Reply To: Week 3 Homework Assignment (Applications of MI)

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Caj MacDonald

Question 1
I found both of the videos clunky and challenging to follow. I felt the clinician talked too frequently, used too many closed ended questions and cut off the consumer when he was sharing his thoughts. I found myself wanting to know what the consumer would have said had he not been interrupted. I also questioned the consumer’s readiness for change even after both videos.

I do not feel the MI strategies used to develop the specific change plan were very effective. As the listener I wasn’t very clear on what the plan was at the end of the video. The consumer indicated he, too. might be uncertain as he noted “I don’t know what I’ll do” and “I’ll ask him (coworker) if he is there (or if it’s at an appropriate time).” There was a great deal of focus on utilizing the support of AA, but the success of that seemed to lie with the coworker and it isn’t clear if the coworker is even able to provide the support or direction needed. The clinician assumed “You can expect him to be supportive because he’s been there before.” In the second video the consumer again referred to not really understanding the process of AA (regarding the meetings) and noting he would watch the game “somewhere safe,” but there was no follow up on clarifying these comments. It also ended without a clear summary (verbally or in writing) .

Question 2
I feel like there should have been more focus on evoking the CAT steps as the consumer still seemed a bit unsure or hesitant at the end of the first video. The clinician summarized “So the goal is not drinking,” yet the consumer didn’t fully endorse that statement. The clinician also added “So you are highly committed,” but again I didn’t necessarily hear that. There were several parts where I felt open ended questions would have been helpful to better understand the consumer’s position. I also noticed the clinician provided a lot of information when it wasn’t requested yet he did not respond to openings such as “I don’t really know what help is available.” The clinician made some assumptions about the role of the church and the willingness of his coworker to assist with AA which I wonder if they were accurate. There was a lot of focus on reengaging with the church (which I wasn’t convinced was a strong possibility), dancing (no elaboration on what that meant) and AA (which I feel the clinician almost tried to talk him out of at times).

I would have used more reflective listening, open ended questions and summarizing during the change planning. I felt like the consumer stated a need (I have to make a change at some point), but the process needed to be slowed down to further explore this. I would want to focus more on clarifying the goal (what would it look like) and specifically what the consumer would like the change to be. In considering options I would explore how effective the consumer sees
each strategy to be and how confident he feels in trying each one. Again, I don’t feel this was fully discussed in the videos leading to possible challenges with his success. I would also focus more on summarizing the plan for clarity both verbally and in writing. The clinician did ask for follow up later that day, but I would also want to explore/utilize the support of the wife which the consumer mentioned several times.

Question 3
In the population I work with others often set goals and expectations for the teens (parent, teacher, peer, etc) and this is often a source of conflict. I have found teens to be very willing to make changes in their life and they often have a great deal of insight on this. I will continue to focus on supporting them as they work to define their own goals, identify various options and problem solve each strategy. I need to be mindful of waiting for permission before providing suggestions or information. In a recent session I offered an option too quickly (and without permission) in regards to a student wanting to stop vaping. I informed the student of a community resource, but it was clear from the reaction that my timing was off. Just like adults, teens aren’t necessarily looking for advice, but a sounding board as they consider changes. I also need to remind myself that change doesn’t happen in a linear fashion and that revisiting the change talk is part of the process.