Reply To: Week 2 Homework Assignment (Applications of MI)

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#24417
Betsey Davis
Participant

Question 1
What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
I was impressed by how respectful this discussion went. He entered therapy highly distressed and resistant and they were able to join fairly quickly which deflated his negative emotions and moved the discussion into a more productive arena. She was respectful and able to empathize despite his sustaining talk. The counselor made it look so very easy. This is a good example of why it is so important to have these skills.
Question 2
Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.
Examples of sustain talk:
1) ” . . . 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. It’s not because I want to do any of this crap you know.” –Reason
2) “It almost sounds like you don’t even know whether you could stop even if you wanted to”—Ability

Examples of change talk:
1) “People keep saying that you need to stop drinking and I ain’t never done that either. I think I could. I’ve tried a couple of times and I wasn’t very. . .”—Ability
2) “My wife had to come bail me out several times. It got pretty costly doing that. Even though I enjoyed it, it was kinds. . . .it got a little bit costly, I got a bad name in town, things like that”-Reason
3) “I want something that will help me with court. . . As long as I’m putting all this money into it I’d like to come out with something.”—Desire
4) “Yeah. Cause if I get out of this, if I can save my house and my hob, I’d better do something that’s gonna keep me from doing this again, don’t you think?”—Need, Activation
Question 3
Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.
Complex reflective listening/strategic examples–impact:
1) “So it’s confusing to you why your drinking should cause a problem or everybody should be talking about that when you look around and you see that other people drink more than you do.”—This statement seemed to validate what client was saying, seemed to make him feel understood and helped deepen client’s thinking. It helped shift his thinking some, increasing discrepancy.

2) “It almost sounds like you don’t even know whether you could stop even if you wanted to.”—This strategic response of aligning with the client’s sustained talk which he began to explore more. He responded with, “I get thinking about it. Honestly”.

3) “So you’re kind of wondering what it would even be like here.”—This strategic response helped address client’s feelings of uncertainty so that he could address them and talk about them, thereby making treatment more of a possibility—something he might be able to do.
Question 4
Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.
Examples of signs of readiness for change:
1) Rounder said, “I don’t know that its true but you might say that.”—This seemed to be one of the first times in the interview that the client verbalized he may not be right about his interpretation of his situation, the first crack in the armor so to speak.

I would ask him to elaborate on that, say more about this. I’d try to get him to be specific in how maybe his drinking wasn’t harmless. I’d ask him for times in his life where it was problematic or it didn’t help move him closer to his goals.

2) Client stated: ”You couldn’t give me an answer and I can’t give you one, so that’s just kinda. . .That’s a hard thing. Maybe that’s something I need to think about before I even do any of this stuff that you’re or they’re talking about.”

I’d want to explore with him what alternatives may look like to help him envision other possibilities for his friendships with his drinking buddies or if he knew of anyone who had stopped drinking and how his friends responded to it. How he may have responded if someone in his life made that change.

3) “I wouldn’t mind coming her to live, but I wouldn’t want to be in one of them places where you sit around din pajamas a bunch of longhaired hippie types crying and bitching and stuff like that. That ain’t my style you know.” At this point in the interviewing, client was asking lots of questions with a lot of energy. He seemed to be moving closer to a resolution of what he wanted or think he may be able to do.

Again, he is trying to envision what treatment could or would look like and how he could fit into it successfully. I would steer the conversation more toward what he could see himself doing, what he may find helpful, etc. I would then ask him what he wanted to see the next step be and what he felt he wanted to do.