Week 1 Homework Assignment (Applications of MI)

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    Carol Acedo

    Question 1.
    My reaction to watching the two videos that I watched were how they were complete opposites. In the first video was on of targeting, no listening and Sal became very defensive and when Sal notices that the therapist was not listening he stopped talking, body language was of Sal becoming irritated and wanted to leave the meeting. The MI video showed compassion, listening and trying to understand Sal’s concerns for his dog, himself and his family. He spoke of how hurt he would be if his family got sick and how devastated he would be if he had to give up his dog. Sal opened up regarding the step he has been taking to try to fix his problems on his own.

    Question 2:
    Issue of ambivalence: I feel ambivalence about doing home repairs after I get home from work.
    One Side: I know that if I help with home repairs after getting home from work the job will get done faster, and I would have to think about them again once done.
    Other Side: I struggle with wanting to do anything beside sitting down and reading after a long day of work that was stressful.
    Tammy on one hand you know that helping your husband take care of home repairs will get them done faster and you won’t have to worry about them getting done. On the other hand after a long day of work with your clients can be stressful, so you read for self care.
    Tammy you seem to be struggling with helping your husband so that he does not have to do all the work on your home alone, wanting to get your repairs done so that you do not have to worry about them any more. It seems important to you to work as a team and get these things done to alleviate your stress of them not being done.
    Tammy you need to remember that self care is very important to maintain you mental health so that you can help your clients to the best of your ability. You need to keep the lines of communication open with your husband to let him know how you are feeling. Communication regarding the tasks at hand is very important to keep your stress level down while at home and with communication your husband will be able to help you to elevate your stress by making a schedule to help with being able to continue with your self care and working as a team to get the projects done.
    I found this exercise to be able to actually think about different ways that I try to do everything for everyone and I feel guilty when I want time to my self. I found that thinking about situations in a different light that some of the stress is brought on by me and not the situation.
    Question 3:
    Consumer goal: Stop using illegal drugs, take better care of her self, get her daughter back into her home.
    My goals: Attend counseling for her drug use 3x per week. Start with healthy choices for purchasing to consume. Attend all court meetings and follow all direction that is required by the court.

    The right reflection I will participate in the ones that are needed to encourage the client to make better choices and that offer support and knowledge to help use different coping skills to be able to achieve sobriety, making healthy food choices and court/ CM proceedings in which the goal is closer to having her daughter returned. This does not line up with my clients desires at time where she can become overwhelmed with the process and at times feels that what ever she does will not be good enough.

    Agenda Setting: I would ask my client where she wanted to start. Having her bring notes and/or concerns on what the topics are that she wants to discuss. Writing these goals down, we both will have a copy to be able to refer back too. Letting the client pick the topics that are the most important to her and working on those first as to not overwhelm and have her walk out if she has increased anxiety regarding these serious topics. Charting progress will help the client better understand even the smallest process is moving forward.

    Jennifer McCaslin

    Question 1:
    Confrontational approach: This approach by the provider was inappropriate and unprofessional. The provider did not use active listening skills when Sal was talking. Provider presented as overbearing and not open to hear what Sal was saying. This caused Sal to be defensive and at times argumentative. Provider was telling Sal what he should be doing instead of offering suggestions and encouragement. Providers tone was harsh and unsupportive. This approach was unproductive and could cause Sal not to use this provider in the future.
    MI counseling approach: This conversation was much more effective. This was a two part conversation with both parties engaging appropriately and hearing each other. Body language was relaxed and tone was soft. Provider offered validation and empathy. Sal was more apt to take providers suggestions with this approach. They worked together to develop a plan on how to tackle Sal’s allergies. This resulted in Sal feeling supported.

    Question 2:
    Jenn’s ambivalence: I feel ambivalent about buying a home.

    One side: Choosing a house is very overwhelming, I don’t have time right now to attend a home buyers course, the whole process is very anxiety inducing.

    Other side: I don’t have to pay rent anymore, I have a home to do what I want with, it gives me a sense of security and accomplishment.

    Double sided reflection:
    On one hand buying a home is very overwhelming and stressful. I struggle with finding the time and motivation to take the home buyers course. On the other hand I will not have to worry about paying rent. There is benefits/security being a homeowner and I will feel accomplished.

    I find that it’s easier to be ambivalent rather taking steps to move forward. With double sided reflection I can see how remaining ambivalent will get me nowhere and my goals won’t be accomplished, however if I start to work through my anxiety with this and begin to take steps I will feel better, gain knowledge and have got closer to my goal.

    Question 3:
    Client’s goals: find housing, not go back to jail, have money for what things I want/need.

    Providers goals: research housing opportunities and resources, compliance with probation and no new criminal conduct, establish a budget with needs prioritized.

    Discrepancies could include what is considered appropriate housing for the client. Client’s idea of housing could not be obtainable due to their budget or expectations. Client idea of not going back to jail could potentially mean not get caught for illegal activity and client’s idea of budget could mean get their wants before the needs. Provider would want to ensure stable affordable housing, not engaging in behaviors that could have the client arrested and ensuring client is paying his bills before they are spending money on wanted items. Even though the goals look similar the actions steps could be very different with client/provider.
    I would use MI skills to provide active listening and identify clients strengths and needs to ensure his objectives are goal targeted and offer support and encouragement.

    Monica Sonner

    • Question 1:
    o Video 1: Sal appeared frustrated and aggregated that his concerns were not being addressed with the dog as indicated by his voice becoming louder throughout the duration of the video. He also becomes argumentative and defensive throughout the video. He even states that the end when she is asking if he understands, “I understand that you don’t get my situation.” This makes him not want to listen to the provider because he feels that his views are being ignored.
    o Video 2; Sal appeared more open to learning and understanding how to help his symptoms of asthma. He was able to discuss what steps he has already taken and has been able to identify what he wants; he wants to alleviate his symptoms of asthma while being able to keep the dog. He has recognized some different triggers that may contribute to his asthma. He was also able to identify signs that his dog may be contributing to these symptoms, but was able to create a plan to help him both keep his dog and improve his health by taking medications and cutting out other things such as smoking and drinking. This makes it easier for the client to be open to change by making it their idea rather than them being told what to do.
    • Question 2
    o Monica’s Ambivalence: I feel ambivalent about ordering take out most nights of the week.
    o One side: Cooking dinner at home takes too much time and then I have to clean the dishes and counters after.
    o Other side: I know that cooking at home will save me money and is a healthier option for me.
    o Double sided reflection: On one hand, ordering take out is quick and saves time, but on the other hand cooking at home helps to fit with the goal of saving money and becoming more financially healthy and being financially healthy is important to you.
    o This helps to address the concerns that the client is feeling while helping them towards their main goal, being more financially healthy which helps motivate them to cook more at home.
    • Question 3
    o Consumer-generated target behaviors: becoming a better parent, becoming more financially independent, and use substances less.
    o My goals: Attend parenting classes and support groups, go through employment development center to obtain employment and alleviate barriers, and to seek recovery coach.
    o Main discrepancies: The client feels overwhelmed with all the different programs. I will acknowledge this and help client come up with a schedule to help with time management. I will help client understand how doing these programs will help with him obtaining his goals.
    o Through MI I can help the client use the goals of having a support group, having a job, and working towards recovery will help with being a better parent and being more financially independent. The client’s goals are being heard and worked on and I am not pushing them to do something that they are not ready for, such as being completely sober.

    April Sawyer

    Homework Questions
    Question 1
    I believe confrontational interviewing created a barrier to not only the client working on what he identified he wanted to work on in session but also the therapeutic relationship. The confrontational interviewing was judgmental and made the client have to fight for their autonomy which closed off parts of the conversation that would have been accessed through motivational interviewing.

    In the confrontational interviewing clip Sal starts out the conversation with the counselor openly. As the conversation progresses Sal is confronted, he becomes defensive, offended, argumentative and at one point is genuinely flabbergasted/overwhelmed due to the stance the therapist was taking. Sal repeatedly attempted to communicate his confusion as to why the dog he has had for 12 years is suddenly the cause for his increased health issues but was not permitted to explore these feelings and concerns.

    In the Motivational Interviewing video Sal is able to fully participate in the conversation and not focus on defending one stance over the other. Sal is able to explore both sides of his ambivalence and get to a place where he can contemplate there might be a situation where he has to give his dog up (something he was not able to consider in the confrontational interview). Sal is able to feel heard, not feel judged, express his own expertise, and explore both sides of the ambivalence.

    Motivational Interviewing would clearly allow Sal to explore both sides of his ambivalence as he is not feeling defensive, is given room for autonomy, and is not overwhelmed by the conversation or flabbergasted by the therapist’s stance.

    Question 2
    I feel ambivalent about my son attending in person classes due to Covid19 and family members at increased risk.
    One Side of the Ambivalence
    My son does better with in person learning.
    My son is struggling with his academics more then he would with in person learning.
    My son is feeling the effects of not being able to interact with his peers in person.
    The Other Side of the Ambivalence
    I worry about the impact on people’s health should he catch Covid19 while attending school in person.
    My son struggles with hand hygiene on his best day.
    The school does not respond to positive Covid19 cases in a way I believe to be sufficient.

    Double-Sided Reflection

    April, on the one hand you recognize that your son does better with in person learning. On the other hand, the thought of your son bringing home Covid19 to family members worries you and it sounds like keeping everyone safe is very important to you.

    April, on one hand you see that your son Is struggling with his academics but on the other hand you recognize his hand hygiene could use some work in order to make you feel comfortable with him going to in person learning .

    April, on one hand you feel like your son is feeling the effects of not seeing his peers in person but on the other hand you do not feel confident in the schools handling of Covid19 cases.

    This exercise was able to highlight my main ambivalences in considering my son returning to in person learning. I think this style helps maintain the client working toward the goal of conflict resolution while maintaining autonomy. I have had clients who have spoken about the only work done with their therapist is the therapist trying to solve their problems for them. The client never follows through with the ideas because they are not invested in the idea and it is not relevant to the client’s life.

    Question 3
    Reduce chronic suicidal ideation, attain social security disability, increase physical health.
    Exercise and healthy eating, medication management and therapy, stay on top of denials/appeals/questionnaires and attain an attorney to help in the court process.

    The client does not want to participate in therapy and feels that medication is what they need, the client does not want to utilize an attorney despite being repeatedly denied, and the client’s current mental health is a barrier to increasing physical activity or eating healthy.

    My righting response is to educate in hopes to sway them. Internally I struggle with the idea that this client could get additional benefits from doing treatment through these additional resources. I explore with the clients the reasoning for not wanting these services. This client feels that taking on too much would derail her which is good insight. I also explore willingness to relook at services at a further date when they might be able to take on more than they were able to before.

    Michael Bean

    Interesting input and insight into the experiences of others.

    Thanks, Mike

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