I was really impressed with how well the interview flowed. I’ve had little exposure to MI outside of this class and noticed how the clinician drew so much out of Rounder, especially since he put up a fight most of the way. The clinician carried the conversation so far by only asking questions about what Roudner had just said. The created space for Rounder to express himself and really to get everything off of his chest. He vocalized his unhappiness and was open and honest and the clinician really did try to change his mind in any way. The clinician also used a nice understanding tone and showed full respect for what many would consider a difficult patient because it does seem that he hasn’t admitted his fault and role in the situation. I think acknowledgement is something that clinicians want to see but when that didn’t come, the clinician wasn’t deterred in any way and continued on with talking to Rounder. It was really great seeing such a successful MI scenario that came full circle from expressing emotions to discussing action steps to be taking.
Sustain Talk Example 1 “I sit out here in front for about an hour before I come in and I was about that close to just cranking that pickup up and heading back home. I’ll let you know, just like I told Rich, I’m not real happy about being here. I hope you understand that…And I’m about up to here with this kind of stuff. I hope you know that. It probably isn’t your fault but that’s just kind of the way things have been going, you know. “
Sustain Talk Example 2: “I’m not motivated to be here or anything, but I don’t like any of this I’ll be honest with you. It’s taking a lot of time that I don’t have. Its taking of money I don’t have for the court and the fines and all this stuff.”
Sustain Talk Example 3: “I can do just about anything but I can’t say yes to that, that I can stop drinking. I think you’re right on that one. There’s a lot of things I can do, but I’ve never tried to stop drinking, I get thinking about it, honestly.”
In these 3 examples, Rounder never says he is against changing. He says change is expensive and that he has never really tried and he’s not too happy about it but he says it’s just the way things are and how things have been going for him.
Change Talk Example 1: “As long as I’m putting all this money into it I’d like to come out with something.” This is a Desire for Rounder
Change Talk Example 2: “if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?” This is a Reason for Rounder
Change Talk Example 3: “I wouldn’t mind coming here to live” This is Ability for Rounder
Example 1: “I’m hearing you loud and clear that being here is not something that is really a high priority for you.” The clinician demonstrates reflective listening from the beginning with this statement. She acknowledges how the client was feeling and repeated, paraphrased and reflected it back to the client. This immediately shows the client that she is not here to argue or disagree with him and that she will be supportive.
Example 2: “Do you kind of have the feeling that your wife and daughter are ganging up against you?” Here the clinician hears Rounder and uses the repeat, paraphrase, reflect technique to share her hypothesis. She also isn’t taking the side of the wife and daughter but asks what the client thinks which also helps in keeping the conversation moving and on target with the topic.
Example 3: “Yeah. That’s real normal for people when they first start thinking about
something like this.” When the client asks “Is that normal?” The clinician responds in an honest way showing that she heard his statement and that he isn’t alone in this process which assists in moving Rounder from sustain talk to change talk and closer to action. She kept the client at the center and really listened for expressions of his feelings.
By using reflective listening and by strategically responding to Rounder, the clinician was able to move Rounder through the conversation that started heavy with sustain talk and ended with more change talk. She kept the conversation going by asking questions and focusing on the client and she clearly gained the client’s trust which caused him to think and express the situation on his own without getting defensive towards the clinician. Overall the use of reflective listening had an immensely positive impact on the conversation and Rounder’s feelings towards change overall.
Example 1: “Is there anything maybe you guys can do maybe about me keeping my license and all that? Could you say something to my, that witch I got for a probation officer, maybe get her off my back, or is there, you know… I wouldn’t mind doing some of this stuff may if there was anything in it for me, but so far I’ve been having to pay this and pay the lawyer and pay for the wreck and pay for the evaluation and everything and so far ol Jim ain’t got nothing”
Example 2: “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.”
For example 1, I ask him what type of benefits he expects to see for the work he is doing. I’d make sure he was setting realistic expectations while still encouraging him and answering his questions on what the possible outcomes could be if he goes through the necessary steps. I’d ask him to think of personal benefits and then the benefits for his grandchildren.
For example 2, I’d ask what Rounder disliked about this mess and why he would want to avoid it again. I’d ask him what’s one thing he could do in the future to avoid this mess. I think a question like this reiterates many of the things he’s said that he disliked about this situation and continues to move him towards action if only to avoid the repercussions. Rounder may not be changing his behaviors because he sees an issue with them but he is willing to do the work to change and that ultimately is a positive outcome for him and his family. And hopefully more understanding will come with time.