Question 1: I really liked the way he listened, both reflective listening and offering encouragers while she spoke. He also used a lot of summarizing after she spoke. He overused an affirmation, able to stop while in the hospital, but was clearly trying to focus on what she could do vs. the challenges. Probably the most significant thing I would do would be to spend more time exploring the challenges to quitting that the patient is aware of that seemed to be glossed over by the interviewer in favor of keeping things positive. I would have balanced all the focus on the challenges with more exploration of desire, reasons, and need to quit.
Question 2: He used reflective listening several times such as “make sure I understand…” He asked about the positive aspects of smoking before asking about the negative. This is the main way I saw him work to resolve ambivalence, which she didn’t have much of, and develop discrepancy. He initially used the 1-10 scale around how important it is to quit and then again for how confident she is about her ability to quit. He then reviewed the confidence scale in a later session.
Question 3: He appropriately used asking, listening, informing around exploring medication interventions specifically “what are your thoughts about medications to quit smoking?” She responded “ I was thinking maybe we could discuss that again because I still need some help.” He listened here, but I also got the impression that they had a prior conversation where perhaps she declined medications. In an earlier video she expressed having tried the patch already but it wasn’t explored that much then. After her one sentence answer giving consent he used informing to give the extensive array of medication options available to support quitting. The patient reacted negatively to the gum for disgust reasons, I didn’t get a clear understanding of why the patient rejected the Zyban, but just honed in on the newer medication. Over all the videos there wasn’t a whole lot of resistance to the physician and so the MI used seemed more subtle than earlier videos and more focused on the positive and commitment aspects. I didn’t see the reaffirm commitment used a lot or expressing commitment to another person, though for a moment when talking about medication I thought that’s what he was doing, he was actually just checking if someone could watch out for her around dangerous medication effects.
Question 4: One thing that stands out is my apprehension about using 1-10 scales, but it was really interesting to take their number response and ask why it wasn’t a lower number, setting them up to focus on why it’s important to them or why they are confident. I think the repeated use of it in the videos got me thinking about how it could be a useful way to focus their thoughts on change. I feel I was already reframing resistance with reflective listening. Another thing that stood out to add to my work is to explore arguments for not making the change first before exploring change statements. I work in a person-centered framework to start which is in alignment with MI principles and techniques, but I can see the opportunity to be much more strategic with my interventions in ways that can help clients become clearer about and meet their goals.