Overall, I really saw the spirit of MI in these videos through the comradery that was formed between the client and the clinician. They were able to laugh and joke together throughout the conversation which I think lightened the mood and showed the true sense of support without diminishing the seriousness of the conversation and the need to change. The client’s body language even showed that he was relaxing and was comfortable talking to a friend. Overall the use of MI was effective because the client reached some important conclusions and came up with actions steps by the end of the conversation. The clinicians focused questions lead to this. At 2:07 the clinician asked “So what do you want to do”. He then followed this up by saying that the plan can be refined and changed which was another way of giving the client control in the situation while also acknowledging and being supportive of the fact that setbacks happen. He also summarized their previous conversations up to that point to ground the actions steps. At 3:15 the clinician asked if the client had any other ideas before suggesting his own. At 4:50 the clinician said “it may or may not work for you” when talking about AA. He then went on to list some of the benefits and focused on the positive in this situation. I also think it was effective because the clinician noticed that the wife would be a big motivator in the change process. When the client was able to laugh and say, Wow if I go back and tell my wife I’m signing up for AA she will be shocked, the clinician noted the importance of family in this situation and joked about the moment. In the second video, the client really incorporated more MI aspects to help make the goal a SMART goal. At 1:15 the clinician asked, when do you see doing this, giving the goal a time frame. At 2:45 the clinician reaffirmed commitment by asking what the client was going to do when the struggle starts to set in. Planning and troubleshooting for future hardships definitely helped this client with confidence. Finally, the clinician got the patient to think critically about the opportunities that would come to him through AA. The patient recognized that AA was a substantial organization and that they had been doing this work for a while. He was confident they could provide the resources and support he needs.
I think the only thing I would do differently is try to connect the clients change to his daughter more. The age of the daughter didn’t come up but it was clear the client valued this relationship in addition to other social relationships. I would have tried to elicit a commitment that he could share with the daughter. I would have asked what he likes to do with his daughter? And then I would suggest that instead of going to the bar to drink with friends during the football game, maybe they could do that activity then. Reinforcing this reason of why he wants to change his behaviors is important and spending time with the daughter could be a great outlet that also supports behavior change.
Another thing I noticed is that throughout the interview (and in the other videos we watched in this lesson) that sometimes the clinician would focus on tasks too far in the future and I found that frustrating and could see it being so to a client. I understand the importance of planning but I think how these points are worded could be done in a way so that the client doesn’t have to keep repeating themselves. For example, if step one is finding out the time for swimming lessons or connecting with a friend to learn more about AA, I think it is time to reinforce this step and then we can discuss how and when we want to check in to see how step one is going and to make sure it gets completed. If you start to ask me questions about how often I am going to go swimming or what I think about certain aspects of AA, I might get frustrated because I don’t know the answer since that is step one. I can’t commit to swimming 3 times a week if classes are only 2 times a week. I can’t speak too much to AA logistics if I haven’t spoken to my friend. I think planning is important but I wish the clinician had at least acknowledged the limitations as they could later be issues that change the plan. Saying “I know you need to contact the swim club to see when they are having lessons but when do you think you’d be comfortable swimming” is different than “When are you doing this” If I say tomorrow morning and the club is closed, that’s an immediate frustration and change to the plan that could turn into a bigger setback.
My favorite part of this lesson was around exploring confidence. As someone who works with youth, I think confidence and self-efficacy are really important factors as many of the resources the kids need are actually provided to them through our clinic or service. I recently had a patient who turned down free transportation to the clinic because they knew they wouldn’t want to call to schedule the pick up and then stick with the set time. When thinking about plans and solutions, knowing how likely they are to follow through can help me to help them with creating tailored SMART goals. I also especially liked this because it’s a quick assessment that can go a long way. I honestly don’t have the time or space to incorporate all these techniques when working with patients but asking “If you decided right now to [change or implement X behavior], how confident do you feel that you will do this? If 0 was ‘not confident’ and 10 was ‘very confident’, what number would you give yourself?” is a great place to start. Then I can be supportive in building that confidence if it is lacking and use the point to frame further discussions. Also, if they give it a low number, I can tell the patient we don’t have to worry about it now and can do something completely different which hopefully removes some of the burden and makes us both feel better.