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

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Colleen Drake

Question #1:
My general impression of this physician’s use of MI to discuss smoking cessation is that it appeared to be quite effective for Jean. Over time, he was able to help evoke change talk and an action plan with Jean that appeared to be quite client-driven. She started the sessions with a strong understanding of the need to quite but a very low confidence in her ability to quit. By the last video she had significantly increased her confidence level (up to 80%) and had set a SMART goal to be totally done with smoking within the next 30 days. The physician appeared to have a caring approach and used affirmation with Jean as part of the OARS technique. There are two things I think I would have done differently, had I been the physician using MI with Jean. 1- I would have tried to spend a little more time with Jean working through eliciting ideas for why she was feeling so ambivalent about quitting in the beginning. 2- I would have asked her permission before providing information about options (such as the medications mentioned in the third video). I think it may have been helpful for Jean to do a bit more reflecting on the reasons behind her ambivalence to help her work through the acceptance piece of letting go of some of her identity as a smoker. I also think it would have been more appropriate to ask for Jean’s permission before providing her with suggestions and options to take a more client-driven approach at that part of the discussion.

Question #2:
The physician used a lot of OARS technique to help Jean resolve her ambivalence about quitting smoking. In each video, multiple times throughout, he used reflective listening, open-ended questions, affirmation and summarization. He asked her open-ended questions about her reasons to smoke and her reasons to not smoke. He also used double-sided statements about her ambivalence and checked with often to ensure he understood her thoughts and feelings about the situation. His use of MI techniques seemed to help Jean think about her options more, and she had already come up with some coping ideas and techniques to use before he suggested them. He helped her with setting SMART goals, using open-ended questions, and Jean was able to set time-frames around the choices she made. He often went back to the confidence rating measures to check in with Jean about where she was at, which I imagine helped her to see the changes that were happening in her own way of thinking about smoking cessation.

Question #3:
The physician did a great job adapting the use of MI techniques in a primary care setting. In my answer to question #1 I had included that I may have spent more time talking with Jean, however I understand that in a primary care setting there is not always time for that. I think he did a great job balancing the use of their limited time, with the use of MI techniques, while still using phrases to indicate that Jean was the one making the decisions and that it made sense that she was feeling the ways that she was. He didn’t really start providing her with much information about options to help Jean quit (such as medication) until the third video, which allowed Jean to brainstorm ideas and try to use what she felt would work best for her first. As I had said in my answer to question #1, I do think he could have done better at asking for Jean’s permission to provide information to her- however it seemed as though Jean was receptive to it and wanted to know more about her options. She expressed being appreciative of his support, noting that having the sessions regularly with him and keeping in contact were some of the things that were helping her to stay on track with her goal. I did not get the sense that Jean felt judged about her decisions and it appeared as though she was happy with the progress made and her final quit goal she had come up with. In the first video Jean seemed to feel a bit ashamed and by the last video she seemed very proud of herself. Her ambivalence dropped significantly over time and her confidence in her ability to quit greatly increased.

I have appreciated this opportunity to take the MI training course. I have taken another MI course in the past, though it was only an introductory one, and I feel that I got a lot out of this one. I think having to do the weekly homework really solidified the concepts for me. I have enjoyed seeing the use of MI play out in the videos and feel that was also a helpful learning tool. I think the use of MI likely leaves the clients feeling more respected by their providers and more in control of their own decision making. I think it also would lend to a higher rate of success with changing health-risk behaviors based on the caring approach and the fact that the person who is considering change takes the lead in decision-making and planning. I think after taking this training I will continue to incorporate and increase the use of MI in the work that I do with clients. I think it has helped me find awareness that I am quick to use the “righting reflex”, out of a desire to help others, and having that awareness will help me use more pause and time for clients to consider things on their own. Thank you!