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

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Question 1
The patient sounds desperate and almost hyper about her recent COPD diagnosis. Through complex reflection and active listening, he actually calms her down and helps her focus. He asks her about the pros and cons of smoking. He reflects back her answers and this seems to slow her down, and calm her down a little. He uses the importance scale to find out how important it is for her to quit smoking. She says 10. He then uses the confidence scale to gauge her confidence level. She says 40%, and then he asks her what it would take to build it to 45%. That’s not much of an increase, but a small enough increase to get her started. He used affirmation in congratulating her for taking the important first step of coming to see him for help. He asked her if she’s willing to monitor her smoking for the next week. He then uses open-ended questions to find out how she feels about his suggestions. He uses affirmations again to point out her success at keeping a journal, and her ability to smoke two to three cigarettes in one week. He asked her more open ended questions about what was not going well. She explains that the weekend was the hardest. They build a plan to continue her journal. She plans to reduce her smoking by five cigarettes. She also makes another plan to come back in a week. Here, I would have taken her suggestion for developing a hobby. I would have also talked about alternatives for oral fixations, like chewing gum, or looking at her diet, perhaps. In her third visit, she’s decided to quit smoking in one month. He then used the confidence scale again to gauge her confidence level, which she admits is now at 80%. This is an affirmation in itself.
Question 2
He used open ended questions, affirmation, reflective listening, and summary reflections (OARS) early and often in his motivational interviewing approach. He used the confidence scale the first two sessions to gauge her confidence level. At first she says 40%, and then he asks her what it would take to build it to 45%. This is such a small push, but achievable, and she agrees. She admits to needing help by talking, and he agrees to see her the following week. He used a lot of open ended questions to get to the bottom of what triggers her habits. By the second visit, she’s at an 80% confidence level. By the third visit, she’s ready to quit in one month, with her 80% confidence level.
Question 3
He used active asking, listening and informing each time. He didn’t ask much in the first video because it was clear she was asking him for specific help to stop smoking, and she seemed pretty desperate. In the third video, he listened to her successes, then asked about what she would have to do to prepare for the date when she says she’s finally quit smoking for good. She talks about what is working, and at about 2:06 in the third video, he asked her the open-ended question of her reaction to medication to quit smoking. She was receptive to it, and he spent a lot of time informing her of the various medications she could use to achieve her goal.

Question 4
I am taking with me the 1-10 scales, and the follow up question of why that number and not a lower number. I love that. I will also share with my colleagues the change plan worksheets, and the personal values card sort. We actually use a card sort with our participants about Money Habitudes. These are great tools to bring awareness and conversations about when working with people who are in transition and open to making changes. Thank you so much. This is a great class.