I noticed initially that clinician said “we want to make sure that you don’t come back here”. While I get the sentiment, it definitely starts the conversation with a negative tone and can make getting care in any form seem like a bad thing. Overall her tone is negative and it is clear she is annoyed and talking down to Sal. Also when she says Wait a second and stutters a bit as she gets her words together, you can sense her frustration which makes Sal more frustrated and defensive. In the first video she never says his babies names even though he introduces his son in that way. That would have been a great personal touch that would help her to connect with the patient and gain trust. And the clinician vocalizing that she is only worried about Sal and not the family shows that she is not in alignment with the wants and needs of her patient. And no empathy is shown towards the dog which is obliviously a part of the family. She said “Do you appreciate” which implies that he should be grateful and that that should be a leading factor for change. Finally, she never listens and is just as defensive as Sal.
For the second interview, she immediately let’s Sal explain the situation and do most of the talking. Everyone’s tone is calmer and he has the opportunity to share what he is working on and to show that he is trying and making progress. They create a space to talk about the true problems and acknowledge that pets can be a factor but that this may not be the case for Sal. This shows that the clinician is acknowledging that his process is unique and different from other people’s processes. She sympathizes with his struggle and that it is hard. Sal can be more expressive with show his love for his dog and he vocalizes what he wants confidently. He says he just wants to keep trying the medication before any other major changes are made. He is proactive in his care. Sal openly expresses his feelings more and a lot of his wants for his family come out. It’s clear he understands the severity of the situation and wants to try all possible solutions before he does something drastic.
It’s clear that removing confrontation from the conversation has it’s benefits. I was annoyed at the clinician in the first video and I think this emphasizes the impact providers have on care options and health behaviors with their patients. Sal is much more responsive to the Spirit of MI style and vocalizes his solutions and steps he will take to manage his asthma. The absence of the negative demeanor and tone from the clinician and the space for him to be open and reflective are key to him managing his care.
The behavior I feel two ways about is exercising daily. On one hand, I know that 1) exercising is a great way for me to stay fit, 2) it is a great way to break up my busy work day and creates space for me to relax, and 3) I can do it with friends and have a good time competing against them. On the other hand, I know that 1) I don’t have time to exercise because work is wild, 2) I’m often sore and tired afterwards and that’s not a good feeling, and 3) gym memberships and classes are expensive and I can’t afford them.
Double-Sided Reflection: It sounds like you want to create a space for you to relax and stay fit with your friends. It also sounds like it’s hard to commit because it can be expensive and you don’t like the way you feel when you are done exercising.
On one had you want to break up your long work day with a fun activity but on the other hand you feel that if you stop working to exercise, you will fall behind on your work.
On one hand you want to keep up with your friends and be able to join them for fun workout classes but on the other hand you have your own budget that you want to stay within and you don’t want to have to break the bank to work out and have fun.
This exercise shows how many different ways we can say how we are really feeling and how vast our experiences around behavior change can be. Writing the double sided reflection almost exposes the solutions without directly saying them which I see as one of the main benefits to this technique. I wanted to immediately respond to the reflection with solutions and I imagine the client often feels this way too, especially since the reflections really show that the clinician is listening and supportive. I felt really engaged in this process.
Patient goals: Going to summer camp with friends. Not having to miss school for doctor’s appointments. Not having to get stuck with a needle at every appointment.
My goals: Taking daily medication without parent’s reminding them. Remembering the names and dosages for all their medications. Making it to all of their appointments.
My patient is very focused on having fun and not missing out on the things their friends are doing. I am very focused on my patient gaining some independence and stepping up to take more ownership in their care. With my “righting reflex” I want to show them how to set medication reminders on their phone and how to make sure they remember their doctors visits and allow enough time so that they aren’t late to their appointments (by using alarms on their phone and mapping their route in advance).
I’d start by asking my patient what they would like to talk about today and how they are feeling about today’s visit and their progress. I would let them know that mom and dad can step out of the room if they want to talk to me alone. I’d let them know I only want the best for them and that I’d like to know what they want? Then I’d ask how we can make that happen. I’d listen and paraphrase back to them so that we can make sure we are both on the same page.