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

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Olivia Hamlin

Question 1

I thought the physician did a good job in utilizing MI techniques to interact with his patient. He created a non-judgmental space and truly rolled with any resistance she brought up. He had great reflections and was able to state back important details to the patient. This showed excellent listening and care. It appeared as though the patient noticed this and felt safe to continue to come back and talk with her doctor. One thing I would do differently is to go deeper into the open ended questions. It did appear that he was supportive, but I would like to have seen the physician dive deeper into the patient’s reasons. I would have used more “DARN” talk to help create commitment with the patient.

Question 2

Overall, it seems as though the physician helped this woman resolve her ambivalence quite well. Progress began quickly, but the goals were SMART. He asked for specific and measurable outcomes, to which the patient provided. Each week he did affirm her for when she made progress – although there could have been more affirmation. It seemed that he had a good combination of listening and giving input. This seemed to help resolve the ambivalence the most, as it showed care and provided education. Specifically when talking about the medication, the physician had a good guiding approach. This helped to increase the patient’s confidence that she could continue to take the steps needed to quit smoking and that she had option for additional support with medication.

Question 3
This physician did an excellent job of utilizing MI in a primary care setting. Obviously, his interventions were short by nature, but none the less, proved their effectiveness. The patient appeared more open and honest each time she met with her doctor. The patient also made progress and was happy to report on the progress each time. The physician set the stage well at the beginning by allowing the patient to state her concerns, while affirming (reflecting) what would be challenging about quitting smoking. He did not push her to quit after the first visit, but allowed the patient to lead based on her comfort level. Over time, this is obvious that the patient developed more confidence and even sought more information. By the last visit, the patient was informing her doctor about the supports she has in friends and family to help and was beginning to gain confidence in herself. This video series helped to identify different phases of the guiding practices used in MI.

Question 4

This course has filled in quite a few gaps of what Motivational Interviewing is and how to use it with clients. The acronyms have been a helpful was to remember terms and are practical in real life conversations with clients. I often work with clients who are ambivalent about change and frequently are determined as non-compliant. I believe these new skills will allow me to see a broader perspective of the change process and to work more patiently with clients. There is a distinction between working harder – as it is shown that even brief interactions can be meaningful. More targeted work that allows the client to feel heard and affirmed is the goal moving forward. I plan to use the OARS in basic conversations and build off of that to see more into a client’s desire and ability. From there, engaging in a commitment that is realistic to the client will help the client move toward their own goals.