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

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#25254
Robert Hussey
Participant

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?

The physician was able to reflect, ask open-ended questions, and guide the conversation with the info provided by client. The client was highly ambivalent about whether she could quit smoking. Her medical diagnosis scared her enough to seek change. She spoke with physician about her options. She informed him of her history. Her parents smoked while growing up, smoking was glamorized at the time on TV, she smokes while anxious or idle, and is also a social smoker. The physician was given a lot of info to work with to help guide a plan. The physician also accessed confidence levels and asked client what she thought could work to help form a plan and make it more attenable, concrete, realistic, and timely. It helped having incremental goals such as reducing the number of cigarettes per day and writing a journal to help keep track of thoughts, amounts, and situations. Check-ins were also part of the plan to help with accountability.

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.

It helped having incremental goals such as reducing the number of cigarettes per day and writing a journal to help keep track of thoughts, amounts, and situations. Check-ins were also part of the plan to help with accountability. Client was proud of incremental successes that she made a commitment to cut back on the number of cigarettes smoked per week even further. Client also looked into hobbies and social groups. She made a promise that she would try to refrain from smoke breaks with coworkers since she acknowledged she was also a social smoker. Client acknowledged that she could still work towards her goal of stop smoking with support and incremental successes to boost confidence.

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 asked open-ended questions, listened, and reflected on what was said. He provided info when given permission. He helped guide the conversation to help the client articulate on why they felt stuck, why they were seeking change, and asking client what they think could work for them? The client recognized that the incremental successes. Client made a new goal to quit smoking cigarettes within 30 days while maintaining supports.

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 like the idea of focusing on goals and exploring options in a more collaborative and empowering way. Clients may be more receptive to change when it appears more attenable, concrete, and within their power. I like how motivational interviewing stresses collaboration and open-ended questions to elicit more engaging responses and narrative. It feels less of a power struggle between client and perceived authority figure especially when the usual assumptions perceived by clients are: “who knows best and listen to and act on the advice given?” The steps to achieve goals need to be tailored and the causes and assumptions need to be explored. The client is the expert pertaining to their life and the physician (or counselor) is the expert in specific subject matter. The client and physician (or counselor) need to collaborate to make progress.