Week 4 Homework Assignment (Applications of MI)

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  • #4476
    Patricia Burke
    Keymaster

    Homework Exercise

    Watch the following 3 short video clips of a physician in a primary care setting discussing smoking cessation with a woman who is ambivalent about quitting. She is high on the importance scale of wanting to quit, but low on the confidence scale that she can quit smoking. These video clips are not coded. So as you watch them jot down examples of OARS, Asking, Listening and Informing, and other counseling strategies consistent with the Spirit of MI (e.g. importance and confidence rulers, decisional balance, evoking change talk, etc.).
     

    MI Smoking Cessation Part I

    This 9-minute video shows various motivational interviewing skills with a patient in a primary health care setting who is ambivalent about quitting smoking and has low confidence that she can quit. This video demonstrates the decisional balance to develop discrepancy, reflective listening, amplified reflection and double-sided reflection, emphasizing personal choice and control, importance and confidence ruler, and asking for an incremental goal or next step.


     

    MI Smoking Cessation Part II

    This 3.5-minute video demonstrates various motivational interviewing skills with the same woman who is back for her first follow-up visit. The focus of the conversation is reviewing and refining the change plan.


     

    MI Smoking Cessation Part III

    This 6-minute video is the third visit of the same woman and demonstrates the MI strategies of developing an action plan for possible risk situations for a recurrence of previous levels of tobacco use, identifying barriers to implementing a change plan, encouraging the “patient” to elicit support from others in reviewing and giving feedback on the change plan and informing her of pharmacological interventions.


    Homework Questions

    Question 1

    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?

    Question 2

    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.

    Question 3

    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.

    Question 4

    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?

     

    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.

    #24993
    Betsey Davis
    Participant

    Homework Questions
    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
    Again, I’m impressed with how collaborative and respectful MI is. The physician was great in terms of summarizing, using OARS ways of communicating and used the scaling questions appropriately, even switching to percentages which was the language of the client, without missing a beat. He did a nice job exploring the reasons for wanting to smoke and reasons for wanting to quit.
    I do feel like there were opportunities for him to explore her ambivalence further, to really understand both her feelings and anxieties about making change as well as exploring what her past experiences had been with trying to quit. There may have been some strategies that did work for her that could have been brought forward. I feel that he missed a crucial piece, which was the peer group element and feeling a sense of connection during smoke breaks. I wished he had reflected on this and explored how to meet this need in another way. He interrupted her once, which was not helpful.
    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
    The physician used scaling questions to identify why she wasn’t identifying a lower confidence level. Offering to see her on a more regular basis to check in and provide support seemed to help her to feel this would be more manageable. He frequently summarized throughout their conversation, which seemed to build momentum, raising client’s confidence and excitement at the option of quitting. He provided psychoeducation to client which also seemed to help (informing).
    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
    Dr: “So what would you have to do to prepare for that date [her quit date]?” He then listened to her responses. He then switched into informing her of medication options. He would have been better off summarizing what she’d said, then asked permission to share information.
    P: The patient’s reactions to him were very positive by the third video. Initially she seemed very fearful and anxious but over the course of their conversations, had relaxed as her confidence increased. She seemed to really trust him and his feedback. She seemed to respond well to his MI way of communicating. By the third video, she was much more expressive to his MI interventions.
    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
    Over the last 4 weeks, it has become much more clear to me how important it is for me to get better with these strategies. I use many and have used them since I was originally training in MI, but not nearly to the degree I should or could be. In listening to clients in counseling, I have heard over and over about changes they are trying to make whether it is to eat healthier, to spend less money, to maintain better boundaries or to manage emotions better. All of these changes can be supported and strengthened by MI practices. I guess I had not realized how much change issues presented in my practice until I was listening for it. I have one client in particular, who is morbidly obese (300+ pounds) and desperate to make change at this time. I have begun to use MI more with her and she is responding well to it. The complicating factor is her substance use that goes along with it, but again, this would be appropriate for MI work. I am excited to start using this more mindfully in my practice as I am a huge believer in people’s ability to make changes and get healthier. It will be important to manage right reflexes. I think that will be the hardest part.

    Thank you!!

    #25030
    Charles Cardoza
    Participant

    Homework Questions #4
    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
    MD confirmed Pt.’s diagnosis of COPD and acknowledged that she had not been feeling well. MD let Pt. established her goal of cutting down and eventually quitting, while also honoring the admission of lacking confidence. MD encouraged Pt. to articulate the benefits of smoking; socializing, relaxation, stress relief and also the consequences; breathing, general cost, physical appearance and health. MD helped Pt. take control as a prelude to quitting; making mindfulness a first step in gaining control. “Be mindful of every cigarette you smoke.” Ct. agreed to keep a written tally of her smoking for a week; change talk, action plan, commitment to action. I don’t think I could improve on how the MD handled the situation. He motivate the Pt. to do an informal cost benefit analysis, contemplate change despite lack of confidence, suggest “baby steps” to initiate change talk and a change plan, and committing to the change plan and a follow up one week later.
    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
    MD honored her admission that she didn’t have much confidence that she could quit smoking. Ct. apparently recognized the need for a change by reviewing the costs and benefits of smoking cessation. Ct. came back the following week having smoked 2 less cigarettes per day than before she initiated here change plan and the MD recognized this success. This appeared to strengthen her confidence and diminish the ambivalence. The Pt. also recognized that she struggled not to smoke when socializing and when inactive. Ct. contemplated starting a hobby to keep her occupied and to reduce times of boredom.
    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
    I’ve got to say, the time the physician spent with this patient is considerably longer than has been my own personal experience and also of taking Ct’s to see their medical providers. That being said, the amount of time and patience he spent with her resulted in telling her opening up and revealing what she needed (quitting smoking r/t to her respiratory issues), as well as specifically admitting to him that she did not have much confidence in her ability to quit. He met her where she was at from the onset and allowed her to process the costs and benefits of smoking, deciding on cutting back with the end result of cessation. He suggested starting small with being mindful of when she smoked and keeping track of it for 1 week. When she returned he praised her success on cutting down instead of telling her she could have done better. This allowed the patient to observe situations where she was triggered to smoke; socializing and idle time; ultimately coming up with a plan to overcome this; starting a hobby. Ct. ultimately reduces her cigarette consumption to 20 per day and commits to quit completely in 30 days. MD offered Pt. further options of counselling and medication; both were considered by the Pt. This probably would not have been the result had he MD used the dictatorial approach; telling her what she had to do rather that give her the opportunity to participate in her own treatment planning.
    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
    It is apparent that it’s best to take a softer approach with a Ct. to effect behavioral change rather than expound on the consequences of the behavior that the Ct. has exhibited – and may or may not be open to changing.
    I’ve since tried to meet my Ct’s where they are at and try to be non-judgmental and allow them the space to weigh the pros and cons of maintaining the status quo or making a change to the behavior at hand. I’ve found that, by doing this, the chances are better that the Ct. will make an informed decision and start discussing and implementing his or her own change plan. The chances seem to be better that they will follow one that they came up with are better that if I constructed it and directed them to follow it.

    #25032
    Melissa Ivey
    Participant

    Melissa Ivey

    Question 1

    I enjoyed watching these videos. I think he did a great job reflecting her thoughts and feelings, especially during the first video. He acknowledged that there were benefits to smoking and why she started. He was interested in her telling her story. I also liked how he changed his scaling questions from numerical to percent, mimicking the language she used. It was also beneficial in the third video that he summarized what she had accomplished and what her goal was going forward. In the third video, I may have tried presenting the medication options differently. It seemed to temporarily change the dynamic of the relationship.

    Question 2

    He did a great job using complex reflections, both in the first video about her confidence and the second about her progress. He also used scaling questions and had her explain why she chose 35-45% confidence level. This helped her acknowledge that it was not at a 10-20%. He helped her focus on what it would look like, why it was not a 100%, which helped her identify possible barriers. He also had her determine the importance of reach her goal of quitting smoking. This allowed her to state that it was important to her, not others. I also think that by asking what was different it helped her move forward in a way that asking how was your week does not.

    Question 3

    In the first video, he appeared to do a lot of asking and listening which helped her tell her story. At the end, he informed her about the strategy of mindfulness and taking small steps towards her goal. The patient appeared to respond to these tactics very well.

    In the second video he continued to ask questions and listen to her responses. He ask what she could do not help move forward with her goal (I can postpone it and not smoke in house). Be listening and asking questions, he helped her establish her own goal of cutting back, not fully quitting.

    In the third video, you see her solidify her goal to quit. He revisits her confidence level (80%), which helps her acknowledge her progress and increase the chances of her success. The only part that I did not agree with was the switch to discussing medication. It did not seem to be a smooth transition. He provided information after asking permission, but the conversation did not appear as productive.

    Question 4

    I have learned that I do not consistently implement these strategies. Over the past few weeks, by being more mindful of their implementation, I have seen more movement with my clients. I work with those that struggle with substance abuse and by helping them create SMART goals, it puts them more in charge of their recovery verses me trying to dictate a goal that I believe would be beneficial. I have also found that be asking what was different this week, I elicit more information from the client at the start of the session. It also allows me to meet them where they are at and not make assumptions.

    Overall, I enjoyed the course and the videos. I look forward to learning more about MI and implementing the techniques, not only with those that struggle with substances, but also those who struggle with other mental health issues.

    #25033
    Carol Acedo
    Participant

    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
    Within these videos, He did a great job on reflecting back on what the PT had done in the past that did not work. Listened and used open ended questions to be able to really listen to what PT had to say regarding her current diagnosis of COPD, how she wanted to quit smoking but had a very low confidence level at first. Although she did not say it was 10-20% confidence level but 40% as she was very focused on quitting smoking and was able to take the Doctors advice. Doctor utilized the information from the patent to give ideas on what might work for her and how she could be in control of the situation. I am not sure I would have done anything different.
    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific
    He asked questions and used reflection to as a way to better understand what she wanted to accomplish. She was not very confident in the first two videos that she could quit smoking as she had a group at work where she enjoyed a smoke with at break time. At home she was smoking at home and in her car, too much idle time on her hands on the weekend made this more difficult for her to not smoke as much. He had asked her the good and bad things around her smoking in the fact that she stated it is very expensive, bad for her health. These questions helped her put into perspective on why it was important for her to work through to help her quit.
    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
    In the first video, he asked questions to be able to better understand what she was thinking about, her reasons to quit smoking and the fact that she was spending a lot of money on smoking, beauty products and the fact that she was just diagnosis with COPD. Suggestion of a smoking journal to help her be mindful on when she would smoke, think about it don’t just do.

    In the second video, he let her tell him on how the first week went, acknowledged the fact that she had cut down by two cigarettes’ a day and was able to listen to her plan that she wanted to put into place to continue to move forward with not smoking as much. He used reflection on what she was doing to help her self and what other options that were there to help her continue to cut down on her smoking,

    The third video, had more refection as to how she was continuing to make progress on cutting down. What steps she had done to make it easier for her to not smoke. She made a plan and she was putting a time frame on quitting all together. He discussed the marked improvements that she made and was able to go over the other visits and showed that he was proud of what she had accomplished so far. He offered medication to help with the end result and listened to why some of the medications did not work for her in the past. He also reminded her of the side effects to some of the medications to inform her on what she was taking and what to look for.
    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
    I have enjoyed this material, although a few of my clients would benefit from this kind of interviewing and most will not. I have thought back on the previous material and have found my self using the information that I have learned to show that I am showing empathy and active listening to better understand my clients needs. I need to let my clients try to understand the goal that they wish to accomplish and do my very best to keep them focused on the importance of what they are interesting in changing.
    I look forward to implement these strategies within my meeting with my clients.

    #25086
    Nichole Proulx-King
    Participant

    Question 1

    In general the physician uses good reflections and elicits good information from the patient in these videos. He also takes opportunities to provide information on ways that she can reduce her smoking and eventually quit. I think that he had more opportunities to use scaling questions, particularly in the second video. I would have used these to more fully understand how she was progressing through the process. The patient did present already feeling somewhat motivated to make changes and had a plan in place to reduce her smoking, which allowed the physician to simply use more reflections rather than initially focusing on resistance.

    Question 2

    I don’t think that the patient presented with much ambivalence to quitting as she seemed relatively motivated from the onset. She had clearly been contemplating her plan for moving forward. The physician did use good reflection early on to help the patient identify the risks for her if she continued to smoke. When the patient mentioned that she was 35-40% ready to commit to quitting, the physician used a good reflection and then followed up by asking what it would take for her to move to 45%. This allowed the patient to think about what would motivate her.

    Question 3

    The physician did well with adapting to a series of brief interventions. He did well to ask questions to understand where the patient was in the change process. He then listened to what the patient had to say about what she wanted to do and what would get in her way. Ultimately he guided her to choose her own steps and commit to the change process. I think the patient responded well to his use of MI. In the second video he immediately asked the patient what was different since their last meeting. He then listened to her success. He did not necessarily engage in informing much after this or in this meeting. By the final meeting he was engaging well in using all three techniques and the patient responded well to these. Ultimately the patient was successful in reducing smoking and she considered using an smoking cessation aid to help with her success.

    Question 4

    I have taken motivational interviewing trainings in the past, and this course was a great refresher of those skills. I don’t think I learned anything necessarily new, but it definitely helped me refocus on the core components and expand my skill levels. I have already been more actively using this with my current clients and am noticing changes in motivation and commitment to the change process.

    #25087
    Jenai Jackson
    Participant

    Question 1:

    I thought the clinician used MI in a very efficient way. The progress the patient made from session to session was very clear and I saw her confidence increase over time, as well. For me this ultimately means it was a success. He was informative and realistic while also being supportive. He was also able to really move the conversation along in the limited time they had. The client expressed early on that she really just needed someone to talk to and so I would have encourage and discussed more outlets in which this could happen. That is the main thing I would have tried to do differently. Making sure she had supports for when our sessions were over.

    Question 2:

    The clinician asked great questions and incorporate a ton of reflective listening throughout the conversation. Sometime the reflective listening sounds very repetitive but I do see the benefit and the openness it brings to the conversations. At one point the clinician assessed pros and cons by asking “What is good about smoking” and this opened up so much information about the patient and their history which provided a lot of context to work with and dig through. The patient shared her family history with smoking and said it’s what the family does. She also said it seems to be an extension of who she is and is a part of her image. This showed what areas need to be targeted in breaking the habit and that the family may not be the most supportive and that outside support groups could be beneficial to this patient. I also liked that the clinician asked a lot of open-ended questions like “Is there anything I missed?”. This created more space for the client to express herself and she revealed even more. I liked his constant use of importance and confidence scales. I also liked that when she said she needed to cut back on cigarettes that he invited the patient to take a step back and journal to really understand her behaviors around smoking. I could tell the client was putting a lot of pressure on herself and when the clinician was able to take a lot of the pressure off of her by inviting her to take a step back and reassess how she is doing and feeling about smoking. And this act brought about behavior change on its own just by increasing awareness. It also showed that weekends are a more challenging time for the patient which can help them tailor more solutions and angles for change. In the last session, the client came in so motivated to change and she expressed it from the very beginning which showed her trust in the provider and the relationship they formed over the many sessions.

    Question 3:

    I really enjoyed seeing the use of MI in a primary care setting. The sessions were shorter and more focused but it focused all the following sessions in a very specific way. In video 2, they accomplished so much in just that quick check in. Also the process of multiple checks in worked for this patient as she expressed she need support and someone to talk to. This format definitely benefited this client. With limited time the ask, listen, inform approach seems like a great fit. It starts off the conversation in a direct way but still gives space for the conversation and work that needs to be done. I think the patient reacted to it well, especially as more sessions passed and she got a feel for the space and environment. With her limited confidence at the beginning, the clinician was really able to open up the space using these techniques so that he could guide her and be supportive without removing the spirit of MI. Over time she was confidence and jumped right into the conversations. Her tone changed and she was a lot happier at the end.

    Question 4:

    Going into this course I knew very little about MI. It was reassuring taking this class and realizing that there are many small ways I can bring the spirit of MI to my work. I never have more than 10 minutes with patients due to the nature of our clinic flow but with a few key techniques like Asking, Listening, and Informing, and with confidence and importance scales, I can build a better foundation for communicating with patients and leading them towards behavior change. My clinic also hopes to create more spaces to connect with patients in the future through support groups and community advisory board meetings and this is the type of language and mindset I want to bring back with me as I engage with patients. I work with a pediatric population and rarely ever talk to patients without a parent or another family member in the room. I think it could be challenging to use these techniques with a third party in the room but also a benefit in a way as the parent will also hear my tone and hopefully I can form relationships with both the patient and parent. Another challenge is the pediatric patients tend to be a bit more introverted and shy (I think because they are used to the parent doing most of the talking). I hope the open-ended questions and reflective listening show that I really am here for them specifically and that they are my focus. I plan to study the information more and feel confident that I can use it in my work setting if I am able to create a physical environment in which I can do so.

    #25138
    Colleen Drake
    Participant

    Question #1:
    My general impression of this physician’s use of MI to discuss smoking cessation is that it appeared to be quite effective for Jean. Over time, he was able to help evoke change talk and an action plan with Jean that appeared to be quite client-driven. She started the sessions with a strong understanding of the need to quite but a very low confidence in her ability to quit. By the last video she had significantly increased her confidence level (up to 80%) and had set a SMART goal to be totally done with smoking within the next 30 days. The physician appeared to have a caring approach and used affirmation with Jean as part of the OARS technique. There are two things I think I would have done differently, had I been the physician using MI with Jean. 1- I would have tried to spend a little more time with Jean working through eliciting ideas for why she was feeling so ambivalent about quitting in the beginning. 2- I would have asked her permission before providing information about options (such as the medications mentioned in the third video). I think it may have been helpful for Jean to do a bit more reflecting on the reasons behind her ambivalence to help her work through the acceptance piece of letting go of some of her identity as a smoker. I also think it would have been more appropriate to ask for Jean’s permission before providing her with suggestions and options to take a more client-driven approach at that part of the discussion.

    Question #2:
    The physician used a lot of OARS technique to help Jean resolve her ambivalence about quitting smoking. In each video, multiple times throughout, he used reflective listening, open-ended questions, affirmation and summarization. He asked her open-ended questions about her reasons to smoke and her reasons to not smoke. He also used double-sided statements about her ambivalence and checked with often to ensure he understood her thoughts and feelings about the situation. His use of MI techniques seemed to help Jean think about her options more, and she had already come up with some coping ideas and techniques to use before he suggested them. He helped her with setting SMART goals, using open-ended questions, and Jean was able to set time-frames around the choices she made. He often went back to the confidence rating measures to check in with Jean about where she was at, which I imagine helped her to see the changes that were happening in her own way of thinking about smoking cessation.

    Question #3:
    The physician did a great job adapting the use of MI techniques in a primary care setting. In my answer to question #1 I had included that I may have spent more time talking with Jean, however I understand that in a primary care setting there is not always time for that. I think he did a great job balancing the use of their limited time, with the use of MI techniques, while still using phrases to indicate that Jean was the one making the decisions and that it made sense that she was feeling the ways that she was. He didn’t really start providing her with much information about options to help Jean quit (such as medication) until the third video, which allowed Jean to brainstorm ideas and try to use what she felt would work best for her first. As I had said in my answer to question #1, I do think he could have done better at asking for Jean’s permission to provide information to her- however it seemed as though Jean was receptive to it and wanted to know more about her options. She expressed being appreciative of his support, noting that having the sessions regularly with him and keeping in contact were some of the things that were helping her to stay on track with her goal. I did not get the sense that Jean felt judged about her decisions and it appeared as though she was happy with the progress made and her final quit goal she had come up with. In the first video Jean seemed to feel a bit ashamed and by the last video she seemed very proud of herself. Her ambivalence dropped significantly over time and her confidence in her ability to quit greatly increased.

    Question#4:
    I have appreciated this opportunity to take the MI training course. I have taken another MI course in the past, though it was only an introductory one, and I feel that I got a lot out of this one. I think having to do the weekly homework really solidified the concepts for me. I have enjoyed seeing the use of MI play out in the videos and feel that was also a helpful learning tool. I think the use of MI likely leaves the clients feeling more respected by their providers and more in control of their own decision making. I think it also would lend to a higher rate of success with changing health-risk behaviors based on the caring approach and the fact that the person who is considering change takes the lead in decision-making and planning. I think after taking this training I will continue to incorporate and increase the use of MI in the work that I do with clients. I think it has helped me find awareness that I am quick to use the “righting reflex”, out of a desire to help others, and having that awareness will help me use more pause and time for clients to consider things on their own. Thank you!

    #25140

    Question 1
    The patient sounds desperate and almost hyper about her recent COPD diagnosis. Through complex reflection and active listening, he actually calms her down and helps her focus. He asks her about the pros and cons of smoking. He reflects back her answers and this seems to slow her down, and calm her down a little. He uses the importance scale to find out how important it is for her to quit smoking. She says 10. He then uses the confidence scale to gauge her confidence level. She says 40%, and then he asks her what it would take to build it to 45%. That’s not much of an increase, but a small enough increase to get her started. He used affirmation in congratulating her for taking the important first step of coming to see him for help. He asked her if she’s willing to monitor her smoking for the next week. He then uses open-ended questions to find out how she feels about his suggestions. He uses affirmations again to point out her success at keeping a journal, and her ability to smoke two to three cigarettes in one week. He asked her more open ended questions about what was not going well. She explains that the weekend was the hardest. They build a plan to continue her journal. She plans to reduce her smoking by five cigarettes. She also makes another plan to come back in a week. Here, I would have taken her suggestion for developing a hobby. I would have also talked about alternatives for oral fixations, like chewing gum, or looking at her diet, perhaps. In her third visit, she’s decided to quit smoking in one month. He then used the confidence scale again to gauge her confidence level, which she admits is now at 80%. This is an affirmation in itself.
    Question 2
    He used open ended questions, affirmation, reflective listening, and summary reflections (OARS) early and often in his motivational interviewing approach. He used the confidence scale the first two sessions to gauge her confidence level. At first she says 40%, and then he asks her what it would take to build it to 45%. This is such a small push, but achievable, and she agrees. She admits to needing help by talking, and he agrees to see her the following week. He used a lot of open ended questions to get to the bottom of what triggers her habits. By the second visit, she’s at an 80% confidence level. By the third visit, she’s ready to quit in one month, with her 80% confidence level.
    Question 3
    He used active asking, listening and informing each time. He didn’t ask much in the first video because it was clear she was asking him for specific help to stop smoking, and she seemed pretty desperate. In the third video, he listened to her successes, then asked about what she would have to do to prepare for the date when she says she’s finally quit smoking for good. She talks about what is working, and at about 2:06 in the third video, he asked her the open-ended question of her reaction to medication to quit smoking. She was receptive to it, and he spent a lot of time informing her of the various medications she could use to achieve her goal.

    Question 4
    I am taking with me the 1-10 scales, and the follow up question of why that number and not a lower number. I love that. I will also share with my colleagues the change plan worksheets, and the personal values card sort. We actually use a card sort with our participants about Money Habitudes. These are great tools to bring awareness and conversations about when working with people who are in transition and open to making changes. Thank you so much. This is a great class.

    #25143
    Michael Bean
    Participant

    Question 1: This client presented having recently had a diagnosis of COPD which the client related to her use of cigarettes. The client discussed that her parents smoked and that smoking was normalized and even glamorized in the media of the day. Client recognizes that she has smoke a lot and that it was impacting her health and her overall appearance. The counselor reviewed and explored the reasons that the client wanted to take a look at her smoking.

    The client identified that she wanted to cut down on her smoking and predicted that she would have a difficult time. She stated that she had tried to cut down/quit before and was unsuccessful. Client identified that smoking had been part of her life for many years. She reported that she tended to smoke more on weekends when she was not working but also recognizes that she had a group of friends that she smoked with at the workplace. In the first video the client agreed to try and cut down her use of cigarettes and document that in writing.

    The client was able to cut down a little in the first work but showed some motivation to further reduce her smoking in the coming week. Client had an action plan and started with a change plan while documenting what her experiences were like reducing the number of cigarettes that she smoked. The client appeared to be quite motivated to reduce her consumption and even talks about the possibility of quitting.

    The client cut down more and in the last video discusses her plan to quit entirely. I doc discussed medications that might be helpful and their side effects. Overall, the doctor did a good job at supporting this client who was quite motivated and goal directed from the start. He was a good listener and was reflective regarding the client’s intent.

    Question 2:The presenting problem for the client was her recent diagnosis of COPD. The client recognized the obvious, that her smoking is the main contributing factor to the diagnosis. The doc did a good job of listening to her COPD report and did some reflective listening and helped the client identify what she liked about smoking and what the consequences of her continuing to smoke moving forward. Client came back the next week and had smoked two less cigarettes a day which gave her some confidence to try reducing her consumption of nicotine a bit more.

    The client gained momentum and motivation to further reduce her smoking. The doc offered her advice as she engaged in her change plan and discussed medications that others had found to be helpful. Client recognizes that she needs to keep busy while reducing her smoking and mentioned that she might find a hobby.

    Question 3: Asking, listening, performing: the doctor did a good job with all in a very brief period of time. The client appeared to be quite motivated due to her health scare and the recognition of the impact on her appearance. The doctor helped her relax, make her own plans and helped her move toward abstinence by discussing medications which may be helpful. The doc did not mention once the seriousness of a COPD diagnosis or that she NEEDS to quit smoking immediately. He was thoughtful and reflective and guided the client through the change process.

    Question 4: I recognize that I have become much more solution focused over the years and this has been a good reminder for me to slow down in my sessions. I recognize that at times I tend to not being the best listener, especially if the client is on probation or need DEEP services. These client’s need to be sober to complete programming successfully and that is the place where I start.

    I enjoyed the videos over the last four weeks which I felt were extremely helpful. A review of the MI process has, overall, been very beneficial and I have enjoyed the opportunity reflect on the role it can and should be as part of my practice.

    #25145
    beckruth
    Participant

    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
    It was good to see a PCP use these skills and well. I like using visuals and probably would have used them. I like “taking dictation” of the plan that the patient has decided on, so they get a copy and it’s in the chart to refer to the next session.
    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific. I liked how this PCP used complex reflections to help highlight her reasons for quitting as well as the ways that she had been successful (if even briefly) in the past. He had her identify what she likes about smoking- I imagine that with some folks that question might take them aback and invite some new ways of thinking. He checked in with her to make sure that he was understanding her correctly and invited her to make corrections- to she was teaching him rather than just being lectured to. Asking her about why she didn’t pick a lower number on the confidence scale meant that she talked about the small ways she was confident and gave herself some positive feedback.

    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific. He used the tools of asking, listening (repeating to her what he understood with amplified reflection) and then asking if he could provide information often. I noticed the patient respond positively to his genuine praise/amplified reflection and she sounded much more confident and less scared by the third session. I also note that the second session was only 3min and yet he still accomplished a great deal with the pt. Often I hear from PCPs that there is not enough time to do this kind of work. I believe that use the ask, listen and informing is a good plan when starting a medication to minimize risk and encourage pt autonomy.

    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors? This is the second course I have taken this year about using MI. I have been finding that these skills come to mind more often and I can use them with more ease. I would like to figure out how to use them more successfully while doing an assessment in the time allotted. I find that I need to practice patience and sit with my own “righting response” and let the process work, though the pressure to stay on time pushes me to be more directive. I would also like to have more chances to do peer supervision with others using MI, I think it would help with model fidelity.

    #25181
    Danielle Wilbur
    Participant

    Question 1
    When he reflects what she is saying without judgment she is open to explore her options. The conversation expands out from what she already knows, he makes sure she understands her options. The guided style is a challenging balance of asking, listening, and informing. The doctor does this very well. I appreciate that in MI there is no judgment of the client’s choices. This really shows in the video when the doctor acknowledges that she gets some benefits from smoking in dealing with stress. When this benefit is compared to the damage to her health and the cost, she is able to consider her options for methods and supports in quitting.
    Question 2
    He helped her focus on her goal to quit using complex reflection that built on her confidence with taking small steps toward success. He also explored possible obstacles and strengths from her perspective. She was able to identify how important reaching her goals was and with each visit her confidence in her ability to reach her goal increased.
    Question 3
    He starts by asking and listening and reflecting back. He gives her information as part of the conversation that included making reasonable goals with her input as to what she believed she could do. The goal to cut back rather then just quit is more attainable and helps her build confidence that can then be used to motivate bigger goals. He checks in with her about her confidence in quitting and that leads to a conversation about medication and the benefits and side effects. I wondered about how I would feel as the client when offered the choice of medication in helping me quit.
    Question 4
    I don’t often work with clients for long periods of time and health risks are not usually the primary focus. That being said, I can see the benefit of using MI when trying to set goals both long and short term. Clients I work with are often overwhelmed to the point that moving forward can seem impossible. They are often ambivalent about a lot of things. I can see how using MI would benefit them and help them to start to set goals and move forward toward their goals.

    #25250
    Jennifer McCaslin
    Participant

    Question 1:
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?

    The physician practiced good MI strategies while patient described her condition, struggles and ambivalence to quitting smoking. Unfortunately it took until getting a serious medical condition to have her consider quitting. Patient at first was very pessimistic and in fear that she wouldn’t be able to quit smoking. Physician reflected back using complex reflection, and open ending questions to have patient see the pros and cons with of her addiction and giving it up. Physician did great job with MI techniques to have client process her commitment to change.

    Question 2:
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.

    Physician was able to use active listening, open-ending questions and complex reflection to have patient be proactive in her commitment to change. They discussed how her journaling has helped with her decreasing her smoking, as well as making changes to her life socially and environmentally has impacted her desire to continue to stop smoking. As she made progress her commitment was affirmed and the physician was able to provide positive feedback and reflect back with her. This boosted her confidence and gave her continued motivation.

    Question 3:
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.

    The physician starts with asking questions, listening and then reflecting back to patient what he is hearing that the client wants and needs. He processes with the client her need and desire to quit smoking. They discuss ways she can make changes that will assist her with her commitment. The physician merely discusses back with the client on her objectives and this seems to have her gain confidence in herself. I do think the focus on medication was to involved and could become confusing for the client, as they went through the options fairly quickly.

    Question 4:

    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?

    I think that the course was very interesting and informative. In my client population I’m not sure how these strategies will come into play. My clients lack focus and motivation with commitment to change and their ambivalence. I do utilize and implement some of MI techniques such as reflective listening and open-ending questions. Watching the videos gave a better insight for me into MI and how it impacts the treatment.

    #25252
    Diane Scalia
    Participant

    Homework Questions
    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
    I was impressed with the way the physician appeared to effortlessly take control of the conversation while time keeping the focus person-centered and respecting the client’s autonomy and self-efficacy. Considering that this intervention took place in a physician office that requires a brief intervention, I think I would have done anything differently.
    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
    In the first video, the physician used open-ended questions and reflective statements to explore the woman’s ambivalence about quitting, he also acknowledge her prior attempts at trying. The physician used decisional balance to develop discrepancy (i.e. “What’s good about smoking?” and “What’s not good about smoking?”), then summarized the woman’s statements. The physician used the importance scale and the confidence ruler to guide the woman towards change talk and generating her own choices, which affirmed her own ability to change. The physician then summarized the client’s plan.
    In the second video, the physician used OARS to reaffirm the woman’s commitment to quit and affirm self-.efficacy. He asked “what’s different, what went well, what did not go well, what will you do, when will you come back” and provided reflective responses.
    In the third video, the physician responded to the client’s decision with CAT and the confidence ruler, open-ended questions and reflective responses. He used ask, listen, and inform to offer the woman a menu of options for medications and tools to help with quitting, and summarized her plan.

    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
    The physician was able to guide the woman from feeling helpless and hopeless in the first video to confidently stating that she had set a quit date in the third video. What impressed me most was that this change occurred in a “brief” setting. The physican directed the conversation, which never seemed rushed or short, the intervention was person-centered, respected the woman’s autonomy, and used basic strategies of MI. The woman remained engaged and motivated throughout the process and reacted positively to the physician’s guidance.
    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
    I work in a setting that serves clients with mental health and co-occurring disorders and I have found that motivating clients who struggle with anxiety and depression can be challenging. I made a little “cheat sheet” with the OARS and SOAR acronyms that I keep taped on my desk to prompt me to use more MI strategies to empower the client to set goals they are more likely to achieve. I also laminated a copy of the “Am I Doing this Right” card that I keep handy to prompt me when I feel stuck. I think it’s easy to get caught up in the time-frame requirements of my work and overlook the fact that client’s know themselves best. This course has helped me increase my skills and I can see how MI can be combines with techniques like CBT and BA to help clients stay engaged and motivated to move forward. I also learned that MI is a skill that comes with practice, practice, practice. I will definitely take more courses and continue to expand my knowledge of MI.

    #25254
    Robert Hussey
    Participant

    Question 1
    What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?

    The physician was able to reflect, ask open-ended questions, and guide the conversation with the info provided by client. The client was highly ambivalent about whether she could quit smoking. Her medical diagnosis scared her enough to seek change. She spoke with physician about her options. She informed him of her history. Her parents smoked while growing up, smoking was glamorized at the time on TV, she smokes while anxious or idle, and is also a social smoker. The physician was given a lot of info to work with to help guide a plan. The physician also accessed confidence levels and asked client what she thought could work to help form a plan and make it more attenable, concrete, realistic, and timely. It helped having incremental goals such as reducing the number of cigarettes per day and writing a journal to help keep track of thoughts, amounts, and situations. Check-ins were also part of the plan to help with accountability.

    Question 2
    What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.

    It helped having incremental goals such as reducing the number of cigarettes per day and writing a journal to help keep track of thoughts, amounts, and situations. Check-ins were also part of the plan to help with accountability. Client was proud of incremental successes that she made a commitment to cut back on the number of cigarettes smoked per week even further. Client also looked into hobbies and social groups. She made a promise that she would try to refrain from smoke breaks with coworkers since she acknowledged she was also a social smoker. Client acknowledged that she could still work towards her goal of stop smoking with support and incremental successes to boost confidence.

    Question 3
    Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.

    The physician asked open-ended questions, listened, and reflected on what was said. He provided info when given permission. He helped guide the conversation to help the client articulate on why they felt stuck, why they were seeking change, and asking client what they think could work for them? The client recognized that the incremental successes. Client made a new goal to quit smoking cigarettes within 30 days while maintaining supports.

    Question 4
    Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?

    I like the idea of focusing on goals and exploring options in a more collaborative and empowering way. Clients may be more receptive to change when it appears more attenable, concrete, and within their power. I like how motivational interviewing stresses collaboration and open-ended questions to elicit more engaging responses and narrative. It feels less of a power struggle between client and perceived authority figure especially when the usual assumptions perceived by clients are: “who knows best and listen to and act on the advice given?” The steps to achieve goals need to be tailored and the causes and assumptions need to be explored. The client is the expert pertaining to their life and the physician (or counselor) is the expert in specific subject matter. The client and physician (or counselor) need to collaborate to make progress.

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