Reply To: Week 1 Homework Assignment (Applications of MI)

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Tiffany Albert

Question 1: The Spirit of MI and the confrontational styles provide a clear difference in response from Sal. The confrontational style elicits a defensive, resistant and overwhelmed response from Sal. He clearly becomes more focused on defending himself than looking at the potential for change. The Spirit of MI style, being client driven, provides an open dialogue that encourages Sal to express his thoughts and ambivalence about making changes. Sal responds to this approach by being more expressive of his emotions and thoughts, including his ideas of change (reducing smoking, reducing drinking to 3 drinks a night) rather than defending his behavior. The Spirit of MI style gives Sal space to share his ambivalence and move toward engaging in action on his own terms, calmly, without fear of judgement.

Question 2: The behavior I feel ambivalent about is waking up earlier in the morning during the work week.
Ambivalence statements:
1) “I’ll have to go to bed earlier and won’t be able to watch my tv shows”
2) “I’ll feel too tired all day if I get up too early”
3) “I don’t know that it will be worth it.”
Other side of ambivalence:
1) “Getting up earlier will mean I can get more done before work”
2) “If I get up early, I will have more time for my morning routine and not feel so rushed.”
3) “Getting up early will mean I can have more time to myself before the kids get up.”
Double sided reflections:
1) “You feel like you would have to miss out on your television shows in order to get enough sleep, but also feel like you will be more productive if you get the rest and get up earlier.”
2) “On the one hand you will be tired if you get up early, but you will also be able to take your time and not be rushed in getting ready”
3) “You are questioning if getting up will be beneficial to you but also are thinking that you may be able to have more self-care with time to yourself before the kids get up.”
By identifying the ambivalence and then reflecting on them, it encourages thinking about what is more important to me. Once I did the reflective listening responses it felt like a “duh” moment – why wouldn’t I want to make changes? The positives outweigh the negatives for change.

Question 3:
Consumer-generated target behaviors that may want to be discussed:
1) Less swearing
2) Not getting as many demerits at school
3) Not being bored
My own agenda:
1) Increasing exercise to improve self-image
2) Getting involved in activities
3) Reducing caffeine intake
Within the two lists there are some overlapping target behaviors, however the ones I identify are more specific, based in my own beliefs of what I think is best, and do not allow for choice from the client. This clearly shows a “righting reflex”, a desire to push the client in the direction of what I feel is the right thing to do. In order to avoid engaging in this behavior as the therapist, my focus should be on supporting the patient in identifying what he wants to address, allowing him to take the lead. The approach is best supported by open ended questions, affirmations, reflective listening and summarizing the information provided by the patient, not interjecting the personal views of the therapist. This would look like asking the patient what he would like to address, using open-ended questions to encourage expression of his views on what has worked/not worked, and summarizing the information provided (being sure that the patient agrees with the summary).