What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.
In the first video, the individual does a fantastic job of engaging in some change planning and presents ideas such as going to church or dancing. At this point, the MI counselor could have done a better job in sorting through these potential options and amplifying the individual’s desire to change. Additionally, the MI counselor presents the idea of AA without first asking the individual for permission to share a suggestion and then at another point in which I am assuming was an attempt to come alongside the individual, begins talking about how at times there can be “heavy drug users” at AA. These comments appear to be a bit unwarranted for the conversation-the individual was not asking what to expect at AA and even shared that he had a friend that went to AA. A better option might have been to spend more time exploring the individual talking more to his friend about AA and maybe exploring attending a meeting together. In the second video, we see this explored a bit more and the MI counselor digs deeper into exploring the individual’s commitment to change. A plan is arrived at, but to be honest, more could be done to explore this plan. For example, part of the plan was that the individual would connect with his friend after leaving the counselor’s office, but this will be in the work setting which the individual didn’t appear to be too comfortable with. The MI counselor could have worked a but more with the individual to better understand how he would like that conversation to occur. In a few cases, it felt as though the MI counselor was leaning into the “expert” rather than really approaching the conversation from a place of curiosity. Additionally, there are opportunities for summarizing and reflecting that are absent. For example, when the individual is speaking about the football game and not attending. The MI counselor misses the opportunity of reflecting this back to the individual, missing an opportunity for a potentially powerful dialogue.
What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?
If I were the counselor in this role, I would likely approach the conversation with more open ended questions. Fore example, in the second video, the counselor expresses his concern about going to a party and rather than ask the individual what they would like to do, the counselor again shifts to the expert and takes the stance that the individual should not go. If I were working with this individual, highlighting when CAT statements are made as well as reflecting back more frequently. Additionally, it could be helpful to utilize more strategic responses to better come “alongside” the individual to again amplify their personal autonomy to change and that we are “here for the ride” and they are in the driver’s seat. I feel that at any moment during the MI counselor’s conversation, it could have been easy for the individual to lean back into resistance and the status quo given the nature of his approach.
How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?
Utilizing MI strategies could play an imperative role in the work that I am accustomed to. For example, in the past I have worked with youth involved in the legal system, often engaging in risky behaviors such as substance use. In working with the adolescent and young adult population, these individuals truly need to know and feel that they have the power to make the decision to change on their own. Utilizing MI strategies with this population allows the youth to engage in change talk, planning and critical thinking from a nonconfrontational standpoint. By removing any sort of opportunity for resistance in the conversation and allowing the individual to remain in the driver’s seat, highlighting that they have the power to make this decision for themselves leads to better opportunities for sustainable change, and ultimately outcomes.