Week 3 Homework Assignment (Applications of MI)

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  • #4478
    Patricia Burke
    Keymaster

    Exercise 1

    Watch the 12-minute video Coded Role Play of Motivational Interviewing Part 4a: Commitment and Planning which focuses on change planning with a client whose change goal is to stop drinking. As you watch the video note the time point in the upper right hand corner, and jot down 2–3 MI strategies the counselor uses to elicit Commitment Activation Taking Steps (CAT) change talk and commitment language. Make a note of how effective the counselor’s use of MI is at this point in time. Make a note of how, if you were the counselor in the role play, you would try a different strategy or improve on the strategy the counselor in the role play uses.

    Please Note: The coding in these videos is not always accurate, so don’t rely exclusively on it for your identification of the MI strategies that elicit CAT change talk and commitment language.


    Exercise 2

    Watch the 12-minute video Coded Role Play of Motivational Interviewing Part 4b: Commitment and Planning which focuses on change planning with a client whose change goal is to stop drinking. As you watch the video note the time point in the upper right hand corner, and jot down 2–3 MI strategies the counselor uses to elicit Commitment Activation Taking Steps (CAT) change talk and commitment language. Make a note of how effective the counselor’s use of MI is at this point in time Make a note of how, if you were the counselor in the role play, you would try a different strategy or improve on the strategy the counselor in the role play uses.

    Please Note: The coding in these videos is not always accurate, so don’t rely exclusively on it for your identification of the MI strategies that elicit CAT change talk and commitment language.


    Homework Questions

    Question 1

    What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.

    Question 2

    What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?

    Question 3

    How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?

     

    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.

    #24557
    Melissa Ivey
    Participant

    Melissa Ivey

    Question 1:

    I enjoyed watching the videos. I thought overall the counselor was very effective.

    The client appeared to arrive fairly committed to not drinking. For example in the first video at 8:30, he states “I have made this decision.“ “There is either drinking or not drinking.” Throughout the video, the counselor uses both simple reflection and complex reflection to help solidify the clients decision to stop drinking. He also provides the client with multiple options. In the first video at 2:15, the client appears to be taking steps to reach his goal of not drinking. He discusses the need to understand his options. At 3:33 he discusses the idea of going to church, and eventually at 5:35, he discusses talking to a friend about attending AA. In the second video, he continues with the change language and develops a specific plan of talking to his friend at work about AA, not attending functions that had alcohol present, disguise of the school with his wife, and within the alcohol from the house.

    When looking at setting up goals, his goal appears to fit the SMART acronym. It is specific about not drinking. It is measurable. The client believes it is attainable. It is relevant and time-based.

    Question 2:

    My only concern was that the counselor appeared a little pushy. I would’ve probably given the client more time to explore his options and for him to develop the list of ideas and steps he was going to take instead of the counselors appearing to push the list upon him. In the beginning of the second video, I would have asked the client and reflected back on what he believed would be helpful and ways he could implement the changes. When he stated he needed to know his options, I might have asked him what he believed was available in his area and ways to find out what is available. When he discussed the guy from work, I might have used complex reflections to explore his comfort level talking to people at work about his drinking. I probably would have used complex reflections regarding the clients ambivalence about attending church verses putting it on him and adding it to the list of activities of things he would be attending.

    Question 3:

    In future I may spend more time brainstorming different options with my client. I like the idea of eliciting from my clients the options and steps they could take to reach their goals. I also like the idea of using the: on a scale of 1 to 10, how likely are you to implement each option. I believe it allows the client to build their confidence in their ability to take the necessary steps towards their goals.

    I currently use the SMART goal set up. I have also discussed with my clients the benefits of using the acronym when it comes to establishing goals. Often times I will take their long-term goal and have them develop ways in the various steps they can take it to reach their goal. This is often part of the brainstorming activity.

    Once a goal has been established, along with their objectives, I will work on reaffirming the commitment with my clients going forward. I will help the client summarize their change plan. I will also help them, through reflections, discuss their commitment and the perseverance they will be needed to reach their goal. I do plan on incorporating questions such as “is that what you intend to do?“ and on a scale of 1 to 10, what do you believe, or how likely, is it that you will take the next step. I will remember the idea that anything under 7 the goals may need to be changed so that they are more achievable. I will also spend more time exploring how confident my clients are in the possibility that they will be able to make the necessary changes to reach their goals and how I can help them succeed.

    #24583
    Danielle Wilbur
    Participant

    Question 1
    What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.
    I think in the swimming video, the client seems very cooperative, and the depression client is a little less motivated. I liked how in the depression video it highlighted each step in the conversation as it went. The client is resistant to taking medication and states an interest in natural choices. When she is resistant to exercising, he respects her autonomy and gives her the choice to explore the topic further and gives her information about how it works. In the summery he gets her to commit to a plan, including the details of how it will work for her. Both clients state that they are committed to this change. I could also see that it could be hard for a client to admit if they did not follow the plan they helped create. Because it is broken down into small attainable steps, they have little room to come up with reasons why they didn’t follow through.
    Question 2
    What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?
    I think I would have done the interview the same with a few small exceptions. In the depression interview, I do not think I would have brought up BDNF and dismissed the explanation of what it is because it could lead to a client becoming defensive or feeling like they are being talked down to. I liked how both councilors kept the client engaged in the conversation. I might have explored what she liked about swimming a little more and included that in the summery.
    Question 3
    How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?
    I think I would need to watch the depression interview a few times to really get the hang of how the conversation should go in MI. I found it helpful that each step was identified along the way, I work with clients who are often at the end of their resources. Some are harder to pivot from a confrontational attitude. I want to practice the flow of MI like a more natural conversation.

    #24587
    Colleen Drake
    Participant

    Question #1:
    My overall impression of the two videos is that the use of MI was noted, but spotty. I think the conversation was effective in helping the client reach a point of willingness to try a commitment plan to quit drinking, although there were things that could have been improved upon if MI had been followed more consistently. The feel of the conversation seemed to me more of an exchange between two friends discussing the concern and not a lot of focus on eliciting change talk from the client. The counselor did help the client come up with some things to try (AA for example) and he did use some complex listening in the interview (I noticed this more in the first video). The client was able to express a reason for change when he mentioned the “priceless conversation” he expected he would have if he went home and told his wife he was going to go to AA. When the client was showing some resistance in the conversation about using church as a strength the counselor followed up with complex reflection about what the client was saying about not fitting in with church. At the end of the interview it did seem as though the client was expressing a readiness to take some steps toward change.

    Question #2:
    The counselor was able to help the client discuss some thoughts about changing and some methods he could try, however I think it could have been improved upon if the use of MI strategies was more consistent throughout the interviews. I noticed, in both videos, that the counselor asked a lot of closed-ended questions (more often than open-ended questions), he interrupted the client a few times, often did not ask permission before providing information (it was used some, but not as much as I would anticipate with the use of MI strategies) and he tended to use simple reflections over complex, reflective listening. There were not many pauses to show true listening and reflection and I didn’t hear much for questions like “what do you think…” that would have helped the client move forward with change talk. I didn’t see a good pattern of elicit-provide (with permission)- elicit being used. If I were the counselor in this situation I think I would have chosen to do more; double-sided reflections, open-ended questions, asking permission before providing information and with helping the client identify SMART goals. I think this would allow for the client to feel less pressure from an outside source (ie. the counselor) and to feel more in charge of the decision himself.

    Question #3:
    I would like to start practicing using the MI approach more in the work that I do. I think it would be an effective way to help people find motivation for change and be more likely to adhere to their plans. Being a Children’s Case Manager, my approach would certainly be different than that of a therapist though. I can think of examples where an MI approach could be helpful in working with my client’s parents, such as helping them explore; other ways to interact with their children and different ways of approaching concerns with schools or providers. I may find the MI approach helpful when speaking with clients, especially my pre-teen and teenaged clients, about goals they have for themselves and how to reach them. For example, when working with an older teenaged client who is initially ambivalent about trying a new treatment or medication I may ask some open-ended questions and use reflective listening to help the client think about things in a different way. Then, with permission, I might offer information to the client about risks and benefits of such decisions.

    #24627
    Betsey Davis
    Participant

    Homework Questions
    Question 1
    What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.

    My general impressions were that the counselor and client seemed very comfortable with one another, as reflected by not only the casual way they spoke to one another but in the duality of their body language. The counselor seemed very comfortable rolling with the resistance that presented and kept a low energy level throughout the interviews. Time was spent in session talking about the reasons for change, exploring options and identifying how and when the client was going to make change.

    Examples of MI to evoke commitment, activation and taking steps included:
    1st video-:22-Counselor stated, “So where do we go from here? What are the options?” He went on to say, “Where are we at?” Client seemed to respond well to this energizing, focused interviewing and went on to say what was motivating him and what he wanted to see happen.

    1:15—Counselor asked, “What are you going to do?…then shortly thereafter, “When are you going to do that, when you leave here?” He pressed the client for commitment and action he could agree to.

    4:25—Counselor asked, “What are those things and what might you do?” Had client restate what he was going to do to further strengthen change talk and commitment.

    3:17–I liked how the counselor stated, “Before I go there, you mentioned some options. . . do you have other ideas?” A little before this, he stated a nice reflection, summarizing what the client has said up to that point.

    9:16—Client stated “She’s going to be happy I made this decision. . . I’m with you there.” Counselor stated the simple reflection of “You’re highly committed.” This was very effective and supportive.
    2nd video-:52—Client stated, “I just need to do this”. Firm commitment toward action.

    6:05—Client stated, “I’m going to tell my wife what my agreement has been with you.”

    Question 2
    What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?

    There was a lot done very well in this video but I feel the counselor missed some opportunities to deepen the activation for change talk.
    Here are a few examples and what I would have done differently:
    2:34—Counselor summarized and moved to planning talk before really identifying a strong commitment from the client. He went on to summarize stating “you’ve said you’re reasonably committed.” I’d want that to be stronger and have the client state it further and build upon his motivation for change. I’d work to elicit a stronger commitment by using scaling questions.

    3:47—Counselor stated, “It might be a REALLY good idea for you to do that [attend church functions]” while client seemed to have a lukewarm response to the whole topic. This wasn’t very effective. Client was not at the center of the conversation at this point. He did the same thing when he brought up dancing, which client didn’t seem to respond well to. I imagine there were better options, but they didn’t spend a lot of time in the brainstorming part. I’d do more of that. I’d also talk with client more about his wife’s concerns as a way to strengthen his commitment as this was important to him.

    4:53-In discussing the option of AA, the counselor stated, “that is a venue that may or may not work for you.” I didn’t like how he said, “I’m sure you’re aware of this” (no room for what if the client was somewhat aware or had not heard about this. ..would have made it hard to then ask for more information).

    Client stated a lot “I’m not opposed to that. . . “. He didn’t seem onboard in a significant way. I think I would have asked, “what do you think may be a better option for you? I’d also ask some of the scaling questions to try to better understand what client was thinking about effectiveness and confidence around the options he was discussing”. Seemed vague without it and less of a commitment made with these statements.

    2nd video
    :52—Client stated, “I just need to do this”. 4:51—”My answer to that is that I need to be prepared to just completely change all my plans. “I need to just completely change.” I would have reflected this back and taken the opportunity to summarize client’s reasons for making change.

    Counselor stated “do you need me to write this down?” Writing it down and sending the plan with client would have strengthen his commitment to it and made it easier for him to talk with his wife about the plan, getting her buy-in.

    6:45—Counselor shared suggestions without asking for permission from client first. Used strong, forceful language, not tentative. This could have caused problems but didn’t seem to as they had a good rapport.

    Question 3
    How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?

    Since starting this online course, I have found I much more aware of change talk/resistance in clients when in session. I’ve tried some of the reflections and found them helpful. Much of this, I was already doing but not enough of it to evoke commitment to change. I particularly liked the chart of the desired change, with brainstorming options then rating them on effectiveness and confidence. I could see this as really helpful, maybe doing with client on a white board in session or have them write things down if working remotely. I often use scaling questions in terms of how clients are feeling. I will definitely be adding the effectiveness and confidence scaling questions in my practice. I appreciated the what to do if a client says “I don’t know”. I feel like I come up against that often and end up in the expert role (either put there by myself or my client). I really liked the suggestion of sharing ideas but checking in with client about any thoughts they may have first. So respectful and collaborative!

    #24629
    Charles Cardoza
    Participant

    Homework Questions 3
    Question 1
    What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.
    The counselor appeared to successfully utilize MI techniques; i.e. open-ended questions, simple and complex reflections, summaries and information after asking permission. The Ct’s presentation indicated that he has a history of willingness to make changes, but lack of success in following through. When asked, “Where do we go from here/where are we at now?” Ct. inquired as to what were his available options and acknowledged a need to stop drinking followed by a lose commitment to try. The Ct. acknowledged that he has a loose support network of church friends, but he admitted that it could be better and also admitted that he was not much of a church goer. After asking permission, the counselor provided information on Alcoholics Anonymous. The Ct. admits that he has little information about AA, but has a colleague from work who regularly attends meetings. The counselor advises that many people find AA helpful but some newcomers are scared off by the God talk. After being asked where he wants to go from here, Ct. appeared to make a commitment to change – to strengthen his support network. Ct. made a commitment to talk to his AA coworker later that day and that he expected that he would be willing to help as this is part of the AA program. The Ct. previously admitted that he has an upcoming social gathering and a football game that he had planned to attend in the near future. He admitted that he would drink at both of the events in the past and h could not see himself not drinking at either event. Ct. was asked how he planned to handle these and he replied that he would be better off not attending either. Also responding to the where do we go from here question, Ct. committed to attending an AA meeting.
    Question 2
    What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?
    The interaction seemed to work out on both sides. The counselor appeared to go out of his way to be non-confrontational and the Ct. presented as being ready to make changes in his lifestyle and open to whatever suggestions the counselor offered. That being said, even if the Client did offer resistance or attachment to his status quo, I would have still tried to remain non-confrontational; asking open-ended questions and asking permission to provide feedback or information. One thing I would do different is, after soliciting permission to offer information, told the Client about other peer-support networks that are available like SMART Recovery, Life Ring, Refuge Recovery and area treatment center based Outpatient recovery groups.,
    Question 3
    How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?
    I find that if I ask a Client what they need and how I or my agency can help them, they usually have a pretty good idea of what they need and how they want to get there. In my case the Client is usually experiencing consequences of substance use which present as legal, physical, and medical issues or a combination. They don’t always want to cease the behavior. Sometimes they are looking for a way to moderate it to the point where there are little to no consequences. Based on the experiences of passed Clients, this is a difficult, if not impossible goal to achieve, but I try to meet the Client where he or she is at and not immediately void their idea. I have found through experience that it is belter to hear them out and ask about their experiences with trying to use moderately in the past. This can be time consuming, but if I listen to what they have to say and honor their experiences, I usually find them circling back to the idea that there is not a way to use safely and look for ideas and suggestion on how to go about staying clean.

    #24660
    beckruth
    Participant

    Homework Questions
    Question 1
    What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.
    I think the counselor used some MI strategies that seemed to work for client. The client spoke with the counselor as if he felt as though they were on the same team in developing a plan. There were times that it seemed that the counselor was struggling to not jump in with the righting reflex, particularly when it came down to getting to developing a specific plan (I can identify with that struggle!)
    At 2:40 the counselor gave a long complex reflection that also included some ideas about planning that were delivered in an MI manner rather than instruction.
    At 6:38 He provided a reflection about church after the client offered resistance that highlighted the parts of church that he enjoyed (social interaction) and also offered some concern about how he’d tolerate the God talk at church.
    At 8:06 The counselor engaged in teaching that was not MI about AA. I was surprised how well it was tolerated.

    Question 2
    What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?
    There were occasions that the counselor used close ended questions and I think I might have used more open ended ones or reflections. I like that he used and open ended question at 2:30 to explore a plan for what the client might want to do on the second day of not drinking. I appreciated that by 6:45 the counselor asked permission before teaching about AA and I really would have liked to see him ask permission in the earlier video as well. In the swimming video, the counselor asked the client to repeat and clarify the plan and I believe I would have tried that technique. I have also “taken dictation” from a client at the end of an appointment so they left with a copy of the typed plan they just explained to me.

    Question 3
    How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients? This has reminded me how useful it has been to have the client tell me what to type out for them in patient instructions, since working at home and having sessions over zoom, this has not been possible. But I believe that there is a way that we could adapt this.

    #24673
    Michael Bean
    Participant

    Michael Bean

    Question 1:The client is certainly not ambivalent about trying to be sober but the catalyst may have been his wife requesting that he get help. The client is not resistant at all and the counselor does a good job at identifying tools that others have found helpful in early sobriety.

    The client is clear that he would not consider an in-patient program but he appeared committed to outpatient therapy, AA, avoiding situations where people drink, and engaging in social situations where alcohol is not available like church and dancing with friends.

    The client appears to have an outgoing personality and and a self-deprecating sense of humor. There was mutual laughter during the sessions but things didn’t devolve into silliness and focus was maintained. The counselor was skilled and knowledgeable about the recovery community and levels of care and the client committed to clinical services, AA and making better social choices.

    The counselor was quite skilled in MI while also informing the client of several tools for recovery that may be available to the client. By laying out the information and allowing the client to reject certain aspects, like in patient treatment the client was in control of their change plan.

    Question 2: The client’s initial goal of taking a look at his drinking allowed the counselor to use MI to explore the client’s willingness to make a commitment to sobriety. The counselor discussed levels of care including inpatient, IOP and outpatient, while also discussing AA. Also, the counselor also discussed specific social events where the client admitted that they would be at high risk of relapse and others which would be low risk.

    The client appeared to be outgoing and gregarious and the counselor came across as quite friendly and open. Discussing a matter as serious as initial sobriety can be stressful for both parties but the counselor kept it light and seemed to have a good sense of humor, as did the client.

    Overall, I thought the counselor was effective in using MI and I wouldn’t change much. Not sure if I would have discussed the “God” aspect of AA unless the client brought up concerns about God and the higher power part. Counselor seemed to offer that information unprompted.

    Question 3: What I have learned in this class is that I use MI quite regularly in my practice but in other cases I blow through MI strategies and do the work in a manner which is solution focused. My MI, like the counselor in the video, is informing the client of the options available to them to allow them to make good decisions when they are ready for change planning. Overall, I am learning a lot and will be reflecting on how I can better integrate MI techniques in my practice.

    #24677
    Nichole Proulx-King
    Participant

    Question 1

    Overall, my reaction is that the counselor asked a good mix of open and closed ended questions as well as engaged in solid reflections that helped the client move forward with a change plan and commit to action steps. The counselor was effective in evoking commitment, activation and change talk. Initially, the client started out with resistance to considering AA, particularly when he talked about not wanting to have anything to do with church. Then the client moved into activation and taking steps change talk by saying that he would call a friend to inquire further about AA. By the end of the second video, the client was considering next steps for engaging in counseling and was committed to steps to rid his home of alcohol and to begin the process of becoming involved in AA. The counselor’s reflections helped the client to reduce his resistance to the process. The counselor also provided good information that helped the client to understand what the process would look like.

    Question 2

    I’m not sure that I would have done much differently in this situation. I would like to think that I would have used a similar combination of reflection and providing information to engage the client in the commitment to the change process. I may have asked more scaling questions to understand how committed the client was to the process and to rate his resistance earlier on. I also may have tried to get the client to commit to additional action steps with regard to relapse planning. The counselor offered good reflections to assist the client with understanding situations that may be problematic for him moving forward. I may have engaged the client in more action steps relating to these situations through using more information and reflections on what client may experience.

    Question 3

    I often use MI strategies for change planning. I most frequently use these to identify ambivalence to change initially. I then use reflections to understand the resistance to change and what would move clients further into the commitment process. Sometimes, I struggle with being clear about the action steps and I need to continue to ensure that these are more concise and reflective of the commitments that clients are making. I often have clients that are contemplating motivation to engage in exercise or healthier lifestyle choices. I use MI to move them forward in the process.

    #24681
    Kelly Jeremie
    Participant

    In the video the client was very willing to start to make plan to change. he even gave a few options that he said may help. Going to church was brought up and the client reported that he doesn’t go that his wife and daughter so he reported that he should probably go but felt that he would be a hypocrite if he went. The counselor reported that sometime church is brough up as a support group due to the AA meeting that gear more toward God. The client reported that he wasn’t against it just he reported that his wife and daughter will go and not even ask him because they are use to him not going. The client reported that he would consider going to maybe spend more time with his wife and daughter as well as consider to attend an AA meeting. I feel that the counselor is very well trained in MI and was able to reflect , strategize and summarize with the client a good plan of action.
    2.In believe I would have done a lot of the same that the counselor did reflection , summarize and engage with the client to as questions on what he wants to do to start the plan to start over and move forward. Maybe ask a few more questions to see what the client is looking at in order to make a change and his plan of action.
    3. I try to use MI strategies to help the client with change however I do feel that I get distracted when the client will change from one topic to another. I could ask more questions to get more information as well to help the client commit to change.

    #24682
    Kristin Giguere
    Participant

    Question 1:
    Watching these role plays I was able to discern times when MI was being utilized and times when the counselor strayed from MI and was less effective than he could have been. There were parts of the process that were missing from the videos, and I’m not sure if that is because the steps were omitted or if they just weren’t part of the role play. The counselor seemed to be pretty effective in evoking commitment and activation, getting the client to commit to talking to a coworker about AA when he gets back to the office. I didn’t notice any Taking Steps change talk in either of the role plays. I did not find the counselor’s use of MI to be very effective in the development of a specific change plan. The client identified that things need to change, but it seemed as though the development of a plan was primarily counselor driven, and not a lot of time went into resolving ambivalence.

    Question 2:
    If I was the counselor in the role play I would spend more time exploring the client’s motivation to change as well as his ambivalence about quitting drinking. I would get into the change planning more gradually than the counselor did in the video. I would not have provided information without asking permission first and I would have tried eliciting from him what knowledge he already has. I would utilize more open-ended questions and I would also have asked about the next steps would be after he speaks to his coworker. I would also have asked a confidence scaling question.

    Question 3:
    In my own work with students I can envision myself eliciting information before providing any. I also can see myself using their values as a way to increase motivation for change. I really like the confidence scaling question, as well, and I can see some ways that could be used in my daily practice.

    #24683

    Question 1
    I think the counselor did an excellent job with the +complex reflection. Each time he paraphrased and added to what the client said, not just repeat word for word what the client said. It was more conversational and made him more approachable. The counselor helped used +complex reflection for each step, and helped the client make a plan for recovery. I especially liked that the counselor asked the client to call him after he talked to his coworker in AA, and his wife. I noticed the counselor also asked for permission to offer suggestions. I’m glad he did that.

    Question 2
    In the second video around 5:41 the client talks about AA having some sort of plan. I think I would tell him more about AA, or even get him to a place of committing to 90 meetings in 90 days to really give him a good start. That’s what a counselor did for me, and I’ve been sober 29 years now. Around 6:29 he talks about the possible pitfalls. I would encourage him to ask his coworker to help him get to a meeting tonight and every night since he’s tempted by parties and football games. About 11:00, I would have told him to also get a sponsor in AA to help him get acquainted with the program, and to have someone to talk to about his recovery in between therapy sessions.

    Question 3
    I’ve really learned a lot about the +complex reflection. I find it to be a very useful tool. I also realize I use these tools quite often with participants of our program. Much of our program is around setting goals and making changes. When some are resistant, I talk with them and do a lot of listening and collective brainstorming once there seems to be some motivation and commitment on their part.

    #24684
    Diane Scalia
    Participant

    Homework question 1:
    After watching each of the videos a few times, it does not seem like a solid change plan was actually developed and I did not hear the client state his reasons for wanting to quit drinking. The clinician did use some reflective listening, summarizing, and affirmations, asked open-ended questions. Overall, I don’t believe the clinician’s use of MI to develop a specific plan was very effective. In the first video, the client did not recapitulate the client’s reasons for wanting to quit drinking. In addition, the client was making CAT statements throughout the first video that the clinician could have seized upon. The clinician did ask if the client had any ideas about what he might like to do, then answered his own question by offering three ideas that the client had already mentioned (staying away from bars, dancing, and church) and offered a solution of his own (AA meetings). In the second video, regarding client’s decision to ask a co-worker about AA meetings, the clinician asked the client “What are you going to do” and “When are you going to do it”, but the client’s response did not sound much like a commitment. The client and clinician discussed coping with triggers. I found it interesting that at the end of the second video, the client summarized his own plan, the session ended with client having unanswered questions, a statement of resistance, and the clinician told the client to call him.

    Homework question 2:
    I would have started with a summary of the reasons why the client wants to quit drinking, and then asked, “I’m wondering if you have any ideas about how what might work for you to accomplish your goal?” To the client’s response of “I don’t know”, I may have used skillful advice giving, asking permission to offer suggestions, offered to brain-storm for ideas, or offered the client a menu of choices, rather than a single idea. I like the suggestion of reviewing the list of ideas and asking the client to rate them for effectiveness and confidence of actually following through with them. Once the client established a plan, I may have asked him what his first step might be, then use a confidence scale to increase his commitment following through until he was able to be specific about who he may ask or contact, when, where, how. I might return to using OARS to help client identify barriers or triggers and identify supports or specify a plan. I would have asked the client to restate his plan. I would have again summarized the plan, written it down, and offered to call the client later that day to check-in and offered a follow up appt.

    Homework question 3:
    I do use some of the strategies discussed in this lesson, but not consistently. I think I need to work on improving my strategic responses. I think I have viewed treatment planning and change planning as being the same process and can now see the distinction. Moving forward I think that using the change planning strategies as a prerequisite would lead to better treatment planning and allow client’s to feel a sense of accomplishment earlier in the treatment process.

    #24685
    Monica Sonner
    Participant

    Question 1:
    I enjoyed that the counselor used open-ended questions to help the client discuss what his goals are and used reflective listening to confirm these goals. I also liked how the counselor used a combination of both using open-ended questions along with reflective listening to help the client come up with goals to help him not drink including helping client with fulfilling his social personality without going to bars which may be triggering to him by discussing possibly going to church. I also liked that the counselor helped to understand some of the risks and benefits were for some of the client’s options such as there being a lot of religion in AA groups which may make some people uncomfortable. I also like that the counselor discussed who might with these goals, such as his family.
    Question 2:
    One strategy that I would utilize if I were the counselor include using a scale to elicit and reaffirm the commitment to better understand the willingness the client has for following through with his goals. I think this is a great strategy to opening the discussion for possible obstacles that the client may foresee and to open the discussion of how the client may alleviate these barriers. I would also try to allow the client to give the client more time to come up with his own ideas.
    Question 3:
    An example of how I can use this is using scales to talk about willingness to change and commit. An example of this is my clients who want to get custody of their children. I can ask what ways they think they can work towards that goal such as going to rehab, getting counseling, parenting classes, support groups, etc. I can ask them how comfortable they are to committing to following through to help get a better understanding of obstacles that they may face.

    #24686
    Jenai Jackson
    Participant

    Question 1:

    Overall, I really saw the spirit of MI in these videos through the comradery that was formed between the client and the clinician. They were able to laugh and joke together throughout the conversation which I think lightened the mood and showed the true sense of support without diminishing the seriousness of the conversation and the need to change. The client’s body language even showed that he was relaxing and was comfortable talking to a friend. Overall the use of MI was effective because the client reached some important conclusions and came up with actions steps by the end of the conversation. The clinicians focused questions lead to this. At 2:07 the clinician asked “So what do you want to do”. He then followed this up by saying that the plan can be refined and changed which was another way of giving the client control in the situation while also acknowledging and being supportive of the fact that setbacks happen. He also summarized their previous conversations up to that point to ground the actions steps. At 3:15 the clinician asked if the client had any other ideas before suggesting his own. At 4:50 the clinician said “it may or may not work for you” when talking about AA. He then went on to list some of the benefits and focused on the positive in this situation. I also think it was effective because the clinician noticed that the wife would be a big motivator in the change process. When the client was able to laugh and say, Wow if I go back and tell my wife I’m signing up for AA she will be shocked, the clinician noted the importance of family in this situation and joked about the moment. In the second video, the client really incorporated more MI aspects to help make the goal a SMART goal. At 1:15 the clinician asked, when do you see doing this, giving the goal a time frame. At 2:45 the clinician reaffirmed commitment by asking what the client was going to do when the struggle starts to set in. Planning and troubleshooting for future hardships definitely helped this client with confidence. Finally, the clinician got the patient to think critically about the opportunities that would come to him through AA. The patient recognized that AA was a substantial organization and that they had been doing this work for a while. He was confident they could provide the resources and support he needs.

    Question 2:

    I think the only thing I would do differently is try to connect the clients change to his daughter more. The age of the daughter didn’t come up but it was clear the client valued this relationship in addition to other social relationships. I would have tried to elicit a commitment that he could share with the daughter. I would have asked what he likes to do with his daughter? And then I would suggest that instead of going to the bar to drink with friends during the football game, maybe they could do that activity then. Reinforcing this reason of why he wants to change his behaviors is important and spending time with the daughter could be a great outlet that also supports behavior change.

    Another thing I noticed is that throughout the interview (and in the other videos we watched in this lesson) that sometimes the clinician would focus on tasks too far in the future and I found that frustrating and could see it being so to a client. I understand the importance of planning but I think how these points are worded could be done in a way so that the client doesn’t have to keep repeating themselves. For example, if step one is finding out the time for swimming lessons or connecting with a friend to learn more about AA, I think it is time to reinforce this step and then we can discuss how and when we want to check in to see how step one is going and to make sure it gets completed. If you start to ask me questions about how often I am going to go swimming or what I think about certain aspects of AA, I might get frustrated because I don’t know the answer since that is step one. I can’t commit to swimming 3 times a week if classes are only 2 times a week. I can’t speak too much to AA logistics if I haven’t spoken to my friend. I think planning is important but I wish the clinician had at least acknowledged the limitations as they could later be issues that change the plan. Saying “I know you need to contact the swim club to see when they are having lessons but when do you think you’d be comfortable swimming” is different than “When are you doing this” If I say tomorrow morning and the club is closed, that’s an immediate frustration and change to the plan that could turn into a bigger setback.

    Question 3:

    My favorite part of this lesson was around exploring confidence. As someone who works with youth, I think confidence and self-efficacy are really important factors as many of the resources the kids need are actually provided to them through our clinic or service. I recently had a patient who turned down free transportation to the clinic because they knew they wouldn’t want to call to schedule the pick up and then stick with the set time. When thinking about plans and solutions, knowing how likely they are to follow through can help me to help them with creating tailored SMART goals. I also especially liked this because it’s a quick assessment that can go a long way. I honestly don’t have the time or space to incorporate all these techniques when working with patients but asking “If you decided right now to [change or implement X behavior], how confident do you feel that you will do this? If 0 was ‘not confident’ and 10 was ‘very confident’, what number would you give yourself?” is a great place to start. Then I can be supportive in building that confidence if it is lacking and use the point to frame further discussions. Also, if they give it a low number, I can tell the patient we don’t have to worry about it now and can do something completely different which hopefully removes some of the burden and makes us both feel better.

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