Reply To: Week 4 Homework Assignment (Applications of MI)

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Betsey Davis

Homework Questions
Question 1
What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
Again, I’m impressed with how collaborative and respectful MI is. The physician was great in terms of summarizing, using OARS ways of communicating and used the scaling questions appropriately, even switching to percentages which was the language of the client, without missing a beat. He did a nice job exploring the reasons for wanting to smoke and reasons for wanting to quit.
I do feel like there were opportunities for him to explore her ambivalence further, to really understand both her feelings and anxieties about making change as well as exploring what her past experiences had been with trying to quit. There may have been some strategies that did work for her that could have been brought forward. I feel that he missed a crucial piece, which was the peer group element and feeling a sense of connection during smoke breaks. I wished he had reflected on this and explored how to meet this need in another way. He interrupted her once, which was not helpful.
Question 2
What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
The physician used scaling questions to identify why she wasn’t identifying a lower confidence level. Offering to see her on a more regular basis to check in and provide support seemed to help her to feel this would be more manageable. He frequently summarized throughout their conversation, which seemed to build momentum, raising client’s confidence and excitement at the option of quitting. He provided psychoeducation to client which also seemed to help (informing).
Question 3
Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
Dr: “So what would you have to do to prepare for that date [her quit date]?” He then listened to her responses. He then switched into informing her of medication options. He would have been better off summarizing what she’d said, then asked permission to share information.
P: The patient’s reactions to him were very positive by the third video. Initially she seemed very fearful and anxious but over the course of their conversations, had relaxed as her confidence increased. She seemed to really trust him and his feedback. She seemed to respond well to his MI way of communicating. By the third video, she was much more expressive to his MI interventions.
Question 4
Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
Over the last 4 weeks, it has become much more clear to me how important it is for me to get better with these strategies. I use many and have used them since I was originally training in MI, but not nearly to the degree I should or could be. In listening to clients in counseling, I have heard over and over about changes they are trying to make whether it is to eat healthier, to spend less money, to maintain better boundaries or to manage emotions better. All of these changes can be supported and strengthened by MI practices. I guess I had not realized how much change issues presented in my practice until I was listening for it. I have one client in particular, who is morbidly obese (300+ pounds) and desperate to make change at this time. I have begun to use MI more with her and she is responding well to it. The complicating factor is her substance use that goes along with it, but again, this would be appropriate for MI work. I am excited to start using this more mindfully in my practice as I am a huge believer in people’s ability to make changes and get healthier. It will be important to manage right reflexes. I think that will be the hardest part.

Thank you!!