Question 1: My general reaction to the two videos is that the counselor did not fully understand the spirit of MI. The counselor often interrupted the patient, played the role of expert/educator most often rather than a collaborator and did not allow for space for the patient to process through their own ideas of change and what that would look like. The counselor’s use of MI was somewhat effective, as the patient did become less ambivalent about change, but I still felt that the patient did not fully commit to making said change. In the development of the change plan the patient still exhibited some hesitancy, which is likely the result of the counselor’s direction of change (“Hopefully that will lead you to going to an AA meeting”) rather than the patient exploring and identifying what he thinks will work for him.
Question 2: If I were in the role of counselor, I would have focused more on allowing the patient to express his own thoughts of change, encouraging him to share what changes he felt he could do, only offering advice/information if asked or with permission and allowing space for reflection without judgement. In the video the counselor seemed to have an agenda as he spoke over the patient, made statements about expectations (“So you can talk to that guy about AA. He will be helpful with that.”, and did not leave much room for the patient to come up with his own plan for change. In the role of counselor, once the patient identified what changes he would like to make, I would solidify a plan with him by summarizing his change talk and working with him to identify what tangible steps he can take to make these changes. The counselor in the video made a plan based on his own suggestions in addition to a few points the patient made. He also did not have a solid plan for follow up, wishing the patient good luck and then telling him to check in about how it went.
Question 3: Within the work that I do I have found that I already engage in some of the MI strategies and have been incorporating more since beginning this training. I work with teens who are often ambivalent about making changes in their lives (mental health treatment, drug use, behavioral changes, etc) and I have seen this strategy help a population that is struggling with a desire to be autonomous the opportunity to do just that. I find that when given a space to work through their own problems, without judgement, with their own direction leading the way, patients often make good choices for their lives and are more successful and stick to their decisions.