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

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Diane Scalia

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?
I was impressed with the way the physician appeared to effortlessly take control of the conversation while time keeping the focus person-centered and respecting the client’s autonomy and self-efficacy. Considering that this intervention took place in a physician office that requires a brief intervention, I think I would have done anything differently.
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.
In the first video, the physician used open-ended questions and reflective statements to explore the woman’s ambivalence about quitting, he also acknowledge her prior attempts at trying. The physician used decisional balance to develop discrepancy (i.e. “What’s good about smoking?” and “What’s not good about smoking?”), then summarized the woman’s statements. The physician used the importance scale and the confidence ruler to guide the woman towards change talk and generating her own choices, which affirmed her own ability to change. The physician then summarized the client’s plan.
In the second video, the physician used OARS to reaffirm the woman’s commitment to quit and affirm self-.efficacy. He asked “what’s different, what went well, what did not go well, what will you do, when will you come back” and provided reflective responses.
In the third video, the physician responded to the client’s decision with CAT and the confidence ruler, open-ended questions and reflective responses. He used ask, listen, and inform to offer the woman a menu of options for medications and tools to help with quitting, and summarized her plan.

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.
The physician was able to guide the woman from feeling helpless and hopeless in the first video to confidently stating that she had set a quit date in the third video. What impressed me most was that this change occurred in a “brief” setting. The physican directed the conversation, which never seemed rushed or short, the intervention was person-centered, respected the woman’s autonomy, and used basic strategies of MI. The woman remained engaged and motivated throughout the process and reacted positively to the physician’s guidance.
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?
I work in a setting that serves clients with mental health and co-occurring disorders and I have found that motivating clients who struggle with anxiety and depression can be challenging. I made a little “cheat sheet” with the OARS and SOAR acronyms that I keep taped on my desk to prompt me to use more MI strategies to empower the client to set goals they are more likely to achieve. I also laminated a copy of the “Am I Doing this Right” card that I keep handy to prompt me when I feel stuck. I think it’s easy to get caught up in the time-frame requirements of my work and overlook the fact that client’s know themselves best. This course has helped me increase my skills and I can see how MI can be combines with techniques like CBT and BA to help clients stay engaged and motivated to move forward. I also learned that MI is a skill that comes with practice, practice, practice. I will definitely take more courses and continue to expand my knowledge of MI.