context has potential to yield valuable insights into the emotions, personal realities and experiences of gifted young adolescents. Furthermore, the co-construction of self-expressive and explanatory narratives supported by a facilitative adult listener appeared to promote healthy self-awareness amongst participants. This paper contributes to narrative exploration in two distinct ways: first, in using online methods for gaining access to the everyday, emotional realities of participants; and, second, in demonstrating the value of listening as a narrative technique for uncovering layers of voices across a body of texts produced over time. These methods represent an innovative attempt to move beyond face-to-face approaches and away from a focus on content and coding techniques that might oversimplify complex emotions.

Extending client-centered support : counselors’ proposals to shift from email to telephone counseling

The availability and use of online counseling approaches has increased rapidly over the last decade. While research has suggested a range of potential affordances and limitations of online counseling modalities, very few studies have offered detailed examinations of how counselors and clients manage asynchronous email counseling exchanges. In this paper we examine email exchanges involving clients and counselors through Kids Helpline, a national Australian counseling service that offers free online, email and telephone counseling for young people up to the age of 25. We employ tools from the traditions of ethnomethodology and conversation analysis to analyze the ways in which counselors from Kids Helpline request that their clients call them, and hence change the modality of their counseling relationship, from email to telephone counseling. This paper shows the counselors’ three multi-layered approaches in these emails as they negotiate the potentially delicate task of requesting and persuading a client to change the trajectory of their counseling relationship from text to talk without placing that relationship in jeopardy.

Motivational Interviewing (MINT) improves Continuous Positive Airway Pressure (CPAP) acceptance and adherence : a randomised controlled trial

Objective: Adherence to Continuous Positive Airway Pressure Therapy (CPAP) for Obstructive Sleep Apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (MINT) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA. Method: 106 Australian adults (69% male) with a new diagnosis of obstructive sleep apnoea and clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders centre. Participants were randomly assigned to receive either three sessions of a motivational interviewing intervention ‘MINT’ (n=53; mean age=55.4 years), or no intervention ‘Control’ (n=53; mean age=57.74). The primary outcome was the difference between the groups in objective CPAP adherence at 1 month, 2 months, 3 months and 12 months follow-up. Results: Fifty (94%) participants in the MINT group and 50 (94%) of participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis. The hours of CPAP use per night in the MINT group at 3 months was 4.63 hours and 3.16 hours in the control group (p=0.005). This represents almost 50% better adherence in the MINT group relative to the control group. Patients in the MINT group were substantially more likely to accept CPAP treatment. Conclusions: MINT is a brief, manualized, effective intervention which improves CPAP acceptance and objective adherence rates as compared to standard care alone.

Artful interviewing: Conducting oral history interviews for practice-led research

Recently, there has been an increased use of oral history as source material and inspiration for creative products, such as new media productions; visual art; theatre and fiction. The rise of the digital story in museum and library settings reflects a new emphasis on publishing oral histories in forms that are accessible and speak to diverse audiences. Visual artists are embracing oral history as a source of emotional, experiential and thematic authenticity (Anderson 2009 and Brown 2009). Rosemary Neill (2010) observes the rise of documentary and verbatim theatre — where the words of real people are reproduced on-stage — in Australia. Authors such as Dave Eggers (2006), M. J. Hyland (2009), Padma Viswanathan (2008) and Terry Whitebeach (2002) all acknowledge that interviews heavily inform their works of fiction. In such contexts, oral histories are not valued so much for their factual content but as sources that are at once dynamic, evolving, emotionally authentic and ambiguous. How can practice-led researchers design interviews that reflect this emphasis? In this paper, I will discuss how I developed an interview methodology for my own practice-led research project, The Artful Life Story: Oral History and Fiction. In my practice, I draw on oral histories to inform a work of fiction. I developed a methodology for eliciting sensory details and stories around place and the urban environment. I will also read an extract from ‘Evelyn on the Verandah,’ a short story based on an oral history interview with a 21 year-old woman who grew up in New Farm, which will be published in the One Book Many Brisbanes short story anthology in June this year (2010).

Effective interviewing of culturally and linguistically diverse clients

Effective interviewing of culturally and linguistically diverse clients Tips from Dr Nigar Khawaja MAPS, Convenor, APS Psychology and Cultures Interest Group