Week 2 Homework Assignment (Applications of MI)

Home Forums Applications of MI Course Forums Week 2 Homework Assignment (Applications of MI)

Viewing 15 posts - 1 through 15 (of 18 total)
  • Author
    Posts
  • #4480
    Patricia Burke
    Keymaster

    Exercise 1

    Review the Rounder: Reflective Listening and Strategic Responses to Sustain Talk video from this lesson.


    Exercise 2

    Download the Rounder Interview Transcript. Go through the transcript and make note of where the interviewer uses open-ended questions, complex reflective listening responses (particularly amplified reflections, reflections of feeling or meaning, and double-sided reflections), and strategic responses to sustain talk (like emphasizing personal autonomy). Go through the transcript again and make note of Rounder’s expressions of sustain talk and his expressions of change talk.


    Homework Questions

    Question 1

    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”

    Question 2

    Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.

    Question 3

    Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.

    Question 4

    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.

     

    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.

    #24346
    Melissa Ivey
    Participant

    Melissa Ivey

    Question 1

    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”

    I enjoyed watching the video. Jim appeared to be very resistant to change at the beginning of the session. It was interesting to watch how Terry was able to help him shift his language from sustained speech to change speech. I believe the use of this language would benefit not only those struggling with substance use, but also those struggling with mental health issues. This whole set of modules provided me with examples of how to slowly move a client forward without coming across as being too pushy.

    Question 2

    Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.

    Sustained speech regarding his ability: “that’s just kind of the way things have been going, you know.”

    Sustained speech regarding his ability: “My daughter she you know, she uh… (sigh) won’t let me see the kids.”

    Sustained speech regarding need:” And I don’t know what the hell she means I need help.”

    Change speech regarding desire: “I wouldn’t mind coming here to live”

    Change speech regarding commitment: “As long as I’m putting all this money into it I’d like to come out with something.”

    Question 3

    Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.

    In the exchange below, Terry use the strategic response that focuses on his autonomy.

    Jim: What’s… you said people come here to live. Do you think I’d have to come here to live?
    Terri: Well I think, you know you’re the one that really needs to make that decision about what’s the right kind of treatment for you. I couldn’t decide that for you.

    By reminding Jim that it is his treatment and he is the only one that knows what will be the most beneficial, she is reminding him that it is his choice. He’s not being forced into treatment. And I believe that this makes it easier for him to begin talking about entering the program. If she told him he had to come and took any his autonomy, I think it would take him longer to make that change.

    It continues below

    Jim: I wouldn’t mind coming here to live, but I wouldn’t want to be in one of them places where you sit around in pajamas a bunch of longhaired hippie types crying and bitching and stuff like that. That ain’t my style you know.
    Terri: So you’re kind of wondering what it would even be like here.

    Terry is being reflective and using the strategic response of reframing what he said. It allows him to state his hopes and his concerns. This will also help him clarify his concerns and solidify his goals. It will continue to help him move forward.

    The last quote is one of reflection.

    Terri: So you kind of feel two ways about it. On the one hand, you know, you think you’d like to have a change and you’d like to quit drinking and on the other hand you think you kind of dread it.

    It also helps him move and continue to use the language mobilization. Again by using these responses and reflections, Terry is able to move him forward

    Question 4

    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.

    The following two quotes are signs of Rounder being ready for change. “I wouldn’t mind coming here to live,” and “as long as I’m putting all this money into it I’d like to come out with something.”

    If I was in the interview with him I would begin to ask questions and use reflective listening skills to help him continue on the path of deciding to move in and begin the process. I would start talking about different steps he could take. I may ask him what some of his goals are while he was at the treatment center and ways for him to reach the goals. I would also try and help him verbalize that he is ready to take the necessary steps. I would want him to verbalize his commitment to the process knowing it may it will not be easy and it will take time. Overall, I would want to focus on the mobilization language of commitment, activation, and taking steps

    #24357
    Charles Cardoza
    Participant

    Homework Questions 2
    Question 1
    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
    Rounder consistently gave off the vibes of Poor me, look at the predicament I’m in. It’s not my fault. If the old lady hadn’t rear-ended me while I was stopped at a stop sign, I wouldn’t be here. My probation officer and daughter are treating me unfairly. Finally he seems resolve that, due to his legal situation he has to be in treatment, so I may as well make the best of it.
    Question 2
    Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.
    “But I never hurt them kids and never in my life done a thing to hurt them.”
    “Hell you know that I’ve had to take him home a lot of times, that I’ve been the one standing and he been passed out and couldn’t walk. It doesn’t make sense. None og this makes sense.”
    “Well, I’m kind of an uptight guy. I have a hard job. I work around a lot of old boys that are pretty rough and tumble. I drive a long ways and unload big trucks. I get tired sometimes. I like to sit down and have a drink.”
    “Well, I want something that will help me with court.” (Reason, Need)
    “If I don’t stop drinking, I’m probably going to be right back in this mess again.” (Desire, Reason)
    “There’s a lot of things I can do, but I’ve never tried to stop drinking. I get thinking about it honestly.” (Desire, Reason, Need)
    Question 3
    Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.
    “So it seems to you like I might try to push you around and make you do a whole bunch of things you don’t want to do.” This causes Rounder to somewhat apologize for his attitude. “It probably isn’t your fault, but that’s just kind of the way things have been gong, you know.”
    “So it’s confusing to you why your drinking should cause a problem or everybody else should be talking about that when you look around and you see other people drink more than you do.” This causes Rounder to somewhat maintain his sustain talk, but validates his behavior as being improved from 10 years ago. “I’ve changed a lot in 10 years….I drink a little bit but I work hard. It’s nothing for me to sit down and drink a six-pack or two and still be able to function.”
    “So drinking kind of helps you relax, you know, cope with life.” Again, Rounder validates his current behavior as being an improvement from the past. “When I get really angry, I don’t have to go slap somebody around…..since I’ve gotten older I kinda have a coup or 3 or 4 beers, kinda cool down a bit.”
    Rounder: “I’m not like one of them bums you see laying down there by the bus depot on the lawn selling his blood and stealing hubcaps.”
    Terri: “So it feels like everyone is looking at your drinking, but it’s just not as bad as everyone thinks it is.” Rounder confirms, but doubtfully. “I don’t know that it’s true, but you might say that.”
    Rounder: Talked about his daughter’s concern: driving under the influence with his grandchildren in the car and how she doesn’t trust him. Indicates he feels betrayed as he regularly helped her out financially in the past.
    Terri: “Kind of a mystery to you why she’d even worry about that.”
    Rounder then follows about how her and his wife are siding with each other against him.
    Terri then asks if he feels they are ganging up on him. Rounder replies that it feels that way, but is not sure if it is true – expresses some doubt.
    Question 4
    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.
    “…the only reason I’m coming here is to maybe same my license so I won’t lose my job and lose my house.” I would run with this for starters – keeping him motivated to do what he had to do the save his license, job and house. This may improve relations with his wife and daughter so that he is allowed to see his grandchildren and further motivate him to stick with recovery.
    “I wouldn’t mind doing this stuff if there was anything in it for me, but so far I’ve been having to pay this and pay the lawyer and pay for the wreck and pay for the evaluation and everything and so far ol Jim ain’t got nothing.” Again, I would redirect Jim to the possibility of saving his license, job, house, and maybe relations with his family.

    #24369
    beckruth
    Participant

    Question 1: The session felt fluid in how it unfolded, from resistance to willingness to consider addressing his drinking. I like how she was able to roll with the resistance, though when he asked her personal questions there seemed to be a bit of a hitch, but it would have startled me too. While I was watching/reading I also noticed myself wondering when or how his assessment was accomplished? How would one apply MI principles to the assessment process? I would love to observe a psychosocial assessment using these tools.

    Question 2:
    Examples of sustain talk:
    “I sit out her in front for about an hour before I come in and I was about to close to just cranking that pickup up and heading back home.”
    “And I think she’s out to just destroy me totally, you know….And I just kind of think you maybe you’re going to do the same thing to me.”
    “And I don’t know what the hell she means I need help.”
    Change talk:
    “So a lot of what I’m doing here or you know why I’m coming here…the only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house.” Reasons
    “I’ve tried a couple of times and I wasn’t very…I think one time I quit for a week or two just to show people I could stop drinking.” Ability
    “Do you think I could come here to live?” Actuation

    Question 3:
    R-“I don’t know why in the hell I stopped anyway.”
    T-“It almost sounds like you don’t even know whether you could stop even if you wanted to.”
    It appears that when he heard Terri restate his sustain talk, it sounded odd to him he started to question it and begin to consider the other side of the equation. He began to wonder what it might be like, noticing that he’d not tried before.
    “There’s a lot of things I can do, but I’ve never tried to stop drinking, I get thinking about it, honestly.”

    Later on Rounder says: “You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.”
    Terri affirms his self observation and reflects back his worry that his drinking will make his life worse. Next, she highlights that he’s really looking hard at this issue as he did in the past with his fighting. Then she affirms that he has the skills ability to make changes, as he’s done in the past. Each one of her responses supports him in moving towards change, creating an environment where he can put his own thoughts and intentions together to make this plan rather than being told he must.

    At then end Terri says “So you kind of feel two ways about it. On one hand, you know, you think you’d like to have a change and you’d like to quit drinking and on the other hand you think you kind of dread it.” Up until this point, there has not been a clear statement about his intention to quit drinking. He’s said he’d like to get his money’s worth and he’s considering change. She validated and normalized his ambivalence with this statement and I notice that he also did not challenge her description of him wanting to quit drinking, perhaps articulating his intent when he was not ready to say it out loud himself.

    Question 4:
    “I wouldn’t mind doing this stuff if there was something in it for me.”
    “As longing as I’m putting all this money into I’d like to come out with something.”

    I would work towards getting more clarification about what he was looking for from a program and ask if I could explain further about what the treatment center has for programs, together looking for a match. I would look for opportunities to validate that it’s his choice to enter treatment/make changes and support a verbalization to committing to give treatment a try.

    #24393
    Danielle Wilbur
    Participant

    Question 1
    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
    He repeatedly states that he does not want to be there and is ambivalent about his drinking. When talking about all the ways his OUI has disrupted his life the MI interview reflects what he is saying without judgment. He starts to respond to the choices he has and goes from defensive to empowered.
    I watched it a few times and the conversation about his issues with blond hair and her having blond hair the same as his probation officer. Asking him to tell her more instead of being defensive or offended, keeps him engaged and talking. I could see how effective this was and how it could easily have gone in a bad direction otherwise.
    Question 2
    examples of Rounder’s sustain talk
    Need : He drinks to deal with the stress in his life and work and to cool down his temper
    Ability: He quit drinking for a couple of weeks but, does not know if he could quit drinking completely.
    examples of Rounder’s change talk,
    Reasons : He says if he doesn’t stop drinking he is going to be in this mess again.
    Need : He needs to seek treatment to hopefully keep his license /job/home
    Question 3
    Give two or three examples of the interviewer’s use of complex reflective listening. strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.
    His sustain talk of not understand why he should have to be evaluated when others he knows drink more then he does or can’t handle their drinking as well as he does. She reflects back how he feels others are picking on him like a bunch of crows about his drinking and asked him since he is here what does he want to do with this time and what would be helpful.
    He talks about how he was successful quitting for a week or two to show people he could but, it did not last. She strategically reflects that it sounds like he does not know if he could stop even if he wanted to. His response seems to turn a corner and recognizes that this could be true.
    Question 4
    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.
    He starts to ask questions about the process of counseling and what he might be asked to do. He also talks about getting something out of all the time and money he will be spending and that maybe the value will be in not drinking anymore. Once he expressed an intention to change, I would ask him to express his commitment to change to me and someone else in his life like his daughter or wife.

    #24395
    Kelly Jeremie
    Participant

    1. what are your general impression of and reactions to the MI interview of Terry Moyers and the Rounder?
    First Jim didn’t want to change and after Terry switched his language from sustained speech to change speech to seemed Jim was able to see where he might need to change. This clearly can help with clients when they are struggling with change and need to recognize why or how to change even using baby steps.
    2. examples of Rounder’s sustain talk: 1. reason sustained speech, Getting angry ” used to slap someone around”
    Ability ” I’d take it to ‘m but since I’ve gotten older I kinda have a couple or 3 or 4 beers , kinda cool down a little bit. 2. so just because you were drinking they kind of used that as an excuse to pin the accident on you. ” Put on me , she walked scott free.

    3. Desire: is there anything maybe you guys can do maybe about me keeping my license and all that change speech, if there s anything in it for me.
    reason and need Terri: Yeah. You’re not here because you think you have a problem. You’re here
    because they sent you here.
    ” Yeah. The court sent me here”.
    ” And that’s the only reason you’re here”.
    ” Yeah I’ll be honest with you. There’s no need in me lying to you because you
    know unless you go down and tell the court that you know I’m not motivated to
    be here or anything, but I don’t like any of this I’ll be honest with you. It’s taking
    a lot of time that I don’t have. Its taking of money I don’t have for the court and
    the fines and all this stuff. On top of that I’ve got to pay my lawyer $1000 which
    I don’t have to represent me and I guess he’s probably one of the reasons I’m here
    today because… but you know he and I drink together? I’ve known this guy ever
    since he got out of law school. He’s a good friend of mine, but I said “Now, why
    do I have to go up there you know I’m paying you $1000 to represent me and I’ve
    got to go over and go through this evaluation and all that.” That does not make
    sense. And he says, “You’ve got a drinking problem.” Hell, you know I’ve had to
    take him home a lot of times, that I’ve been the one standing and he been passed
    out and couldn’t walk. It doesn’t make sense. None of this makes sense.
    Give two or three examples of Rounder’s signs of readiness to change
    People keep saying that you need to stop drinking and I ain’t never done that
    either. I think I could. I’ve tried a couple of times and I wasn’t very… I think one
    time I quit for a week or two just to show people I could stop drinking. I wasn’t
    too happy. Really I didn’t know why in the hell I stopped anyway.
    It almost sounds like you don’t even know whether you could stop even if you
    wanted to.
    “That’s a funny thing to say. I can do just about anything but I can’t say
    yes to that, that I can stop drinking. I think you’re right on that one. There’s a lot
    of things I can do, but I’ve never tried to stop drinking, I get thinking about it,
    honestly.”

    #24396
    Colleen Drake
    Participant

    Question #1:
    Jim seemed to be very guarded through most of the session, taking the defensive and making it clear that he was there due to a court mandate. The interviewer took a patient approach and validated what Jim was expressing about his lack of desire to be involved in treatment. It was clear that Jim was not really ready to consider quitting drinking until further through the interview when he was able to identify some of the reasons why it may be beneficial for him. I would wonder if Jim would have been willing to engage in any of the change talk if the interviewer had taken a different approach with him. I think she created a comfortable space for him to voice his opinions and to provide feedback.

    Question #2:
    Sustain talk: “…the only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house. It’s not because I want to do any of this crap you know.” “It’s taking a lot of time that I don’t have. It’s taking of money I don’t have for the court and the fines and all this stuff.” “I wasn’t too happy. Really I didn’t know why in the hell I stopped anyway.”
    Change talk: “Maybe that’s something I need to think about before I even do any of this stuff that you’re, or that they’re, talking about.” DESIRE “You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.” REASON “Yeah. Cause, if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?” NEED

    Question #3:
    Complex reflective listening: “Yeah. You’re not here because you think you have a problem. You’re here because they sent you here.” So, it’s kind of the same thing you were saying before which is that it feels like everybody’s looking at your drinking but it’s just not as bad as everybody things it is.” “It almost sounds like you don’t even know whether you could stop even if you wanted to.”
    Strategic responses: “I’m hearing you loud and clear that being here is not something that is really a high priority for you.” “So it seems to you like I might try to push you around and make you do a whole bunch of things you don’t want to do” “Kind of a mystery to you why she’d even be worried about that.”
    The interviewer’s strategic responses and use of complex reflective listening seemed to have an impact on the ability for Jim to feel comfortable being honest and opened up the door to a bigger conversation of considering why he may benefit from quitting drinking. This brings the conversation, toward the end, to a place where Jim starts seeking more information about treatment and what it would be like. He starts identifying, on his own, what impacts there will be if he doesn’t quit drinking (such as loss of his job and/or home). Jim started the interview being on the defensive and making it clear that he had no desire to change and ended the interview considering entering a treatment facility and talking about the things that may help keep him motivated toward change.

    Question #4:
    Jim showed a readiness to change when he; mentioned that he was unsure if he would be able to quit drinking, started asking for more information about the treatment programs and started identifying the pieces of his life which may improve/resolve should he quit drinking. If I were interviewing Jim I would continue the conversation and ask him if he would like more information about treatment options. I might also ask him to elaborate on what some of the positive outcomes he might experience if he were to quit drinking. I might ask him what steps he would be willing to take within the next day, week or month towards and action plan for change.

    #24397
    Monica Sonner
    Participant

    Question 1:
    At first, Jim seemed resistant towards talking with Terry because he mentioned having some difficulties trusting other service providers he has recently worked with. Terry was able to help meet him where he is and provide an understanding of his concerns and thoughts. This helped to gain rapport and build trust between Terry and Jim to move forward with finding his goals and how to achieve them.
    Question 2:
    Reason: “the only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house. It’s not because I want to do any of this crap you know”
    Ability “I wouldn’t mind doing some of this stuff may if there was anything in it for me”
    Desire: “I want something that will help me with court”
    Reason: “if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again,”
    Question 3:
    Example 1:So the fact that your daughter won’t even take your word for the fact that you won’t drink kind of bites at you a little bit.
    This helped to open up Jim to see the perspective of his family members and how it may be impacting their relationship. This helps to create motivation for him to create goals that are motivating to help with his relationship with his family.
    Example 2: So drinking kind of helps you relax and, you know, cope with your life.
    Terri was able to identify why he is using alcohol to help provide a path to seeking other coping skills and helping him see how it is impacting other life domains despite the fact that it is helping him with coping with life.
    Example 3: It sounds like if you look ahead take look at your drinking and see where you’re going to go with that, you’re kind of worried about that
    This helped to guide Jim to understanding what motivates him to help him reach his goals.
    Question 4:
    “You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.”
    “I wouldn’t mind doing some of this stuff may if there was anything in it for me, but so far I’ve been having to pay this and pay the lawyer and pay for the wreck and pay for the evaluation and everything and so far ol Jim ain’t got nothing.”
    I would start talking about what some of his goals are; having a better relationship with his family, being a better worker, keeping his independence, etc. I would ask him how he thinks he could reach these goals and provide him with a direction on how we could help him get to these goals. I would also help guide him to breaking down his long-term goals into short term goals to help come up with an overall plan.

    #24398

    Question 1 What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
    I loved this because it reminds me of people I grew up with in the South. His expressions, dialect, and the first thing he points out is her hair color. He is immediately on the defensive and trying to put a woman in her place. He’s every defiant. He’s very much in denial. He’s received a nudge from the judge, and everything in his life is everyone else’s fault. She does a beautiful job of building trust and turning the conversation around. I love the scale of 1 to 10 method, and using the scale to ask why he didn’t pick a lower number. Brilliant. That really surprised me. I’ll be using that myself with clients.

    Question 2 Give two or three examples of Rounder’s sustain talk:
    “I drink a little bit but I work hard. It’s nothing for me to sit down and drink a six-pack or two of beer and still be able to function. I’m not like one of them bums you see laying down there by the bus depot on the lawn selling his blood and stealing hubcaps. I’ve never stoled anything and I’ve worked every day since I got a social security card.”

    “And he says, ‘You’ve got a drinking problem.’ Hell, you know I’ve had to take him home a lot of times, that I’ve been the one standing and he been passed out and couldn’t walk.”

    “Well, I’m kind of an uptight guy. I have a hard job. I work around a lot of old boys that are pretty rough and tumble. I drive a long ways and I unload big trucks. I get tired sometimes. I like to sit down and have a drink.”

    Two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.
    Desire: “Yeah. Cause, if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?”
    Reason: “As long as I’m putting all this money into it I’d like to come out with something.”

    Question 3 Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.

    “It almost sounds like you don’t even know whether you could stop even if you wanted to.” This is an extremely important moment in the session because he seems almost dumbfounded. It was like he had a moment of clarity when he responded, “That’s a funny thing to say. I can do just about anything but I can’t say yes to that, that I can stop drinking. I think you’re right on that one. There’s a lot of things I can do, but I’ve never tried to stop drinking, I get thinking about it, honestly.” His response was a far cry from his stance when he arrived.

    “You know you’ve mentioned that twice already you used to be more hot tempered than you are right now. What do you think caused you to kind of become more…less angry and less violent?” This is brilliant because she’s trying to get him to see that he drinks at people. His drinking has increased as a way for him to control his anger. He begins to reminisce about the times he got into fights and got thrown in jail. She follows up with, “So it looks like that was causing you problems in a lot of different areas, with the law and your family and other people in town.” This brings him back to his current problem – the DWI.

    Question 4
    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.

    “What would that be like for you? If you didn’t drink and you were around them?” This is the moment where he really can’t even conceive giving up drinking. He admits drinking is who he is. She can’t imagine not being a psychologist, and he can’t imagine not drinking. He says, “That’s a hard thing. Maybe that’s something I need to think about before I even do any of this stuff that you’re, or that they’re, talking about.” This was a step in the direction of change. Very slight, but he’s getting there. I would probably have asked him what kind of person he might see himself being without it.

    “This treatment center thing- is that here at this facility?” This question is his first real step toward a commitment, even if it is because he’s wanting to get off the hook. He begins to ask the questions about living arrangements, so he’s contemplating commitment. I don’t know that I would have done anything differently at this point. I’m tempted to ease into telling him he needs to do this for himself, not anyone else, but at this point, getting him in the treatment center was a huge success. The rest will come.

    #24399
    Kristin Giguere
    Participant

    Question 1:
    This video showed how smooth a process MI can be; it was obvious that Terri is comfortable with the technique, as she was able to elicit valuable information, help bring Jim to some self-reflection, and normalize his responses. It was good how Terri didn’t make promises and she kept bringing things back to him, how the results would vary according to what Jim is willing to do and what changes he is willing to make. Even though Jim was a reluctant attendee at the appointment, he was becoming more open to the idea of making changes and engaging in treatment by the end.

    Question 2:
    Examples of Sustain Talk:
    “It’s nothing for me to sit down and drink a six-pack or two of beer and still be able to function.”
    Talking about his friends, “Yeah and I don’t know how they’d feel about me quitting drinking. I don’t know what they’d call me.”
    “Well, I’m kind of an uptight guy. I have a hard job. I work around a lot of old boys that are pretty rough and tumble. I drive a long ways and I unload big trucks. I get tired sometimes. I like to sit down and have a drink.”

    Examples of Change Talk:
    “I think one time I quit for a week or two just to show people I could stop drinking.” (Ability)
    “I wouldn’t mind doing some of this stuff may if there was anything in it for me.” (Reason)
    “If I don’t stop drinking I’m probably going to be right back in this mess again.” (Need)

    Question 3:
    Terri’s use of complex reflective listening and strategic responses helped put Jim at ease and reduced his use of sustain talk, increasing his use of change talk.
    Examples:
    “What would you like to do with the time that you spend with me here? What would be helpful for you?”
    “It almost sounds like you don’t even know whether you could stop even if you wanted to.”
    “There’s just all-different kinds of ways to do it. There’s definitely more than one right way.”
    “Right, you were successful in changing that in the past and sounds like you’d kind of like to be successful changing this.”
    “So you kind of feel two ways about it. On the one hand, you know, you think you’d like to have a change and you’d like to quit drinking and on the other hand you think you kind of dread it.”

    Question 4:
    Some of the signs that Jim was moving toward being ready to make a change include Jim saying “Yeah. Cause, if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?” and “As long as I’m putting all this money into it I’d like to come out with something.” His asking about treatment options and what it’s like at the center also indicate readiness for change, with him even saying ” I wouldn’t mind coming here to live”.

    My next step would be to ask him to measure where he is at on a scale of 1 to 10 with regard to his readiness, ask what puts him there, and try to find out either what step he is ready to take if his response is indicative of being at that stage, and if not, I would ask what he thinks would increase his readiness.

    #24400
    Robert Hussey
    Participant

    Question 1
    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”

    I enjoyed how the counselor was able to use reflective responses to get the client to answer their own questions. The client might have been more confrontational if the counselor was simply telling him what to do. This approach promoted change since the client had to come up with potential solutions himself and decide if these solutions were reasonable.

    Question 2
    Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.

    Sustain talk:
    I drink a little bit but I work hard. It’s nothing for me to sit down and drink a six-pack or two of beer and still be able to function. (ability, reason)
    I have a hard job. I work around a lot of old boys that are pretty rough and tumble. I drive a long ways and I unload big trucks. I get tired sometimes. I like to sit down and have a drink. (desire, need)
    Yeah and I don’t know how they’d feel about me quitting drinking. I don’t know what they’d call me. (reason)
    Change talk:
    I wouldn’t mind coming here to live. (activation)
    Well, I want something that will help me with court. (activation)
    Cause, if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think? (activation)

    Question 3
    Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.

    “Right, you were successful in changing that in the past and sounds like you’d kind of like to be successful changing this.” The counselor is reflecting on client’s admitted strengths.

    “So you kind of feel two ways about it. On the one hand, you know, you think you’d like to have a change and you’d like to quit drinking and on the other hand you think you kind of dread it.” Counselor is summarizing the client’s thoughts, feelings, and concerns on whether he should proceed with treatment.

    Question 4
    Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.

    “As long as I’m putting all this money into it I’d like to come out with something. You’d like to get something for your money, huh?” At this point, I would talk about value of money and commitment since finances appear to be important to client. Maybe client will be more likely to change when talking about positive financial outcomes and negative financial consequences since value of money seems important to client.

    “So you’re kind of wondering what it would even be like here.” At this point I would probably provide an overview of the facility to gauge interest.

    #24401
    Carol Acedo
    Participant

    Question 1
    What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
    Jim was conflicted on why he was there, what good it was going to do him and didn’t understand the money he was putting in and he seemed to not believe that he was going to get anything out of it. Terry did not make any promises but stated to Jim that this was his decision on how he wanted to help him self as well as giving feedback to his statements and concerns of how he was going to address his situation.

    Question 2
    Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.
    Reason: I am here because the court says I have to be, I don’t want to do this, I can handle my drinking.
    Ability: I would do this if I knew there was something in it for me.
    Desire: I want someone/something to help me with court.
    Reason: If I stay here, I can get help to stop drinking and save my license, job and home.
    Question 3;
    Terry states that Jim does not think if he can quit drinking or not, even though he has quit for a week or two in the past, he has never gotten past 2 week. It was like he had a moment of clarity when he responded, “That’s a funny thing to say. I can do just about anything but I can’t say yes to that, that I can stop drinking. Funny question that I have never been able to answer.
    Question 4:
    I have to come here and spend this money, I feel that I should be getting something out of this. I would talk about the commitment to change, leading in questions that will have him think regarding the money he is spending on his treatment to his overall needs and desires that will come with treatment. The client may be more willing and committed to change when speaking of building trust with his daughter again to see his grandchildren.

    #24402
    Jennifer McCaslin
    Participant

    Question 1:
    The video was interesting to watch how Jim transformed from ambivalence with his drinking and treatment to willingness and acceptance. The interviewer used open ended questions and reflective listening which was effective with Jim to see his problem with alcohol. At the beginning of the session Jim was blaming others for his legal issues and family conflicts and after processing with the interviewer he was able to take some accountability and be open to some help.

    Question 2:
    Sustain talk:
    Need : Jim drinks to deal with the stress in his life.
    Ability: Jim quit drinking for a couple of weeks but, does not know if he could quit drinking completely.
    Reason: “the only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house. It’s not because I want to do any of this crap you know”.
    Desire: “I want something that will help me with court”.

    Change talk:
    Need: “If I don’t stop drinking he is going to be in this mess again”.
    Reason : “I wouldn’t mind doing some of this stuff may if there was anything in it for me.”
    Desire: “I wouldn’t mind coming here to live”.

    Question 3:

    JIM: My daughter she you know, she uh… won’t let me see the kids. “Well she’ll let me see them but she won’t let me take them anywhere anymore”. ” And that really has me upset you know. She’s afraid that I’ll take them and hurt
    them driving around, drinking and driving and things like that. And I never have
    hurt one of them kids”. Even when I say to her that I wouldn’t drink she still don’t trust me now. And
    that’s really got me upset, really got me ticked off.

    Interviewer: “So she’s afraid that if you take the children with you that you’ll be drinking and
    then you might hurt them or get in an accident. : So the fact that your daughter won’t even take your word for the fact that you won’t drink kind of bites at you a little bit. “So its kind of a mystery to you why she’d even be worried about that.
    The interviewer is processing with Jim on his daughters worries and reasoning why she is concerned for her kids. This reflective listening opens up a more in depth dialogue to Jim’s drinking and behaviors while he is drinking. Interviewer’s approach has been effective with Jim recognizing his alcohol problem.

    Question 4:

    At the beginning of the interview Jim clearly exhibited ambivalence and resentment for having to be there and people’s concerns regarding his drinking. He was quick to deflect and blame others. However as the interview continued and Jim began to engage, change his thinking, take some responsibility and acknowledging the benefits for making changes such as not losing his job, license or home and having a better relationship with his family. With utilizing MI strategies the interviewer was successful with Jim on his readiness to make some changes which would impact his life positively.

    #24403
    Diane Scalia
    Participant

    Homework question 1:
    I am in awe of the skillful way that Moyer was able to move the “Rounder” from pre-contemplation to action. Her interaction with this client could have potentially gone horribly awry. The client came into the meeting “on fire” and she was able to build an alliance with him by meeting him where is was at and rolled with the resistance with the use of reflective responses to gain insight into the his values (family, work, reputation). She primarily used reflective listening to move the client from sustain talk to change talk.
    Homework question 2:
    Three examples of Rounder’s sustain talk:
    “I’m paying my lawyer $1000 and he says, ‘You’ve got a drinking problem’…he and I drink together…I’ve had to take hime home a lot of times…”
    “I used to be a rounder…I’ve settled down…I drink a little bit but I work hard…”
    “My buddies might say I quit drinking because I can’t hold my liquor …I can outdrink all of them…”
    Three examples of Rounder’s change talk:
    “I wouldn’t mind doing some of this stuff maybe if there was anything in it for me” (Reason)
    “I wouldn’t mind coming here to live, but I wouldn’t want to sit around in pajamas” (Desire)
    “I want something that will help me in court” (Desire)
    “As long as I’m putting all this one into it, I’d like to come out with something.” (Reason)
    Homework question 3:
    Examples of complex reflection:
    “It seems to you like I might try to push you around and make you do a whole bunch of things you don’t want to do.”
    “Do you kind of have the feeling that your wife and daughter are ganging up against you?”
    The reflections of meaning and feeling above, decreased Rounder’s sustain talk. He began speaking about his own feelings and values. He was able to verbalize his desire to save his driver’s license and keep his job and his house.
    Examples of strategic responses:
    “It almost sounds like you don’t know whether you could stop even if you wanted to.”
    This statement reflects the Rounder’s ambivalence to change. He admits that Moyer is “right” in her assessment and Rounder admits that there are “ a lot things I can do”.
    “Just because you were drinking they kind of used that as an excuse to pin the accident on you”.
    The Rounder’s statement about the “grandma’s driving around crazy” more than likely described the reason why he got the DWI.
    Home question 4:
    Examples of Rounder’s readiness to change:
    The Rounder became curious in what he could get out attending treatment at the center, what treatment involved. The Rounder then moved to expressing a good reason for attending treatment and envisioning something different by stating, “If I don’t stop drinking, I’m probably going to be right back in this mess again”…and, “if I get out of this, if I can save my house and my job, I’d better do something that’s gonna keep me from doing this again, don’t you think?”
    At this point, I may give Rounder a tour of the center and provide more elaboration as to the various treatment options that the treatment center offers.

    #24408
    Jenai Jackson
    Participant

    Question 1:
    I was really impressed with how well the interview flowed. I’ve had little exposure to MI outside of this class and noticed how the clinician drew so much out of Rounder, especially since he put up a fight most of the way. The clinician carried the conversation so far by only asking questions about what Roudner had just said. The created space for Rounder to express himself and really to get everything off of his chest. He vocalized his unhappiness and was open and honest and the clinician really did try to change his mind in any way. The clinician also used a nice understanding tone and showed full respect for what many would consider a difficult patient because it does seem that he hasn’t admitted his fault and role in the situation. I think acknowledgement is something that clinicians want to see but when that didn’t come, the clinician wasn’t deterred in any way and continued on with talking to Rounder. It was really great seeing such a successful MI scenario that came full circle from expressing emotions to discussing action steps to be taking.

    Question 2:

    Sustain Talk Example 1 “I sit out here in front for about an hour before I come in and I was about that close to just cranking that pickup up and heading back home. I’ll let you know, just like I told Rich, I’m not real happy about being here. I hope you understand that…And I’m about up to here with this kind of stuff. I hope you know that. It probably isn’t your fault but that’s just kind of the way things have been going, you know. “

    Sustain Talk Example 2: “I’m not motivated to be here or anything, but I don’t like any of this I’ll be honest with you. It’s taking a lot of time that I don’t have. Its taking of money I don’t have for the court and the fines and all this stuff.”

    Sustain Talk Example 3: “I can do just about anything but I can’t say yes to that, that I can stop drinking. I think you’re right on that one. There’s a lot of things I can do, but I’ve never tried to stop drinking, I get thinking about it, honestly.”

    In these 3 examples, Rounder never says he is against changing. He says change is expensive and that he has never really tried and he’s not too happy about it but he says it’s just the way things are and how things have been going for him.

    Change Talk Example 1: “As long as I’m putting all this money into it I’d like to come out with something.” This is a Desire for Rounder

    Change Talk Example 2: “if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?” This is a Reason for Rounder

    Change Talk Example 3: “I wouldn’t mind coming here to live” This is Ability for Rounder

    Question 3:

    Example 1: “I’m hearing you loud and clear that being here is not something that is really a high priority for you.” The clinician demonstrates reflective listening from the beginning with this statement. She acknowledges how the client was feeling and repeated, paraphrased and reflected it back to the client. This immediately shows the client that she is not here to argue or disagree with him and that she will be supportive.

    Example 2: “Do you kind of have the feeling that your wife and daughter are ganging up against you?” Here the clinician hears Rounder and uses the repeat, paraphrase, reflect technique to share her hypothesis. She also isn’t taking the side of the wife and daughter but asks what the client thinks which also helps in keeping the conversation moving and on target with the topic.

    Example 3: “Yeah. That’s real normal for people when they first start thinking about
    something like this.” When the client asks “Is that normal?” The clinician responds in an honest way showing that she heard his statement and that he isn’t alone in this process which assists in moving Rounder from sustain talk to change talk and closer to action. She kept the client at the center and really listened for expressions of his feelings.

    By using reflective listening and by strategically responding to Rounder, the clinician was able to move Rounder through the conversation that started heavy with sustain talk and ended with more change talk. She kept the conversation going by asking questions and focusing on the client and she clearly gained the client’s trust which caused him to think and express the situation on his own without getting defensive towards the clinician. Overall the use of reflective listening had an immensely positive impact on the conversation and Rounder’s feelings towards change overall.

    Question 4:
    Example 1: “Is there anything maybe you guys can do maybe about me keeping my license and all that? Could you say something to my, that witch I got for a probation officer, maybe get her off my back, or is there, you know… I wouldn’t mind doing some of this stuff may if there was anything in it for me, but so far I’ve been having to pay this and pay the lawyer and pay for the wreck and pay for the evaluation and everything and so far ol Jim ain’t got nothing”

    Example 2: “You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.”

    For example 1, I ask him what type of benefits he expects to see for the work he is doing. I’d make sure he was setting realistic expectations while still encouraging him and answering his questions on what the possible outcomes could be if he goes through the necessary steps. I’d ask him to think of personal benefits and then the benefits for his grandchildren.
    For example 2, I’d ask what Rounder disliked about this mess and why he would want to avoid it again. I’d ask him what’s one thing he could do in the future to avoid this mess. I think a question like this reiterates many of the things he’s said that he disliked about this situation and continues to move him towards action if only to avoid the repercussions. Rounder may not be changing his behaviors because he sees an issue with them but he is willing to do the work to change and that ultimately is a positive outcome for him and his family. And hopefully more understanding will come with time.

Viewing 15 posts - 1 through 15 (of 18 total)
  • You must be logged in to reply to this topic.