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

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Diane Scalia

Homework question 1:
After watching each of the videos a few times, it does not seem like a solid change plan was actually developed and I did not hear the client state his reasons for wanting to quit drinking. The clinician did use some reflective listening, summarizing, and affirmations, asked open-ended questions. Overall, I don’t believe the clinician’s use of MI to develop a specific plan was very effective. In the first video, the client did not recapitulate the client’s reasons for wanting to quit drinking. In addition, the client was making CAT statements throughout the first video that the clinician could have seized upon. The clinician did ask if the client had any ideas about what he might like to do, then answered his own question by offering three ideas that the client had already mentioned (staying away from bars, dancing, and church) and offered a solution of his own (AA meetings). In the second video, regarding client’s decision to ask a co-worker about AA meetings, the clinician asked the client “What are you going to do” and “When are you going to do it”, but the client’s response did not sound much like a commitment. The client and clinician discussed coping with triggers. I found it interesting that at the end of the second video, the client summarized his own plan, the session ended with client having unanswered questions, a statement of resistance, and the clinician told the client to call him.

Homework question 2:
I would have started with a summary of the reasons why the client wants to quit drinking, and then asked, “I’m wondering if you have any ideas about how what might work for you to accomplish your goal?” To the client’s response of “I don’t know”, I may have used skillful advice giving, asking permission to offer suggestions, offered to brain-storm for ideas, or offered the client a menu of choices, rather than a single idea. I like the suggestion of reviewing the list of ideas and asking the client to rate them for effectiveness and confidence of actually following through with them. Once the client established a plan, I may have asked him what his first step might be, then use a confidence scale to increase his commitment following through until he was able to be specific about who he may ask or contact, when, where, how. I might return to using OARS to help client identify barriers or triggers and identify supports or specify a plan. I would have asked the client to restate his plan. I would have again summarized the plan, written it down, and offered to call the client later that day to check-in and offered a follow up appt.

Homework question 3:
I do use some of the strategies discussed in this lesson, but not consistently. I think I need to work on improving my strategic responses. I think I have viewed treatment planning and change planning as being the same process and can now see the distinction. Moving forward I think that using the change planning strategies as a prerequisite would lead to better treatment planning and allow client’s to feel a sense of accomplishment earlier in the treatment process.