COMMENTARY

Motivational Interviewing of People With Schizophrenia

Patrick W. Corrigan, PsyD

Disclosures

November 09, 2005

In This Article

Introduction

Effective treatment for people with schizophrenia combines medication management with psychiatric rehabilitation strategies. Proponents of psychiatric rehabilitation believe that effective services of any kind begin with an assessment of the person's goals.[1] Goal assessment assures that the treatment focus is driven by the consumer's perceptions of important needs. Consumer advocates believe that the kind of personal power embodied in goal assessment is essential for people with severe mental illness to regain equal status and independent living in their community.[2] A variety of methods have evolved to assess goals[3,4]; typically, such methods combine open-ended questions about the person's needs with Likert scale ratings about the importance of these needs. Unfortunately, these methods frame goal identification as a yes/no determination; for example, "yes, obtaining supported housing is important to me and I'd like some assistance in this area" or "no, I don't want to change my work experiences now." Rather than viewing a specific goal as a categorical decision, a more comprehensive picture may be obtained by considering the profile of factors that motivate and discourage a specific decision. For example, what are the advantages and disadvantages for a consumer to change his or her current work setting?

This kind of activity not only provides a rating of readiness, it also identifies specific targets for treatment (eg, disadvantages to work are barriers that must be overcome). Advantages represent the benefits the person will enjoy. Motivational interviews help the consumer consider the various advantages and disadvantages of specific life goals. An overview of motivational interviewing is provided in this column. Motivational interviewing makes sense in terms of a stages-of-change model, so this paradigm is reviewed first.

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