Motivational Interviewing in Career Counseling
Specifically for Clients with Mental Illness
Melanie Jubb
Southern University
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Motivational Interviewing in Career Counseling
Specifically for Clients with Mental Illness
Employment plays a vital role in sustaining and enhancing the health and social functioning of people with mental illness and in promoting social inclusion. With the ongoing trend towards deinstitutionalization of persons with psychiatric disabilities and increased emphasis on community-based care, attention has turned to psychosocial interventions. The goals of these interventions include: enhancing interpersonal and social functioning, promoting independent living and community engagement, decreasing symptom severity and associated comorbidities (e.g., substance abuse), and improving illness management.
Individuals with mental illness have significantly lower employment rates and report shorter job retention rates when compared to the general population. This is unfortunate, because research shows that when this population is employed, there are a multitude of benefits: reduced financial strain on mental health systems, reduced poverty, improved quality of life, increased self-esteem, and improved psychological health and social well-being (Larson, 2008). Larson also notes that individuals with psychiatric disabilities express a desire to work, and usually see work as an important and meaningful goal in their recovery (2008).
Characteristic Barriers for Individuals with Mental Illness
Marginalization is the process of pushing a particular group of people to the edge of society by not allowing them an active voice, identity, or place in it. Through both direct and indirect progressions, marginalized groups are made to feel as if they are less important. People living with mental ill health are among the most socially and economically marginalized members of the community (Miller, 2010). Several barriers have been identified that may prevent people with severe mental illness from seeking and retaining a job. These range from concern about losing benefits, the belief that they will not be offered employment because of the stigma of mental illness, and worries concerning poor functioning and relapse arising from their mental health problems (Butler, Howard, Choi & Thornicroft, 2010).
Butler et al. states that for people with mental illness, better employment outcomes are related to younger age, and suggests that White individuals are significantly more likely than Black and minority ethnic individuals to obtain employment (2010). However, a study of long-term unemployment in an inner-city setting of adults with severe mental illness by Goldberg et al. found that ethnicity was not significantly related to the length of employment (Butler et al., 2010).
Evidence-Based Practice of Supported Employment
In recent decades, there has been tremendous growth in the development and assessment of vocational rehabilitation models for persons with a serious mental illness. The most significant advances have been in the evaluation of the supported employment model, which is based on the place-train approach to vocational rehabilitation (the person is helped to first obtain a competitive job, which is then followed by any required skills training) rather than the train-place approach (skills training is provided first to train the person for competitive work), which dominated the field until recently (Mueser & McGurk, 2014) .
Evidence-based practice of supported employment (EBSE) for people with mental illness is based upon eight principles: eligibility based on client choice (zero exclusion), integration of mental health and employment services, focus on competitive employment, rapid job search, attention to client preferences, systematic job development, benefits counseling and follow-up supports after placement (Drake, Bond, & Becker,2012). Evidence-Based Supported Employment (EBSE) significantly increases employment rates for individuals with severe mental illness; however, 40% to 60% of EBSE participants fail to secure employment. Perhaps EBSE provides effective services for individuals to find employment; however, it lacks components to intervene with individuals indicating ambivalence about finding and maintaining employment (Larson, 2008). Employment outcomes may be related to the client’s viewpoint of the pros and cons of working rather than limitations of EBSE (Larson, 2008).
Motivational Interviewing
Motivational Interviewing is an effective and evidence-based approach, which has a theoretical basis in the Transtheoretical Model, more commonly known as the Stages of Change Model, developed by Prochaska et al (1992). This model identifies a cycle of change which people move through before effecting permanent change. Although MI was first described in 1983, it was not until 1995 that Miller and Rollnick provided the first explicit definition of MI. They described MI as a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (Rollnick & Miller, 1995).