Question 1: General Impressions
This video shows the gradual transition of a patient who does not recognize/acknowledge a need for change to someone who is not only open to change but recognizing the need to make change. Rounder is a more challenging patient to begin, not in session because he wants to be but because the court has put him there. The Spirit of MI allows a natural flow, opening the possibilities of change and what this might look like. It was an impressive process.
Examples of sustain talk:
1) “I don’t know what the hell she means I need help.”
2) “… the only reason I’m coming here is so I can maybe save my driver’s license, so I won’t lose my job and so I won’t lose my house. It’s not because I wasn’t to do any of this crap you know.”
3) “I drink a little bit but I work hard.”
Examples of change talk:
1) “I can do just about anything but I can’t say yes to that, that I can stop drinking” – this is an example of change step ability (DARN) where patient is unsure of his ability to be successful with change.
2) “I wouldn’t mind coming here to live…” – this is an example of desire (DARN) as pt is beginning to envision himself being a part of the program, suggesting desire for change
3) “If I don’t stop drinking I’m probably going to be right back in this mess again” – this is an example of reasons (DARN) as pt is beginning to identify why change may need to happen
Examples of interviewer’s use of complex reflective listening and strategic responses with impact:
1) “You’re not here because you think you have a problem. You’re here because they sent you.” – This reflection is at an important time. It shows that the psychologist is listening and recognizing what the patient is saying, without any judgement. Rounder begins to open up about how he feels about the situation and what has been going on.
2) “What do you think caused you to kind of become more… less angry and less violent” – this response encourages the idea of change, that Rounder has engaged in change previously.
Examples of readiness to change:
1) Rounder begins envisioning the possibility of being a part of the treatment facility – “I wouldn’t mind coming here to live…”
2) Rounder recognizes that drinking is having a negative impact on his life – “If I don’t stop drinking I’m probably going to be right back in this mess again.”
3) Rounder increases his questions about change, asking about his own ambivalence and whether or not this is normal.
Next steps: I would summarize the change talk that Rounder has begun, reiterating his statements about how he believes continued drinking will cause more challenges like this in the future and that he could see himself living at the facility. This would be an opportunity to offer/provide more information about the facility, answer questions about treatment and inquire from Rounder what he would like to see happen, how he would like to move forward for the next session.