Reply To: Week 3 Homework Assignment (Applications of MI)

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#24587
Colleen Drake
Participant

Question #1:
My overall impression of the two videos is that the use of MI was noted, but spotty. I think the conversation was effective in helping the client reach a point of willingness to try a commitment plan to quit drinking, although there were things that could have been improved upon if MI had been followed more consistently. The feel of the conversation seemed to me more of an exchange between two friends discussing the concern and not a lot of focus on eliciting change talk from the client. The counselor did help the client come up with some things to try (AA for example) and he did use some complex listening in the interview (I noticed this more in the first video). The client was able to express a reason for change when he mentioned the “priceless conversation” he expected he would have if he went home and told his wife he was going to go to AA. When the client was showing some resistance in the conversation about using church as a strength the counselor followed up with complex reflection about what the client was saying about not fitting in with church. At the end of the interview it did seem as though the client was expressing a readiness to take some steps toward change.

Question #2:
The counselor was able to help the client discuss some thoughts about changing and some methods he could try, however I think it could have been improved upon if the use of MI strategies was more consistent throughout the interviews. I noticed, in both videos, that the counselor asked a lot of closed-ended questions (more often than open-ended questions), he interrupted the client a few times, often did not ask permission before providing information (it was used some, but not as much as I would anticipate with the use of MI strategies) and he tended to use simple reflections over complex, reflective listening. There were not many pauses to show true listening and reflection and I didn’t hear much for questions like “what do you think…” that would have helped the client move forward with change talk. I didn’t see a good pattern of elicit-provide (with permission)- elicit being used. If I were the counselor in this situation I think I would have chosen to do more; double-sided reflections, open-ended questions, asking permission before providing information and with helping the client identify SMART goals. I think this would allow for the client to feel less pressure from an outside source (ie. the counselor) and to feel more in charge of the decision himself.

Question #3:
I would like to start practicing using the MI approach more in the work that I do. I think it would be an effective way to help people find motivation for change and be more likely to adhere to their plans. Being a Children’s Case Manager, my approach would certainly be different than that of a therapist though. I can think of examples where an MI approach could be helpful in working with my client’s parents, such as helping them explore; other ways to interact with their children and different ways of approaching concerns with schools or providers. I may find the MI approach helpful when speaking with clients, especially my pre-teen and teenaged clients, about goals they have for themselves and how to reach them. For example, when working with an older teenaged client who is initially ambivalent about trying a new treatment or medication I may ask some open-ended questions and use reflective listening to help the client think about things in a different way. Then, with permission, I might offer information to the client about risks and benefits of such decisions.