My first reaction to watching the two videos of Sal was how very different they felt to me. Sal became very defensive, spoke less and exhibited closed nonverbal communication by turning away from the interviewer several times in the confrontational video. He also told her she wasn’t understanding what he was saying. In comparison, the MI video felt much more collaborative and respectful. Sal seemed to respond well to the interviewer’s curiosity and reflective listening. He seemed much more verbal, sharing a lot more of why it was so hard to understand the connection between his asthma and his pet and how and why it was so painful to look at losing his dog.
The MI video seemed to close with Sal determining his next steps (being on the highest medication dose available to see how his asthma responded). He seemed to be considering what he’d need to do if that did not work, including possibly rehoming his pet.
Issue of ambivalence: “I feel ambivalent about doing concurrent documentation.”
One side: “I know that doing clinical documentation in session is smart as it means I won’t fall behind and won’t have to think about it later.”
Other side: “I struggle with doing concurrent documentation, as I feel like it takes away from my presence in session with clients.”
Betsey, on the one hand, you know that doing concurrent documentation is smart as it means you won’t fall behind on your paperwork and won’t have to think about it later. On the other hand, you feel like it takes away from your presence in session with clients.”
Betsey, you seem to be struggling with competing values. On the one hand, it’s important for your paperwork to get done in a timely fashion to reduce your stress and worry over it. It also seems important for you to be genuinely present for your clients. You enjoy being in the moment and not dividing your attention between them and your notes.
Betsey, you may be wondering which to pay more attention to. Your own mental health is important by keeping your stress level down and keeping up on your paperwork is a big part of this. You will be able to give more to your clients if you are not feeling overwhelmed by all you have to do. Your clients feeling heard and validated is very important to you as well as this is their time and they are paying you to give them 100%.
This exercise was interesting. I found it a little hard to keep to the structure (am not sure I did this entirely), instead having other modalities and techniques popping into my head. I found that after doing this, my ambivalence was largely resolved. As much as I may enjoy just sitting with clients, it would be far harder on me to spend my whole weekend doing notes. I’d be exhausted and have that much less to bring to the table, so to speak.
Client goals: To get some motivation. To not be a brat to my sister. To smoke less.
My goals: To keep to a daily structure, get up the same time every morning. To confront her sister over the identity she has been given within the family. To not smoke at all during weekend days.
What I see as discrepancies in these two lists are her goals are very broad and nonspecific. Mine are more focused.
In terms of the righting reflex, I found I want to immediately problem-solve with her around these goals instead of looking at what is sustaining them. I want to break things down so we can work on them instead of leaving things so broad. I want her to feel success and that she can experience something other than failure. I want her to see herself as something other than the victim in her family. I want her to experience sobriety and see what that is like for her.
Agenda Setting: I would ask my client what she would like to be sure to focus on and take notes to ensure these are addressed in our time. I would use reflective listening to ensure I heard correctly and would ask client to start when ready. During the session, I would summarize periodically and be mindful of the time for client so that she got what she needed or ask if she wanted to stay on the topic she was as our time was running out.