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

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Kelly Colbath

1. My general reactions to the videos are that the physician did a really great hob using MI strategies to address the smoking with his patient. Throughout all of the video, the physician utilizes reflective listening, open ended questions, and allowed the patient to not only lead the conversations but also identify for herself what she wants treatment to look like moving forward in an effort to get the best results. By doing this, the physician was able to elicit more confidence from the patient about her willingness and ability to quit smoking as the conversations progressed. Throughout these conversations he also emphasized and encouraged self choice by having the patient identify small goals, elaborating on them, as she began to slowly see progress and develop more confidence to ultimately develop a larger goal of quitting smoking completely within 30 days. I don’t believe I would have done anything differently… instead I think these conversations really showed the effectiveness of MI strategies and the success and growth of confidence when the conversations are client/patient focused and the questions are open ended.
2. The physician helped this patient resolve her ambivalence about quitting by encouraging her to dictate how her treatment goes, set small goals for herself that do not seem overwhelming or forced, and emphasizing personal choice and control. I liked how he used reflective listening to repeat back what she had stated in an effort to elicit more information and have her elaborate on why she may feel the way she does; which helps get to the root/cause of the behavior which is crucial towards addressing how to change it. These videos were great examples of how effective MI can be when addressing a variety of change behaviors because it allowed me to see the progression of confidence… I think lack of confidence is one of the largest deterrents to change, especially with my own clients. So the whole point is to let the client decide for themselves what they feel capable of doing, elaborating on that, encouraging efforts, and eventually when they start seeing progress for themselves, their confidence grows to a point where they feel able to take on larger goals.
3. The physician effectively adapted MI to the interventions in a primary setting because he allowed the conversations to be patient focused and led. He did so by his repeated and consistent use of asking, listening, and informing. Throughout all of the conversations, the physician asked open ended questions about what the patient wants to identify as the behaviors she is struggling with. The physician also effectively used the strategy of “informing” throughout the conversations but not in a forceful manner that might deter progress… instead he asked to share with the patient and only during times where she had introduced a level of willingness to explore further options into the conversation. I liked how he also left room in the conversation for the patient to identify why she feels the need to smoke and the underlying reasons (i.e. the benefits of it- makes her feel good, uses it as a way to socialize, relaxes her, etc). by doing this, I think it allowed the patient to be more open to exploring solutions. The patient responded positively to the physician’s approach and it is shown by her repeated willingness to continue engaging with him and allowing him to play a role in her treatment and next steps. All of these conversations depict a patient who is working through her ambivalence to change the behavior of smoking, grow in confidence, and open up to different treatment options for a higher likelihood of success.
4. I found this course incredibly informative and helpful. The MI skills and foundations covered in this course has allowed me to take on a different perspective on how I speak with my clients and how I address change behaviors. Moving forward, I can see myself completely changing the approaches I take towards conversations with my clients about changing certain behaviors. I work with youth in the state who have mental health diagnoses and also involvement with the department of corrections… this population is accompanied by a lot of ambivalence as well as health-risk behaviors. This course has challenged me to take a look at my own approaches with these kids and allowed me to see that I may be seeing more ambivalence than I am progress/outcomes because of my own conversational methods. I plan on implementing the MI approaches and skills I have learned throughout this course to adjust the ways I have conversations with my clients and make sure that each conversation moving forward is: client focused and led, full of open ended questions, reflective listening, and grounded in the spirit of MI in order to give my clients a sense of control over their own lives and choices and encourage a growth in confidence.