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

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Jenai Jackson

Question 1:

I thought the clinician used MI in a very efficient way. The progress the patient made from session to session was very clear and I saw her confidence increase over time, as well. For me this ultimately means it was a success. He was informative and realistic while also being supportive. He was also able to really move the conversation along in the limited time they had. The client expressed early on that she really just needed someone to talk to and so I would have encourage and discussed more outlets in which this could happen. That is the main thing I would have tried to do differently. Making sure she had supports for when our sessions were over.

Question 2:

The clinician asked great questions and incorporate a ton of reflective listening throughout the conversation. Sometime the reflective listening sounds very repetitive but I do see the benefit and the openness it brings to the conversations. At one point the clinician assessed pros and cons by asking “What is good about smoking” and this opened up so much information about the patient and their history which provided a lot of context to work with and dig through. The patient shared her family history with smoking and said it’s what the family does. She also said it seems to be an extension of who she is and is a part of her image. This showed what areas need to be targeted in breaking the habit and that the family may not be the most supportive and that outside support groups could be beneficial to this patient. I also liked that the clinician asked a lot of open-ended questions like “Is there anything I missed?”. This created more space for the client to express herself and she revealed even more. I liked his constant use of importance and confidence scales. I also liked that when she said she needed to cut back on cigarettes that he invited the patient to take a step back and journal to really understand her behaviors around smoking. I could tell the client was putting a lot of pressure on herself and when the clinician was able to take a lot of the pressure off of her by inviting her to take a step back and reassess how she is doing and feeling about smoking. And this act brought about behavior change on its own just by increasing awareness. It also showed that weekends are a more challenging time for the patient which can help them tailor more solutions and angles for change. In the last session, the client came in so motivated to change and she expressed it from the very beginning which showed her trust in the provider and the relationship they formed over the many sessions.

Question 3:

I really enjoyed seeing the use of MI in a primary care setting. The sessions were shorter and more focused but it focused all the following sessions in a very specific way. In video 2, they accomplished so much in just that quick check in. Also the process of multiple checks in worked for this patient as she expressed she need support and someone to talk to. This format definitely benefited this client. With limited time the ask, listen, inform approach seems like a great fit. It starts off the conversation in a direct way but still gives space for the conversation and work that needs to be done. I think the patient reacted to it well, especially as more sessions passed and she got a feel for the space and environment. With her limited confidence at the beginning, the clinician was really able to open up the space using these techniques so that he could guide her and be supportive without removing the spirit of MI. Over time she was confidence and jumped right into the conversations. Her tone changed and she was a lot happier at the end.

Question 4:

Going into this course I knew very little about MI. It was reassuring taking this class and realizing that there are many small ways I can bring the spirit of MI to my work. I never have more than 10 minutes with patients due to the nature of our clinic flow but with a few key techniques like Asking, Listening, and Informing, and with confidence and importance scales, I can build a better foundation for communicating with patients and leading them towards behavior change. My clinic also hopes to create more spaces to connect with patients in the future through support groups and community advisory board meetings and this is the type of language and mindset I want to bring back with me as I engage with patients. I work with a pediatric population and rarely ever talk to patients without a parent or another family member in the room. I think it could be challenging to use these techniques with a third party in the room but also a benefit in a way as the parent will also hear my tone and hopefully I can form relationships with both the patient and parent. Another challenge is the pediatric patients tend to be a bit more introverted and shy (I think because they are used to the parent doing most of the talking). I hope the open-ended questions and reflective listening show that I really am here for them specifically and that they are my focus. I plan to study the information more and feel confident that I can use it in my work setting if I am able to create a physical environment in which I can do so.