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

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April Archibald

Question 1
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.

I found myself feeling frustrated while watching both videos. The counselor seemed to have a understanding of the some MI techniques and would begin by implementing a technique but seemed to quickly abandoned it and provide information/education instead. This seemed be the focus of the counselor. Rather than truly hearing what the client was saying, the counselor seemed to be more focused on his own responses. At times is seemed as if the counselor wanted the client to hurry up and finish talking so he could give more information. There were several missed opportunities where the counselor could have asked permission to inform the client or asked the client if he knew more about AA or how it might be helpful. I was also irritated that in some of the spots where the client seemed as though he was going to elaborate, the counselor interrupted him and side tracked the change talk. It seemed in the second video the counselor misunderstood what the client was trying to say regarding attending the party. Some reflections might have been helpful there as well as some open questions or request for examples. Overall the conversation seemed disjointed, confusing, and disorganized and I had to review it several times in order to identify the plan. It seems the only plan that was agreed upon was for the client to talk to his co-worker about AA. There were brief mentions about church and dancing (?) but I was unsure where this was heading. I can imagine the client might have been confused as well. I do not feel as though the counselor’s use of MI was helpful. Some attempts showed promise but overall his techniques did not seem facilitate change talk or planning.

Question 2
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?

I would do several things differently if I were the clinician. First, I would sit still. The counselor seemed to be very uncomfortable which gave me the feeling that he was not interested in what the client was saying and his movements were distracting. I would ask permission to provide information and check in to see if he had any thoughts about the information or if anything I said gave him other ideas. I might ask if the client wanted to make a list of options and then how successful each option might be. I would follow that up by asking he client how confident he felt he would be in succeeding with the options. I would then evoke a plan and commitment from the client. If the plan was to attend an AA meeting, I would see if we could narrow down the day, time, location, etc. of a meeting he would attend. I would ask how confident he felt about succeeding and perhaps if he saw any obstacles.

Question 3
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?

I use MI frequently with my clients that struggle with ambivalence or feel as though they are stuck. I like to use the scale as I feel as though this is helpful in affirming their level of commitment to change. It often surprises them how motivated they are or how important the change is. Helping them set goals for change adds to their investment, particular if the goal is manageable and attainable. It is rewarding to hear a client at their next appointment talk about how they accomplished their goal or made progress. They are often surprised and pleased with the outcome and reported the plan was easier than they anticipated. This course has been helpful in refreshing some concepts and the videos are a great tool in seeing techniques at work.