Question 1: The session felt fluid in how it unfolded, from resistance to willingness to consider addressing his drinking. I like how she was able to roll with the resistance, though when he asked her personal questions there seemed to be a bit of a hitch, but it would have startled me too. While I was watching/reading I also noticed myself wondering when or how his assessment was accomplished? How would one apply MI principles to the assessment process? I would love to observe a psychosocial assessment using these tools.
Examples of sustain talk:
“I sit out her in front for about an hour before I come in and I was about to close to just cranking that pickup up and heading back home.”
“And I think she’s out to just destroy me totally, you know….And I just kind of think you maybe you’re going to do the same thing to me.”
“And I don’t know what the hell she means I need help.”
“So a lot of what I’m doing here or you know why I’m coming here…the only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house.” Reasons
“I’ve tried a couple of times and I wasn’t very…I think one time I quit for a week or two just to show people I could stop drinking.” Ability
“Do you think I could come here to live?” Actuation
R-“I don’t know why in the hell I stopped anyway.”
T-“It almost sounds like you don’t even know whether you could stop even if you wanted to.”
It appears that when he heard Terri restate his sustain talk, it sounded odd to him he started to question it and begin to consider the other side of the equation. He began to wonder what it might be like, noticing that he’d not tried before.
“There’s a lot of things I can do, but I’ve never tried to stop drinking, I get thinking about it, honestly.”
Later on Rounder says: “You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.”
Terri affirms his self observation and reflects back his worry that his drinking will make his life worse. Next, she highlights that he’s really looking hard at this issue as he did in the past with his fighting. Then she affirms that he has the skills ability to make changes, as he’s done in the past. Each one of her responses supports him in moving towards change, creating an environment where he can put his own thoughts and intentions together to make this plan rather than being told he must.
At then end Terri says “So you kind of feel two ways about it. On one hand, you know, you think you’d like to have a change and you’d like to quit drinking and on the other hand you think you kind of dread it.” Up until this point, there has not been a clear statement about his intention to quit drinking. He’s said he’d like to get his money’s worth and he’s considering change. She validated and normalized his ambivalence with this statement and I notice that he also did not challenge her description of him wanting to quit drinking, perhaps articulating his intent when he was not ready to say it out loud himself.
“I wouldn’t mind doing this stuff if there was something in it for me.”
“As longing as I’m putting all this money into I’d like to come out with something.”
I would work towards getting more clarification about what he was looking for from a program and ask if I could explain further about what the treatment center has for programs, together looking for a match. I would look for opportunities to validate that it’s his choice to enter treatment/make changes and support a verbalization to committing to give treatment a try.