Reply To: Week 2 Homework Assignment (Applications of MI)

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Kelly Colbath

1. General impressions of the “Rounder” approach is that it seems to be more effective than many other interviewing styles I have seen… mainly because the open ended questions that are asked allows for the person being interviewed (Jim) to explore their own ambivalence to certain behaviors. I noticed that at the beginning of the interview, Jim seemed very irritated to be there, ambivalent to any talk of change, and somewhat closed off. However, towards the end, the tone of the conversation changed and Jim seemed to be more open to exploring his “unhealthy” behaviors and possible solutions he would feel comfortable with pursuing.
2. Examples of Rounder’s sustain talk primarily take place at the beginning of the interview while Jim shares why he is there and what has been going on recently. Coinciding with the examples of sustain talk are statements that are blaming towards others and Jim not acknowledging his responsibilities or taking accountability for his actions. Examples of this sustain talk are in the beginning when Jim talks about how his daughter expresses her concerns about his drinking but Jim is in denial about this and immediately turns it around to acknowledge the fact that he has “always bailed her out”. This shows an unwillingness/not wanting to change this behavior and instead, emphasizing what is wrong with others’ concerns about the drinking. Another example of the sustain talk is when Jim talks about how annoyed/irritated he is with having to engage in these services and that he is not here because he wants to be but because others are stating he has behaviors he needs to change. Another statement that stuck out to me was when Jim was trying to downplay the drinking… for example he was telling Terri that the drinking is not as bad as everyone things because he “drives short distances” and only “drinks a little bit”. This seemed like the turning point in the conversation when Jim almost started to acknowledge the behavior itself but was still declining the “problems” with the drinking. Rounder’s change talk starts to become more apparent towards the middle/end of this interview as Jim starts to open up about exploring changing his behaviors and solutions to it. For example, Jim says “People keep saying that you need to stop drinking and I aint never done that either. I think I could.” This is an example of Rounder’s ability step of change talk. He begins acknowledging that he COULD stop if he really tried but claims that he is ambivalent to stopping. Another example of change talk is when Jim states “I wouldn’t mind coming here to live” in response to the idea of the treatment facility. This is an example of desire as Jim begins to open up about the possibility of pursuing a solution/change to his drinking. And lastly, when Jim acknowledges that if he does not stop drinking, he will be in this situation again and states, “as long as I’m putting all this money into it I’d like to come out with something.” Which is an example of commitment as well as reasons because Jim is showing that there is something to gain out of changing this behavior and is willing to put in the money and work into committing to trying.
3. The interviewer uses a lot of reflective listening during the interview which is shown by her repeating what he says back to him. This allows Jim to hear what he just said, maybe in a different phrasing, and continue to elaborate more on that thought. I think the interviewer does a lot of reframing during this interview especially when Jim has statements of ambivalence towards changing his drinking behavior or his ability to. For example: the interviewer repeats back what Jim has already shared in the interview pertaining to his previous progress when he has attempted to stop drinking before by saying “right, you were successful in changing that in the past and sound like you’d kind of like to be successful changing this.” This allows Jim to steer the conversation in the direction of change based on information he already had shared with her earlier in the interview that evoked a sense of change. Throughout the interview, the interviewer continuously repeats back and focuses on Jim’s statements towards changing his behavior to evoke more from Jim about his thoughts towards what he feels he could change and how.
4. One example of Rounder’s signs of readiness to change is when he states “cause when I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?”. This statement is an example of envisioning and change talk as Jim begins to acknowledge how the continuation of his drinking will affect his future and what his future would look like with and without the drinking. Another example is when Jim begins asking the interviewer questions about if ambivalence is “normal”. This kind of talk is an example of questions about change and overall, deceased sustain talk. Towards the end of the interview, Jim stops denying and defending his drinking and instead transitions into a state of mind where he is open to exploring ways to change the behavior, asking the interviewer what to expect, and sharing that he is aware of the need for change but ambivalent about how to go about it—but still willing to explore ways, such as the treatment facility. If I was the interviewer and saw these signs of readiness, my next step would be to summarize the change talk elicit a commitment to change by asking Jim to express his commitment to change. I would highlight what he shared throughout the interview that involved acknowledging a willingness to change and being open to exploring changes. By focusing on these pieces and asking for him to express his level of commitment to this change (i.e. what is the next step for you) it allows for Jim to continue in the direction of being motivated to change/take action.