I had a bit of a hard time staying focused on these videos. I thought there were more closed-ended questions and times where the clinician provides feedback or information when permission was not yet asked. There was feeling that the clinician was acting as the expert and that he was guiding the client to do what he believed was needed. Some open-ended questions/statements were used in attempts to evoke commitment to a plan were “What are you going to do?” and “When are you going to do that?”, which did get the consumer to think in concrete terms about committing to a plan and taking steps in the plan. However, I’m not confident in and did not get a feeling that the consumer was really committed to the plan and would follow through when leaving.
If I were the counselor in this role, I would have used more open-ended questions, double sided and amplified reflections, and rolled with the resistance. I think more validation around the hard parts of making steps toward change would have increased rapport, and led to more in depth discussion around the two sides of ambivalence. I also was put off at times when the counselor provided education and information without asking permission – I would make sure this is done. I also think that even though there felt like some guidance toward a plan, there was some discussion around plans to attend AA, etc. I think I would also have used the change ruler scale to assess the consumer’s commitment to the plan (though I think more exploration could have been done to nail down and even more concrete plan).
I see MI strategies for change planning coming up a lot in the work that we do with children/youth and families. Often, there are discussions around families or clients being “stuck”, or staff noting concerns about the ambivalence of clients (namely, having ideas or goals or thoughts around service options and resources, but that clients do not move forward with them). I think that leaning into validating the two sides of ambivalence is a way to build rapport with families, and also accept them. I think intentional work can be done around identifying the change talk we hear from our clients and families, returning to it, and exploring it more deeply. It also takes the frustration out of the equation for staff as they are not responsible for the outcome. Youth are particularly responsive when given space, freedom, and control – which comes naturally within the spirit of MI.