Week 1 Homework Assignment (Applications of MI)

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  • #4482
    Patricia Burke
    Keymaster

    Exercise 1

    Review the Non-MI confrontational approach to counseling Sal about his asthma:

    and the Spirit of MI counseling approach to counseling Sal about his asthma:

    Jot down your observations about Sal’s reactions to both interviewing styles.

    Exercise 2

    Write down a behavior that is not too emotionally toxic (like procrastination) that you feel two ways about. Then make two columns on your paper. On one side write down at least three statements that express one side of your ambivalence and on the other write down at least three statements that express the other side of your ambivalence about that behavior. Finally, craft a double sided reflection of meaning or feeling for each statement.

    Example: Patricia’s Ambivalence
    “I feel ambivalent about brushing my teeth before bed.”

    One Side of the Ambivalence

      “I am tired when I get upstairs and I have a lot of other things to do to get ready for bed.”

    The Other Side of the Ambivalence

      “I know that taking care of my teeth is important for my overall health and I want to be healthy.”

    Double-Sided Reflection

    “Patricia, one the one hand you are tired at night and it can feel overwhelming to brush your teeth with all the other things you have to do to get ready for bed. On the other hand brushing your teeth fits into you overall plan for being healthy and being healthy is very important to you.”

    Exercise 3

    Reflect on a person you work with and generate a list of 3–4 consumer-generated target behaviors that might be a focus of a conversation. Now generate a list of health behaviors that you would like this person to focus on.

    Homework Questions

    Question 1
    What are your general reactions to the confrontational and Spirit of MI styles of the interviewing in the two videos? How does Sal respond to the confrontational style? How does he respond to the Spirit of MI style? Which of the two interviewing styles helps Sal move closer toward some kind of action to improve the management of his asthma? Why? Be specific.

    Question 2
    Tell us the behavior you feel two ways about. Tell us the 3 statements of ambivalence as in my example. Share 3 examples of a double sided reflection of meaning or feeling using your expressions of ambivalence. Use “you” as if you were a provider offering reflective listening responses to you as the consumer. What are your general reactions to this exercise? What, if any, impact did the reflective listening responses have on your ambivalence? Be specific.

    Question 3
    Respecting the confidentiality of the person you work with, tell us the 3–4 consumer-generated target behaviors that this consumer might be willing to discuss with you. Tell us 3–4 target behaviors on your own agenda. Describe any discrepancies between these two lists. Describe some of your “righting reflex” responses to the consumer-generated target behaviors that do not match up with your list of target behaviors? Describe how you might use the MI Agenda Setting strategy described in this lesson to engage this person in a person-centered conversation about what he or she would like to discuss with you. Be specific.

    Please Note
    While answering the homework questions please only share personal information or specific responses to the homework exercises you feel comfortable sharing. It is up to you to decide how much or how little to disclose. Please respect the privacy and confidentiality of consumers/clients and other class participants in your sharing.

    To post your assignment, please reply to this topic below.

    Click here to go back to the course.

    #24237
    Melissa Ivey
    Participant

    Melissa Ivey

    Homework Question 1:

    In the first video, the confrontational style was used. Sal’s reaction was defensive and argumentative. He did not appear to be open to listening to what the provider had to say regarding changes she wanted him to make. He talked about just increasing the medication versus discussing the possibility that his dog may be triggering his asthmatic symptoms

    In the second video, Sal appeared patient and willing to participate in the discussion regarding his dog. He was able to receive validation for the changes in his lifestyle that he was making. He was also more receptive to her ideas and wanted to work with her to solve his issues with asthma.

    Overall, I thought the spirit of MI styles of interviewing was more effective. The confrontational style made me very uncomfortable watching how frustrated and upset Sal became. The MI styles seemed to move Sal closer to the action stage. He was willing to discuss how he would wheeze when the dog laid down next to him. He seemed more willing to work with the provider to discover what was best for him and did dot dismiss her ideas about his dog.

    Homework Question 2:

    Melissa’s ambivalence:
    I feel ambivalent about exercising regularly.

    One side of the ambivalence: My shifts at work are 12 hours long, and I am tired at the end of the day. I am not sure when to schedule regular exercise. I am out of shape and get discouraged quickly.

    The other side of the ambivalence: If I exercise regularly, I would feel less stressed and more physically fit. I would be able to participate in hiking trips I would like to take this summer. I would lose weight that I gained during the pandemic.

    Double sided Reflection:
    Melissa, on the one hand you work long shifts and you are not sure when exercise would fit into your schedule. On the other hand, you understand that regular exercise will help reduce stress and anxiety.

    Melissa, you also feel discouraged when you try to exercise and get winded quickly. On the other hand, if you did exercise regularly it would fit into your goal of becoming physically fit and losing weight.

    You become discouraged when you’re not able to exercise for as long a duration as you would like, on the other hand, you really want to get in shape in order to complete several hikes this summer.

    I found this to be an interesting exercise. I started off being very ambivalent about wanting to go out and walk. As I was doing the double reflections. I noticed myself becoming more encouraged to give it a try. I found myself playing with my schedule my head in order that I am able to incorporate exercise over the next few weeks. I even reminded myself of the time change that may help motivate me to exercise after work

    Homework Question 3:

    Consumer goals: Increase interactions with others. Gain some independence. Feel better about herself.

    My goals: She would take her seizure medication as prescribed. Attend AA regularly. Leave her house 2-3 times a week.

    The right reflections I participate in are the ones to encourage the client to take medication related to their seizures. This does not always line up with my clients desire to improve their quality of life or independence. They’ve had negative reaction while on the medication.

    Agenda Setting:
    I would start off by asking my client where they would like to begin. I may also have them list the topics that they wanted to make sure we discussed. I would list these topics on a piece of paper we could both see. Depending on the client, I may ask them how much time the believe we should try to spend on each topic. This would provide us with a framework for the session and the client would be shown that they have a say in the process.

    #24242
    Betsey Davis
    Participant

    Question 1-
    My first reaction to watching the two videos of Sal was how very different they felt to me. Sal became very defensive, spoke less and exhibited closed nonverbal communication by turning away from the interviewer several times in the confrontational video. He also told her she wasn’t understanding what he was saying. In comparison, the MI video felt much more collaborative and respectful. Sal seemed to respond well to the interviewer’s curiosity and reflective listening. He seemed much more verbal, sharing a lot more of why it was so hard to understand the connection between his asthma and his pet and how and why it was so painful to look at losing his dog.

    The MI video seemed to close with Sal determining his next steps (being on the highest medication dose available to see how his asthma responded). He seemed to be considering what he’d need to do if that did not work, including possibly rehoming his pet.

    Question 2-
    Issue of ambivalence: “I feel ambivalent about doing concurrent documentation.”
    One side: “I know that doing clinical documentation in session is smart as it means I won’t fall behind and won’t have to think about it later.”
    Other side: “I struggle with doing concurrent documentation, as I feel like it takes away from my presence in session with clients.”

    Betsey, on the one hand, you know that doing concurrent documentation is smart as it means you won’t fall behind on your paperwork and won’t have to think about it later. On the other hand, you feel like it takes away from your presence in session with clients.”

    Betsey, you seem to be struggling with competing values. On the one hand, it’s important for your paperwork to get done in a timely fashion to reduce your stress and worry over it. It also seems important for you to be genuinely present for your clients. You enjoy being in the moment and not dividing your attention between them and your notes.

    Betsey, you may be wondering which to pay more attention to. Your own mental health is important by keeping your stress level down and keeping up on your paperwork is a big part of this. You will be able to give more to your clients if you are not feeling overwhelmed by all you have to do. Your clients feeling heard and validated is very important to you as well as this is their time and they are paying you to give them 100%.

    This exercise was interesting. I found it a little hard to keep to the structure (am not sure I did this entirely), instead having other modalities and techniques popping into my head. I found that after doing this, my ambivalence was largely resolved. As much as I may enjoy just sitting with clients, it would be far harder on me to spend my whole weekend doing notes. I’d be exhausted and have that much less to bring to the table, so to speak.

    Question 3-
    Client goals: To get some motivation. To not be a brat to my sister. To smoke less.

    My goals: To keep to a daily structure, get up the same time every morning. To confront her sister over the identity she has been given within the family. To not smoke at all during weekend days.

    What I see as discrepancies in these two lists are her goals are very broad and nonspecific. Mine are more focused.

    In terms of the righting reflex, I found I want to immediately problem-solve with her around these goals instead of looking at what is sustaining them. I want to break things down so we can work on them instead of leaving things so broad. I want her to feel success and that she can experience something other than failure. I want her to see herself as something other than the victim in her family. I want her to experience sobriety and see what that is like for her.

    Agenda Setting: I would ask my client what she would like to be sure to focus on and take notes to ensure these are addressed in our time. I would use reflective listening to ensure I heard correctly and would ask client to start when ready. During the session, I would summarize periodically and be mindful of the time for client so that she got what she needed or ask if she wanted to stay on the topic she was as our time was running out.

    #24262
    Charles Cardoza
    Participant

    Homework Questions
    Question 1

    The confrontational style triggered resistance in Sal. He automatically took the opposite side. “I’ve had the dog for 12 years with no issues. Why is it a big problem now? His experience was not honored or validates as it was in the spirit on MI interview where it was acknowledged that it hasn’t been a problem so far and, if he makes other changes, it may not be, but to be open that it may be in the future. Sal took a closer look of the importance of taking his medication as prescribed and the potential impact it would have on his child.
    Question 2

    The behavior is taking a 1 hour walk in the state park at least 5 days per week. Walking is a great way to maintain my overall health. Walking makes me feel so good that I don’t know when to stop. When I walk for more than 1 hour, it usually makes my back hurt for the rest of the day. When I walk for one hour or less, I still feel good and my back rarely hurts. If I walk for ½ hour, meditate for 15 minutes and then walk for another 1/2 hour, I feel great on all levels and rarely experience any discomfort. Excessive walking contributes to physical discomfort, but not walking at all contributes to spiritual, emotional and physical discomfort. It got me to think about different ways to look at taking a walk in the woods. I realized that if I took a break (to meditate) in the middle of the walk, it would help to at least minimize feelings of physical discomfort, if not eliminate it completely, and I still achieve the spiritual, mental and physical benefits.
    Question 3

    Discussed behaviors for Clients often include stopping or moderating drinking / drugging, taking care of physical health (eating, medication, physical activities), Behaviors that result in legal issues such as selling drugs, and relationships issues such as domestic violence or non-payment of support..
    Behaviors on my list can include abstaining from mood altering substances, peer support participation, not smoking, maintaining spirituality, regular exercise and maintaining a healthy diet, and abstaining from tobacco use.
    My partiality to abstaining from ETOH et al could conflict with a client who is trying to cut down intake as an alternative to abstinence or using MAT as a harm reduction method. My choice of abstinence from tobacco could conflict with a client’s wish to cut down. The other lifestyle choices can also conflict with a client’s choice to initially reduce the occurrence of the behavior instead of stopping entirely. I may be inclined to right the clients thinking by insistence that my agenda or preferences is the only way success can be achieved with past consequences of behaviors such as overeating, alcohol/drug abuse or domestic and legal issues. I may be swayed to offer unsolicited advice such as attendance in peer-support groups, IOP’s, psychotherapy, or inpatient treatment. This could ultimately produce resistance in the client resulting in little or no progress for him/her.
    My best course would be to listen to the client articulate his or her needs and what they think is the best course of action particular to their situation. If I wish to give advice, I should ask permission first.

    #24289
    beckruth
    Participant

    Question 1: I found that I wanted to avoid watching the “how not to MI video” a second time. I was surprised that Sal stayed in his chair through this interaction. He was very defended. I also wondered if I have behaved as the therapist did? Eek. (I also wondered what breed of dog Oscar was- 12yrs old is quite elderly for most breeds of dog. Given perhaps a short period of time, this will be a non issue. Why are we pitching our flag on this hill to die?)
    In the second video, I noticed that Sal was physically leaning into the conversation. It felt collaborative, they could both work together to help him sort through his choices to be as healthy as he could be. I also noticed that he did more talking in the second interview.

    Question 2:
    I feel ambivalent avoiding sweets.
    One on hand: I like how sweets taste and I find them satisfying.
    On the other hand: I like being a healthy weight and I know I don’t need them

    Becky, you really enjoy deserts, but you can see how eating them don’t support your health goals.
    Becky, sweets seem to satisfy a need, perhaps to reward yourself, but you can also recognize that they are wants, not needs.
    Becky, you enjoy deserts as a treat, however, you also enjoy being able to be healthy enough to engage in activities you like.

    Question 3:
    My client’s goals: to satisfy Maine Pre Trial, to not get a felony by showing a PTSD dx, to have custody of her children.
    My goals: to live in a safe place, to be physically healthy, to be emotionally healthy

    I am not sure that there’s a good deal of conflict between our goals, but the time line and priorities my certainly be different. I would like my client to live in a safe environment now, and my urge is to problem solve to make this so. However, she is her own expert about the dangers of her current living situation and when it’s safe to leave. She set the agenda at the start of the session- she wanted an assessment done to satisfy the requirements of pre-trial and did not want to engage in therapy as she had a working relationship with another counselor. I followed her lead during the assessment, but also asked for an ROI to communicate with her counselor about her current engagement in treatment.

    #24292
    Colleen Drake
    Participant

    Homework Question #1:
    In video #1 Sal became increasingly uncomfortable and defensive, as noticed in his body language, word choices and tone of voice. In video #1 he became a bit argumentative, as did the interviewer, and seemed to be annoyed by her pushiness. In video #2 Sal appeared more open to the discussion about his asthma. He seemed more relaxed, as noticed in his body language, and he seemed to be more willing to explore his options about what to do to improve upon his situation. The wording he used and the tone of voice he used in video#2 suggested that he felt understood by the interviewer. Sal seemed to have benefited more from the MI approach due to his increased engagement and the thoughtfulness that occurred when he was asked clarifying questions. At the end of video #2 he was more willing to explore options and to start problem solving his situation, for example he stated he plans to now weigh the pros and cons of the situation.

    Homework Question #2:
    “I feel ambivalent about getting my notes done by the end of each work day.”
    One side of the ambivalence:
    “By the end of the work day I am tired and have a difficult time focusing on typing notes.”
    Another side of the ambivalence:
    “I feel better about what I have done if I finish my notes by the end of each work day, instead of waiting until Friday to complete all of them.”
    Double-sided Reflection:
    “Colleen, on the one had you feel tired and have a difficult time focusing on completing your notes at the end of each work day. On the other hand, you feel more accomplished and less stressed about getting them done if you complete them daily instead of saving them all to complete on Fridays.”
    “Colleen, on one had you find it challenging to complete your notes daily. On the other hand, you seem to be aware of the stressful impact it can have on you when you wait until Friday to get them all done.”
    “Colleen, you’re expressing some ambivalence about getting your notes done daily and you indicated that you have a difficult time focusing by the end of the day. You are also expressing that you feel more accomplished and less stressed if you do them daily.”
    I found this exercise helpful in trying to come up with the wording for reflection statements instead of jumping to suggestions. I think it can be easy at times to let our desire to help people impact how quickly we jump to giving suggestive feedback, which can sometimes let the listening piece get lost in the mix. At this end of this exercise I found myself thinking about my schedule and how to better fit the time to get notes completed, like doing some between meetings instead of waiting until the end of the day.

    Homework Question #3:
    Client generated target behaviors: To not smoke inside the home, to yell less and to try not to get caught up in other people’s drama
    Provider generated target behaviors: To quit smoking, to use more positive feedback and to increase family routines
    There are some discrepancies between the lists. The client would like to stop smoking inside the home, however the provider would like her to stop smoking altogether. The client would like to yell less, and the provider would like her to practice increasing the use of positive feedback. The client would like to avoid getting caught up in other people’s drama and the provider would like the client to focus on building stability and positive relationships within her family. The knee-jerk react to try and provide solutions (from provider to client) would include the provider saying to the client things like; “Quitting smoking would be more beneficial for your health and your family’s wellbeing that just smoking outside of the home.” “Yelling less would be nice but wouldn’t it be better to work on increasing your positive feedback responses?” or “It isn’t helpful for you to get caught up in other people’s drama, as your focus really should be on increasing positivity within your own family.”
    To use the MI approach in this situation the provider might say to the client; “I hear you saying you want to stop smoking inside the home. It seems important to you that you reduce your smoke exposure to the other people in your home. Do I have that right?” “You are saying you want to yell less. Are you thinking that you would be more effective in your communication with others if you were to yell less?” “You are noticing that you want to avoid getting caught up in other people’s drama. Are you feeling stressed out by involving yourself in things that other people are having difficulties with?” These types of reflective statements followed by questions that elicit a feeling-related response from the client would likely result in less confrontation and more collaboration between client and provider. There is validation involved and openness to discuss the situation from the client’s point of view.

    #24313
    Danielle Wilbur
    Participant

    Exercise 1
    In how not to: Sal’s words and body language is defensive and agitated.
    In how to: Sal’s words and body language is more relaxed and engaged.
    Exercise 2
    Example: Danielle’s Ambivalence

    “I feel ambivalent about washing dishes after dinner.”
    One Side of the Ambivalence
    “I am tired and full and want to watch T.V, and relax before bed.”
    The Other Side of the Ambivalence
    “I know that the dishes will need to be washed or we will run out of clean dishes when we need them again the next day.”
    Double-Sided Reflection
    “Danielle, on the one hand you are tired at night and full after dinner, and it can feel like a lot of effort to wash the dishes. On the other washing the dishes give you clean dishes the next day to use and that is important to you.”
    Exercise 3
    target behaviors : tapping foot
    yawning repeatedly in the afternoon
    humming
    health behaviors : drinking less caffeine
    more/ better quality of sleep
    balanced diet

    Question 1
    Sal meets confrontational with a defense position. He claims the dog is not an issue because he has had him for many years. The Spirit of MI style helps him to sort through his options and feel in control of what he will do. This feeling of being in control gives him a chance to focus on his choices and not being/feeling defensive.
    Question 2
    Example: Danielle’s Ambivalence
    “I feel ambivalent about folding clothes once they are clean.”
    One Side of the Ambivalence
    “I don’t enjoy folding and it seems like I have to do it all the time.”
    The Other Side of the Ambivalence
    “I know that the clothes will wrinkle, and some may need to be washed again or ironed which means twice the work of folding.”
    Double-Sided Reflection
    “Danielle, on the one hand you don’t enjoy folding and it seems like a never-ending task. On the other if you don’t fold the clothes you will have twice the work to do.”
    Example: Danielle’s Ambivalence

    “I feel ambivalent reducing my sugar intake.”
    One Side of the Ambivalence
    “I love sugar and often eat it to feel happy.”
    The Other Side of the Ambivalence
    “I know that sugar is not good for me and my health is important to me.”
    Double-Sided Reflection
    “Danielle, on the one hand sugar is a reward you give yourself to feel happy. On the other sugar is not good for your health and your health is important to you.”
    Example: Danielle’s Ambivalence

    “I feel ambivalent about planning out dinners for the work week.”
    One Side of the Ambivalence
    “I want my family to agree on the menu and enjoy what we have for dinner and not waste a lot of my evening. ”
    The Other Side of the Ambivalence
    “I know that if I plan ahead, I don’t have to run out to the store to grab missing items and I have more time to enjoy my evening.”
    Double-Sided Reflection
    “Danielle, on the one hand the process of getting my families positive input on what we will have for dinner can be frustrating, On the other, trying to figure it out on the night of can lead to greater frustration and an unplanned store run on a weeknight.”
    I found this exercise to be surprising and empowering. To look at a problem without judgment, just a choice to make. I could see how this could encourage change, which is often hard, even if it is a small change or in your own benefit.
    Question 3
    Client target behaviors: reduce smoking to 1 pack a day.
    Be less confrontational.
    Smoke less marijuana
    My own agenda: Quit smoking with support from a stop smoking support program.
    Stop smoking marijuana.
    See your councilor about confrontational behavior

    Describe any discrepancies between these two lists.
    My client is willing to reduce smoking both marijuana and cigarettes and believes they can address their confrontational approach to anything that bothers them. I want them to plan and take action and use supports.
    Describe some of your “righting reflex” responses to the consumer-generated target behaviors that do not match up with your list of target behaviors?
    Putting my goals first will only create confrontation. The focus needs to be on resolving ambivalence.
    Describe how you might use the MI Agenda Setting strategy described in this lesson to engage this person in a person-centered conversation about what he or she would like to discuss with you. Be specific.
    As in the examples, I would reflect to the client the two sides to their ambivalence. Once the client agrees that that is what they feel I would present the double-sided reflection. This gives the client a chance to see the possibility of change as a choice for them to make.

    #24314
    Michael Bean
    Participant

    Michael Bean

    Homework Question 1:

    First Video: Sal appears defensive and certainly does not agree that his dog may be the major cause of his asthma symptoms. The provider appears incredulous that Sal will not get rid of the dog as a way to potentially reduce his discomfort.

    Sal seems to want to try to address his illness with medication management and does not support the counselor’s premise that the pet is the cause of his current symptoms. The counselor does not appear to recognize the importance of the dog within the structure of the family unit as a whole.

    The counselor appears to be saying: “this is what I think” and “this is what I think you should do about it.”

    In the second video the counselor allows Sal to frame the narrative and discuss/review potential outcomes to reduce his symptoms. The counselor clearly is listening to Sal and encouraging to explore his options without her having an overt opinion.

    Question 2:

    I want to be healthy and try to walk every day.

    One side of ambivalence: walking is great exercise and certainly helps my overall emotional wellbeing.

    Other side of ambivalence: When it is dark, cold, snowy and rainy, I dread getting out there.

    Double sided reflection: Walking is great for overall good health and it sounds like it is an important part of your day. You live in Maine. If poor weather contributes to dread and overall discomfort is getting out there everyday helpful or a hinderance to overall good health?

    Question 3:

    Target behaviors of client:

    Stay out of jail (is on probation).
    Parent his children.
    Financially support his family.

    My target behaviors for client:

    Stay sober.
    Be a good role model for children.
    Be a good employee.

    Main discrepancy is the abstinence piece. Using substances would disrupt this man’s freedom and impact all areas of his life. Realistically, my target behaviors are a reflection of probation restrictions already in place and substance use would impact all behaviors client is targeting. Whether client wants to stay sober or not, hopefully we can both agree that it is a priority. MI would involve recognizing the interrelation between the client’s goals and abstinence.

    Hopefully, through MI techniques I could help the client realize that his goals hinge on his ability to stay sober and all areas of life would be enhanced simply by not going to jail. Client will be heard and encouraged to embrace abstinence and recognize that my target of his abstinence is also a reflection of his place in the criminal justice system. MI would also help the client recognize that we both are focused on positive outcomes for him and we can work together to chart a path to give him the best opportunity to succeed.

    #24315
    Nichole Proulx-King
    Participant

    Question 1
    I found myself cringing and feeling generally uncomfortable when watching the confrontational style of interviewing. I watched Sal respond very defensively to this style and it did not appear effective or as if he had any buy in to the suggestions or directives. In the Spirit of MI style video, it felt relaxed and like Sal was able to identify where he was at on his own. Sal also did not become defensive in this video. The MI style definitely helped Sal move closer to action as he began to consider things that would help him address his asthma.

    Question 2
    I often feel ambivalent about regular exercise.
    3 statements: I know that exercise always makes me feel better in the long run. Exercise requires a lot of motivation. Getting up early in the morning and exercising makes me feel the best and gives me more energy during the day. I require a lot of sleep and getting up early is difficult. Exercise makes me feel more confident about my body. Exercise can also make me feel frustrated when I don’t see immediate results.
    3 double sided reflections: I heard you say that you know that exercise always makes always makes you feel better in the long run, but it take a significant amount of motivation to get started. Early morning exercise is the most helpful for giving you energy during the day but you also require a lot of sleep and this can hold you back from getting up to exercise in the morning. Exercise helps to boost your confidence in your body but can also lead to an increase in frustration if you don’t see results immediately.
    I was easily able to see that making a choice to change is difficult because there is evidence that maintains the ambivalence. The responses helped validate this feeling and that maybe my not making choices to change weren’t necessarily because I am lazy. I think it moved my ambivalence a little more toward thinking about what I can control and what I can change.

    Question 3
    Consumer generated behaviors: Better study habits, not isolating self, getting better sleep, exercising more.

    My agenda behaviors: Develop a routine, spend less time on social media, engage in self care regularly, better hygiene habits.

    Discrepancies: The person in mind often has poor hygiene habits and this is not something they are stating they want to change, but I want to address this with them as I believe that it is impacting their self isolating behaviors. My instinct for them to spend less time on social media is also related to their goal of wanting to get better sleep and not self-isolate, but they are not stating that this is their goal. I want to help them get their goals “right” by inserting some of my own and this will not be helpful for them.

    Using MI Agenda Setting: I would start by asking them what goals they have and what ways they have imagined changing these. I would then reflect their answers and determine if there is any ambivalence present. Then we could move into exploring what stage of change they are in.

    #24316
    Kristin Giguere
    Participant

    Question 1: Watching the confrontational style of interviewing made me feel shut down even watching it – the way she reacted to Sal not having read the materials he had been provided came across as judgmental. In the confrontational style, the provider is driving the session and telling him what needs to change in his life and as a result he seems to be digging in and verbalizes “this is too much”.

    In comparison, with the Spirit of MI counseling approach, Sal seems to be driving the session, identifying why he is there and what he is aware of as possible contributing factors. He verbalizes “that feels good” when talking about it being his decision.

    The Spirit of MI approach is more likely to help Sal move forward in making changes to better manage his asthma because in that approach he is the driving factor in what changes he wants to make, why he wants to make the changes, rather than being told what he needs to do.

    Question 2: I feel two ways about my beverage consumption, specifically my preference of diet soda (Diet Pepsi primarily) over water. “I feel ambivalent about making a change to drink more water than diet soda.”

    One side of the ambivalence: “Water doesn’t taste good to me.” “I need to take more bathroom breaks when drinking water compared to diet soda.” “I like the energy that I get from diet soda.”

    The other side of the ambivalence: “I know that artificial sweeteners are unhealthy.” “Water is important to healthy body function and weight loss.” “I want to role model healthy behaviors for my kids and my students.”

    Double Sided Reflection:
    “Kristin, on one hand, you don’t enjoy the flavor of water, but on the other hand you realize that artificial sweetners aren’t healthy for you.”
    “Kristin, one one hand, you see the importance of drinking water to have healthy body functions and to lose weight, but on the other hand you have to take more bathroom breaks when you drink water.”
    “Kristin, on one hand you like the energy you get from the caffeine in your diet soda, but on the other hand you want to be a healthy role model for your students and your own children.”

    When doing the activity, before doing the actual assignment questions, I tried combining it all into one double sided reflection, which was ““Kristin, one the one hand you are constantly tired at night and the caffeine in diet soda helps you get through the day, working, and raising three kids. It can be difficult to make the time to take bathroom breaks when you are already feeling so busy. On the other hand, drinking water fits with your long-term goals of losing weight and being healthier for your children.”

    My general reaction to this exercise was thinking about the similarities to doing a pros and cons list, which is an approach that I tend to go toward, even if it is not done formally in writing. The reflective listening responses didn’t have a big impact on my ambivalence but it did contribute to me engaging in some mental problem solving, such as replacing some of my Diet Pepsi with canned seltzer water that contains caffeine.

    Question 3:
    Consumer generated target behaviors: “Quit vaping” “Get school staff off back” “Be able to reach adulthood with autonomy around life choices”

    Target behaviors on my agenda: “Quit vaping” “stop being high on marijuana when it is time for class” “find an approach to learning that fits this individual”

    And in my setting, in addition to target behaviors on my agenda, there are also target behaviors that would be on the agenda of my employers; some examples of these would be “attend classes” “complete assignments” “refrain from using marijuana”.

    I don’t see a lot of discrepancies between my agenda and the agenda of the consumer; any discrepancies that I do see are ways in which I think the consumer’s agenda and that of my employer can both be met, which is not solely following the individual’s. As for “righting reflex” responses I think that a lot of the ways in which those would be seen in my agenda would be in my desire to help the consumer find a way to still get an education (which the consumer does not want) in a way that would fit their personal learning styles and preferences.

    MI agenda setting strategy: I would start by asking them what brings them to meet with me, and if other people told them they need to work on something specific, I would ask if that is a goal of theirs as well. If it was not, I would ask them what they would like to get out of our work together. I would reflect on their answers and ask clarifying questions to work on coming up with smaller steps toward reaching their goal. I would ask permission to make suggestions of strategies that I am aware of that might help them reach their goals. We would then pick a starting point and rate their readiness to make the change according to a likert scale. To conclude the session I would summarize my understanding of why they are there, what they would like to accomplish, their reasons for that and any ambivalence they have, followed by the starting point that they chose to work on before their next meeting.

    #24317
    Kelly Jeremie
    Participant

    First video the confrontational style was argumentive First he wasn’t open to take the providers advise not was the provider really listening to his concerns.
    The second video Sal did seem to be more attentive to listening to the provider and even showed he would give a try to make things work.
    In personally don’t like confrontation and using MI styles accepting and being partners in communicating together can help a provider to see the needs of the client.
    2nd question I feel ambivalence about showering everyday. One side I know that showering is good for health and hygiene I feel ambivalent about showering every day but I feel that it takes to much time to get ready in the morning and don’t want to be late for work.
    Sally, on one hand you now good hygiene is the best every day to be healthy on the other hand you feel that it takes too much time to complete.
    Sally you seems to struggle with completing your ADL’s on the other hand you see the importance of having a healthy hygiene and not having a routine of not showering .
    Sally you may be wondering which to pay more attention to the time it takes to shower or the importance of your hygiene daily and creating a routine daily to take care of your self.
    Question 3
    My behavior is learning to adapt and complete my PT exercise daily to benefit the pain in back and legs. I know that it can benefit my body to have stronger muscles. Maybe I can take breaks in between each set of stretches and drink water to help.
    Client behavior : trying to stop smoking marijuana . I first would ask the client where he wanted to start to work on the struggle and use reflective listening in order to see where he is struggling. I would ask the client to take some notes and look at areas that he may be able to participate in making this happen. I would ask why he or she feels that she needs to do this and what it making he or she feel that there is no other option.

    #24318

    Question 1
    In the Non-MI confrontational approach to counseling, Sal’s body language is more animated. His tone is somewhat aggressive, and he sounds more defensive. In the Spirit of MI approach to counseling, Sal seems more open and interested in finding a solution that he can buy into. He seems more relaxed and even excited about a plan. The Spirit of MI style moves Sal closer toward some kind of action. He recognizes the stress, and he doesn’t feel good about it. She asks him more open ended questions about how, when, and if he would know when to make a decision about keeping the dog. He concludes that if having the strongest medicine doesn’t work, then he will have to make some hard decisions.

    Question 2
    One Side of the Ambivalence
    “I am sad that we never speak anymore, and I want to tell her again how sorry I am.”
    The Other Side of the Ambivalence
    “I know that taking care of myself and not engaging will help me with my shame and guilt.”
    Double-Sided Reflection
    “Gigi, one the one hand you are missing your ex and feeling really sad about the breakup. On the other hand, working on your shame and guilt fits into your overall plan for emotional sobriety, and I know that is very important to you.”

    Question 3
    Her agenda: Smoke less, save more money, focus on re-entry from incarceration.

    My agenda: Stop smoking in order to save more money, and work on a realistic budget for re-entry expenses.

    Discrepancies: Our concerns are immediate, but I feel mine are more grounded in the realities of re-entry. For example, stopping smoking could save her $200 per month. Smoking less isn’t saving enough money fast enough.

    Righting Reflex Responses: The cost of your smoking is equal to a car payment.

    MI Agenda Setting strategy: I would ask this person to talk about their ideal living situation when they get out. I would work with them on a budget and put it all down on paper, asking open ended questions about their needs and wants. I would then ask about how much they have saved in their prison account, and how much they plan to make upon release. I would then show them on paper the budget we built, and ask her where she can cut expenses. What would be the additional benefits of smoking less, or even quitting smoking all together?

    #24319
    Jenai Jackson
    Participant

    Question 1:

    I noticed initially that clinician said “we want to make sure that you don’t come back here”. While I get the sentiment, it definitely starts the conversation with a negative tone and can make getting care in any form seem like a bad thing. Overall her tone is negative and it is clear she is annoyed and talking down to Sal. Also when she says Wait a second and stutters a bit as she gets her words together, you can sense her frustration which makes Sal more frustrated and defensive. In the first video she never says his babies names even though he introduces his son in that way. That would have been a great personal touch that would help her to connect with the patient and gain trust. And the clinician vocalizing that she is only worried about Sal and not the family shows that she is not in alignment with the wants and needs of her patient. And no empathy is shown towards the dog which is obliviously a part of the family. She said “Do you appreciate” which implies that he should be grateful and that that should be a leading factor for change. Finally, she never listens and is just as defensive as Sal.

    For the second interview, she immediately let’s Sal explain the situation and do most of the talking. Everyone’s tone is calmer and he has the opportunity to share what he is working on and to show that he is trying and making progress. They create a space to talk about the true problems and acknowledge that pets can be a factor but that this may not be the case for Sal. This shows that the clinician is acknowledging that his process is unique and different from other people’s processes. She sympathizes with his struggle and that it is hard. Sal can be more expressive with show his love for his dog and he vocalizes what he wants confidently. He says he just wants to keep trying the medication before any other major changes are made. He is proactive in his care. Sal openly expresses his feelings more and a lot of his wants for his family come out. It’s clear he understands the severity of the situation and wants to try all possible solutions before he does something drastic.

    It’s clear that removing confrontation from the conversation has it’s benefits. I was annoyed at the clinician in the first video and I think this emphasizes the impact providers have on care options and health behaviors with their patients. Sal is much more responsive to the Spirit of MI style and vocalizes his solutions and steps he will take to manage his asthma. The absence of the negative demeanor and tone from the clinician and the space for him to be open and reflective are key to him managing his care.

    Question 2:

    The behavior I feel two ways about is exercising daily. On one hand, I know that 1) exercising is a great way for me to stay fit, 2) it is a great way to break up my busy work day and creates space for me to relax, and 3) I can do it with friends and have a good time competing against them. On the other hand, I know that 1) I don’t have time to exercise because work is wild, 2) I’m often sore and tired afterwards and that’s not a good feeling, and 3) gym memberships and classes are expensive and I can’t afford them.

    Double-Sided Reflection: It sounds like you want to create a space for you to relax and stay fit with your friends. It also sounds like it’s hard to commit because it can be expensive and you don’t like the way you feel when you are done exercising.

    On one had you want to break up your long work day with a fun activity but on the other hand you feel that if you stop working to exercise, you will fall behind on your work.

    On one hand you want to keep up with your friends and be able to join them for fun workout classes but on the other hand you have your own budget that you want to stay within and you don’t want to have to break the bank to work out and have fun.

    This exercise shows how many different ways we can say how we are really feeling and how vast our experiences around behavior change can be. Writing the double sided reflection almost exposes the solutions without directly saying them which I see as one of the main benefits to this technique. I wanted to immediately respond to the reflection with solutions and I imagine the client often feels this way too, especially since the reflections really show that the clinician is listening and supportive. I felt really engaged in this process.

    Question 3:

    Patient goals: Going to summer camp with friends. Not having to miss school for doctor’s appointments. Not having to get stuck with a needle at every appointment.

    My goals: Taking daily medication without parent’s reminding them. Remembering the names and dosages for all their medications. Making it to all of their appointments.

    My patient is very focused on having fun and not missing out on the things their friends are doing. I am very focused on my patient gaining some independence and stepping up to take more ownership in their care. With my “righting reflex” I want to show them how to set medication reminders on their phone and how to make sure they remember their doctors visits and allow enough time so that they aren’t late to their appointments (by using alarms on their phone and mapping their route in advance).

    I’d start by asking my patient what they would like to talk about today and how they are feeling about today’s visit and their progress. I would let them know that mom and dad can step out of the room if they want to talk to me alone. I’d let them know I only want the best for them and that I’d like to know what they want? Then I’d ask how we can make that happen. I’d listen and paraphrase back to them so that we can make sure we are both on the same page.

    #24322
    Diane Scalia
    Participant

    Exercise 1:
    Video 1: My initial observation was the body language. The clinician’s physical stance looked like she was in attack mode and matched the tone of her words, which in turn evoked a defensive response from the client. The conversation between clinician and client was not collaborative and the client was not the center of the conversation, the clinician made the Oscar the center of the conversation and showed a lack of empathy for the client’s feelings, referring to pets as “problems”. The clinician did not acknowledge the changes the client has already made and acted as the authority in the discussion by telling the client what his “next step” should be”. The therapist also did not acknowledge the client’s statement that the doctor was unsure whether it was Oscar, stress, or client’s drinking that was the cause of the client’s increased symptoms.
    Video 2: The clinician asked the client open-ended questions beginning with “how” and “what”. She affirmed the client’s strengths by acknowledging the work the client has already done to change some behaviors and acknowledged that the doctor was uncertain whether Oscar was the cause of the client’s increased asthma symptoms. She reflected back the client’s feelings and acknowledged that the client had “big decisions” to make. The clinician summarized the client’s goals of “take the medication, keep Oscar, and feel better” to “You want to be healthy for your wife and baby”.
    Exercise 2:
    Example: “I feel ambivalent about doing my taxes”.
    One Side of the Ambivalence:
    “I have so little time , I’m tired when I get home from work, and have chores and errands that I have to get done on the weekend.”
    The Other Side of Ambivalence:
    The sooner I file my taxes, the sooner I get my refund, and they will be off my mind.”
    “Diane, on the one hand you’re tired when you get home on week nights and have important things to accomplish on the weekends. On the other hand, it doesn’t take that long to do them, you could use the extra money and getting them done would be one less thing on your mind.”
    Exercise 3:
    Consumer-generated target behaviors:
    1. Be more stable in my mental health
    2. Be more consistent about visiting with my son.
    3. Feel accepted by others
    Clinician-generated target behaviors:
    1. Engage in psychiatric medication management services and take medications as directed.
    2. Develop positive supports in the community and engage in social activities.
    3. Increase awareness of distorted thinking habits and increase sense of self.
    The client admits to experiencing audio hallucinations since her “enlightening” experience of consuming MDMA. She is adamant that she does not want to engage in any type of substance use treatment. She is however willing to her work on her mental health and is willing to seek help from psychiatric provider. I believe she minimizes the severity of her symptoms. The client copes with her symptoms by isolating and fixating on researching various and specific topics on her computer for hours and days. She feels judged by her family members, feels that others do not accepted for who she is. The client admits that she has been inconsistent in maintaining a relationship with her son and believes she work on being more emotionally stable before she commits to a regular visitation schedule.
    I like the idea of using the “dinner plate” example presented in the lesson and allow the client to choose and prioritize her own agenda. I don’t believe we are that far apart in generating target areas. I believe that this client would resist and disengage from services if her autonomy was not respected and she would feel like her clinician was treating her like everyone else in her life.

    #24323
    Robert Hussey
    Participant

    Question 1
    The first video seemed very confrontational, defensive, and reactive. Sal reiterated his position that his dog is not the problem whereas the counselor maintained the position that the dog is the problem. Other possible causes or potential solutions were not addressed. Neither the client nor the counselor was receptive to what the other was saying. Both were adamant to maintain and defend their positions. They were at an impasse and could not progress forward. There was no open-ended dialogue trying to find the underlying reasons or trying to find a solution or change agent.

    The second video seemed conversational, exploratory, and receptive. The session felt more like a conversation exploring possibilities. Both the counselor and client seemed actively engaged listening to each other. The client was providing possible answers and describing what potential solutions could look like. Sal is more likely to move toward some kind of action to improve the management of his asthma with the Spirit of MI style of interviewing. Sal feels more empowered to take control of his actions with this style.

    Question 2
    I am ambivalent about exercise.

    On one hand I am told exercise will better help with mental and physical wellbeing.
    On the other hand, finding the time to exercise tends to not happen with everything else I need to do.
    Bobby, it sounds like you understand the benefits of exercise, though you are having trouble finding the time to exercise due to other commitments.

    Bobby, it sounds like promoting mental and physical health is important to you, but you are having difficulty allocating time for yourself to realize the benefit.

    Bobby, it sounds like you are aware of the benefits of exercise to promote better mental and physical wellbeing, but you are struggling to set aside time for yourself amidst all your other commitments.

    Saying the person’s name personalizes and humanizes the ambivalence. Practicing the reflective statements makes me more aware of my word choice and perceived meaning. The reflective listening statements provides the client the opportunity to talk and think out loud. The perceived affirmation and understanding might help client pinpoint the change agent. Change can occur only if the client is willing. I am responsible for change. Questions: How can I progress? What do I need to do?”

    Question 3
    Consumer generated list: cut back on smoking, cut back on drinking alcohol, don’t skip meds, need to visit doctor/dentist
    Counselor list: reduce cigarette use, reduce alcohol intake, take medication as prescribed, schedule appointments with doctor/dentist

    The wording discrepancy is a “righting reflex” which can denote different meanings for client. The client’s list is more vague and uses informal wording. The counselor’s list uses more formal wording Questions: “What do you think you need to do? What does the goal look like? How do you know when you reach goal? How do you know when to make new goal?” Basically, the counselor is the sounding board for the client where the client can talk and think out loud and receive reflective responses. I would provide structure and flexibility. If I already have some background info, I might generate a concept list or visual and ask client where they want to start while also indicating the client could talk about something else. Things might be interconnected or flow from one topic to the other. It may not matter where we start as long as we start and try to make progress instead of being stuck identifying the change and desire to change.

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