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

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#24627
Betsey Davis
Participant

Homework Questions
Question 1
What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.

My general impressions were that the counselor and client seemed very comfortable with one another, as reflected by not only the casual way they spoke to one another but in the duality of their body language. The counselor seemed very comfortable rolling with the resistance that presented and kept a low energy level throughout the interviews. Time was spent in session talking about the reasons for change, exploring options and identifying how and when the client was going to make change.

Examples of MI to evoke commitment, activation and taking steps included:
1st video-:22-Counselor stated, “So where do we go from here? What are the options?” He went on to say, “Where are we at?” Client seemed to respond well to this energizing, focused interviewing and went on to say what was motivating him and what he wanted to see happen.

1:15—Counselor asked, “What are you going to do?…then shortly thereafter, “When are you going to do that, when you leave here?” He pressed the client for commitment and action he could agree to.

4:25—Counselor asked, “What are those things and what might you do?” Had client restate what he was going to do to further strengthen change talk and commitment.

3:17–I liked how the counselor stated, “Before I go there, you mentioned some options. . . do you have other ideas?” A little before this, he stated a nice reflection, summarizing what the client has said up to that point.

9:16—Client stated “She’s going to be happy I made this decision. . . I’m with you there.” Counselor stated the simple reflection of “You’re highly committed.” This was very effective and supportive.
2nd video-:52—Client stated, “I just need to do this”. Firm commitment toward action.

6:05—Client stated, “I’m going to tell my wife what my agreement has been with you.”

Question 2
What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?

There was a lot done very well in this video but I feel the counselor missed some opportunities to deepen the activation for change talk.
Here are a few examples and what I would have done differently:
2:34—Counselor summarized and moved to planning talk before really identifying a strong commitment from the client. He went on to summarize stating “you’ve said you’re reasonably committed.” I’d want that to be stronger and have the client state it further and build upon his motivation for change. I’d work to elicit a stronger commitment by using scaling questions.

3:47—Counselor stated, “It might be a REALLY good idea for you to do that [attend church functions]” while client seemed to have a lukewarm response to the whole topic. This wasn’t very effective. Client was not at the center of the conversation at this point. He did the same thing when he brought up dancing, which client didn’t seem to respond well to. I imagine there were better options, but they didn’t spend a lot of time in the brainstorming part. I’d do more of that. I’d also talk with client more about his wife’s concerns as a way to strengthen his commitment as this was important to him.

4:53-In discussing the option of AA, the counselor stated, “that is a venue that may or may not work for you.” I didn’t like how he said, “I’m sure you’re aware of this” (no room for what if the client was somewhat aware or had not heard about this. ..would have made it hard to then ask for more information).

Client stated a lot “I’m not opposed to that. . . “. He didn’t seem onboard in a significant way. I think I would have asked, “what do you think may be a better option for you? I’d also ask some of the scaling questions to try to better understand what client was thinking about effectiveness and confidence around the options he was discussing”. Seemed vague without it and less of a commitment made with these statements.

2nd video
:52—Client stated, “I just need to do this”. 4:51—”My answer to that is that I need to be prepared to just completely change all my plans. “I need to just completely change.” I would have reflected this back and taken the opportunity to summarize client’s reasons for making change.

Counselor stated “do you need me to write this down?” Writing it down and sending the plan with client would have strengthen his commitment to it and made it easier for him to talk with his wife about the plan, getting her buy-in.

6:45—Counselor shared suggestions without asking for permission from client first. Used strong, forceful language, not tentative. This could have caused problems but didn’t seem to as they had a good rapport.

Question 3
How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?

Since starting this online course, I have found I much more aware of change talk/resistance in clients when in session. I’ve tried some of the reflections and found them helpful. Much of this, I was already doing but not enough of it to evoke commitment to change. I particularly liked the chart of the desired change, with brainstorming options then rating them on effectiveness and confidence. I could see this as really helpful, maybe doing with client on a white board in session or have them write things down if working remotely. I often use scaling questions in terms of how clients are feeling. I will definitely be adding the effectiveness and confidence scaling questions in my practice. I appreciated the what to do if a client says “I don’t know”. I feel like I come up against that often and end up in the expert role (either put there by myself or my client). I really liked the suggestion of sharing ideas but checking in with client about any thoughts they may have first. So respectful and collaborative!