Reply To: Week 4 Homework Assignment (Applications of MI)

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Natalie Lonstein

Question 1:

I thought this provider did a pretty good job using MI skills to support his client. I feel like exploring the good things about smoking in the initial video increased her buy in and she felt validated. By asking about the good things she experiences, it also named for the client that she gets something positive out of the experience instead of focusing heavily on things she needs to change. I believe that he used some good reflections, summarized things well, and naturally used the importance and confidence rulers. I would have tried to ask permission when explaining what different medications could be used when planning for quitting.

Question 2:

I thought the provider did a good job of exploring his client’s ambivalence in this video. As noted above, I think by leaning into both sides of her ambivalence and exploring both the good things and not so good things about smoking, it increased her buy in and validated her. Instead of feeling pressure to report out on why she “knows smoking is bad”, she was able to be genuine, open, and honest, about the multiple factors influencing her to keep smoking, or the good things about it. These were placed on a level playing field of both being impactful for her. After this exploration, the provider first asks about the importance of quitting smoking, then asks her confidence in doing so. The client gave a high score for the importance of quitting, but a low one on her confidence – the provider asked about why he did not rate herself even lower, which gave space to encourage more change talk from the client.

Question 3:

I think there was a pretty good balance between Asking, Listening, and Informing in these videos. In the first video, the provider focuses more on asking open-ended questions to gather information from the client, explore her current feelings about smoking, and inquiries about the two sides of her ambivalence. He listens to her responses, validates her, and summarizes what she shares by repeating back to her what he has heard. In the spirit of MI, he supports the client in her ambivalence, and gently explores the importance and change rulers with her. In the third video is when the provider does more informing, which landed well with the client. If the provider did more informing in the first video, I’m not sure the client would have had as positive as a reaction. By focusing on asking and listening as they developed a working relationship, the client built confidence in herself, and was actually excited to share change and quitting plans with her provider. Her confidence increased the more success she had.

Question 4:

I have enjoyed working through this course of the last several weeks. I have greatly appreciated the concrete information and skill building work, and how we can integrate these skills into our practice. In the work that we do in the community with children/youth and families – I can see MI skills being helpful in a majority of situations. Not only are there conversations that can be had with some of our youth/teens about their decision-making, use of substances, and other risky behaviors, MI skills and approaches can be used when working with parents on behalf of their children. In addition to continued practice using OARS, incorporating the importance and change rules into my work could be especially helpful not only for clients, but with staff. Something I continually try to remind myself and staff of, is that we are responsible for the process and intervention, not the outcome.