[Adeena Vogel]

Question 1: My general reactions to the way that the physician used MI was that he was effective and gave space for the patient to explore where she was at in regards to her stage of change and desire to quit smoking. Honestly, I am not sure that there would be anything that I would do differently in these situations. In fact, I strive to be that open ended in my questioning for my clients. I appreciated that he was able to summarize for her, which allowed to reflect even further into things that may be beneficial for her, as well as barriers that she experiences.

Question 2: I do believe that this physician was able to help this woman resolve her ambivalence about quitting, as well as increase her confidence. In the first session, he questioned when she has thought to quit by, but importantly, what about smoking does she like, as well as what she does not like. Those questions alone opened up the conversation. Throughout the first and second session he asked the patent to rate her smoking on level of importance and her confidence to quit. By going back to this scale in later sessions, he was able to elicit insight into her stages of change.

Question 3: I do believe that this physician was effective in implementing MI techniques through the use of asking, listening, and informing. He asked many open-ended questions to elicit information from the patient and allow her to reflect on her own things. He used summarization throughout the sessions to help make sure that he was understanding what she was expressing to him. In the last session, he was able to provide information, which the patients consent, on alternatives or techniques to help with quitting. I do think that the patient responded well to this technique, as evidenced by her responses to him, such as “I never thought about it that way,” or “these sessions are helpful.”

Question 4: These past 4 weeks have been an incredible tune up for my MI skills that I use on the work with my consumers. I always knew that this was an effective therapeutic intervention, but the clips that we were provided was helpful in seeing the practice put into place. Evaluating the effectiveness of these techniques in the videos was also very helpful. I believe that I will continue to use these skills in the work that I do. I am constantly helping people assess their stages of change in terms of substance abuse counseling, and I do believe that this intervention will be helpful in that arena!

[Adeena Vogel]

Question 1: Well, these two videos were honestly very difficult for me to get through. I really did not feel like there was a whole ton of MI techniques done throughout the clips; in fact, I felt as though the therapist used a lot of closed ended questions, was interruptive, and redundant (e.g. “what are you going to do?” essentially being his only open ended question). I felt as though the therapist was great at putting in his two cents and offering information (sometimes he was given permission to do so by the client), but it almost felt as though the therapist geared the conversation and did not allow the client to make his own decisions impacting his care through guided questions. I think that the client was able to create a change plan, however I do think that the counselor had significant influence on that. Would he have come to those conclusions without the therapists input? I am not sure. Do I believe the client would have identified AA or Church as part his plan without the counselors influence? Honestly, it doesn’t really feel like he would; he was able to articulate that Church was not really his thing, but the counselor glazed over that, like he did throughout much of the session. The counselor kept reiterating the “plan” which evoked a sense of commitment, activation and step taking on behalf of the client, but I do not see the client following through with this plan, because it didn’t really feel like it was his idea.

Question 2: If I were to do things differently, I would start by not asking so many closed ended questions. The point of MI is to work collaboratively with the client and help them uncover their own needs, plans and commitment without our influence. We are walking with them, not in front of them. For instance, when he talked about his desire for social activity, I would have asked something like, “what ways can you better meet your needs for social activity?” without quickly interjecting the idea of Church or AA. Instead of saying things like, “you could at least try,” I might phrase things like, “what do you think that experience would be like for you if you tried?” Honestly, I would avoid doing much of what that counselor did. He was interruptive, used closed ended questions, and I felt like he disregarded what the client was saying. For that, I do not think he effectively utilized MI techniques. I lost count of him asking “what are you going to do?”

Question 3: I can definitely see myself utilizing the MI strategies with my clients, because it is something that I already incorporate into the work that I do! I think it is always important to first assess where a client is on the readiness for change (if they do not want to change, how can we enable that?)/ When they are ready for change, I work collaboratively with them to help them create a plan for themselves (their own plan!) and how they can best maintain and support the change that they wish to elicit. Part of change planning means that I would check in regularly with my clients to explore what has been working, and what has not been working, and make adjustments with them as needed. I always try and offer information to them if it is something that they desire and something that is relevant to their presenting issues or concerns. MI is collaborative, and that is what I strive to be with the people that I serve!

[Adeena Vogel]

Question 1: My general impressions of this interview is that it was a great intervention to help facilitate the client in bringing about his own awareness to a perceived issue (e.g. “if I don’t stop drinking, I’ll be in this same mess again.”). Generally, I like how the therapist was calm and collected throughout despite the initially “grumpy” client. She was able to meet him where he is at and offer him autonomy in his choices. I think her validation in her summarizations was most of the reason why he was able to open up and reflect more freely.
Question 2: Rounder provided several examples of sustain talk and change talk throughout this interview. An example of change talk, specifically commitment, was towards the end of the interview when he spoke about how he would be willing to attend treatment, but set his limits about wearing pajamas and singing kum-bah-ya. Rounder express desire in change talk when he processed feeling like he wanted this “mess” to go away and be done with. In change talk, Rounder at one point emphasized “maybe I need to think about this.” In change talk, Rounder used reasons when he reflected on going camping with friends and not being able to consume alcohol with them. Sustained talk with Rounder was more evident in the beginning of the interview. Rounder initially was unwilling to take accountability for his drinking and their consequences. He identifies several times that he did not have a problem with drinking and that it was just a perception from everyone else. Towards the end of the interview, Rounder was able to process his ambivalence, which I believe was an example of change talk.
Question 3: I think that the interviewer did a great job at utilizing complex reflective listening and strategic responses throughout the interview regarding Rounder’s sustained talk. Initially, she was able to identify, “you are not here because you think you have a problem.” She was able to reflect on his anger with “it looks like this was causing a lot of problems for you,” which helped Rounder see the potential parallel of that situation. Through listening and responses, the interviewer was able to meet Rounder where he was at and give him an opportunity to open up more and explore the reasons as to why he was currently at the place that he was at. She was validating, while also being able to be dialectical with him. I do believe that these particular skills allowed Rounder to be more open and exploratory throughout the interview process.
Question 4: There were a few signs that Rounder gave regarding his readiness to change. Towards the end of the interview, he said, “If I don’t stop drinking, I’ll be in this mess again.” In this part of the interview, he was able to reflect on how his drinking may create further consequences for him. When Rounder started to ask more questions regarding the treatment center, I believe that this was also an indication of his readiness to change. He was able to look at how this could be a helpful intervention for him. He processed his ambivalence towards the end of the interview regarding not wanting things to change, but knowing that it would be helpful for him if things did change (regarding his drinking). If I were the interviewer with Rounder, I would likely do what the therapist in the clip did; I would encourage him to make his own decisions about the treatment he needs, while offering any information that I could about the treatment itself or the effects of substance use (but again, only if he identified that this was something that he was interested in).

[Adeena Vogel]

Question 1: My general reactions to the videos were that they are two completely different styles. I felt as though the first one was far more confrontational and less therapeutically approached. You could see in the non-motivational video that Sal was incredibly defensive, as there was less questioning and what appeared to be more blaming, on the part of the therapist. When you compare to the MI video, Sal is much more relaxed and far less defensive. He is able to explore potential causes of his asthma without feeling attacked for the appropriateness of keeping his dog. I would have to argue that the MI interview style clearly helps Sal move closer to an action plan. In this technique, Sal was able to explore other potential contributors to his asthma and was asked to explore the ways in which he could make changes for himself that he thought would be helpful (e.g. cutting back on drinking). In this technique, Sal was able to create solutions for himself that would be appropriate for his personal, and specific situation. (side note; I would also be very defensive if someone told me I had to get rid of my dog!)

Question 2: The behavior that I feel ambivalent about is exercising in the morning before work. My three statements of ambivalence are;
I feel ambivalent about exercising in the morning before work.

(On the side of ambivalence) I am tired when I wake up and I have limited time to prepare myself before the work day.
(The other side of ambivalence) I know that exercising is healthy for my body and mind and will help get me started and motivated for my day.
(Double sided reflection)
“Adeena, on one hand you are tired in the morning and have a ton of things to do to get yourself ready for the work day, but on the other hand, you know that exercising won’t take that long and it will help you feel better during the day.”
“Adeena, on one hand you don’t have the time to exercise in the morning, but on the other hand, you can just wake up 20 minutes earlier to do it because you know it will help your overall health and well being.”
“Adeena, on one hand you really want to incorporate this behavior into your daily routine, but on the other hand, you are not sure if you will have the time or energy.

I particularly liked this exercise. I was able to really think about how literally one half of me understands that I want to engage in this activity, while the other half avoids it. It was validating to me when I questioned why I do not/do not want to, exercise in the morning. It was a way to help me weigh my options and sort out my discrepancies.

Question 3: One of the clients that I work with has the following 3 consumer generated target-behaviors; engage in daily ADL’s, stay connected positively with family and friends and better manage finances. 3 targeted behaviors on my own agenda for this particular client are the following; process grief and loss, explore barriers to managing day to day life, and discuss and explore unhealthy communication patterns. There are pretty big discrepancies among these lists. What I notice is that even though I have my own opinions on what the client “should” work on, I need to be mindful that it is something that they may not necessarily believe is a problem for them. I feel clearly that I want to help “fix” things that I deem to be a problem, but I need to remind myself that this is not my treatment and if the client is not ready or willing to engage in these targeted behavior changes, than that is something that I will have to accept. By using the MI agenda strategy, I would specifically ask my client what it is that she would like to focus on in the session that day. I could ask her if she would like to talk about relationships or managing day to day life things, such as ADL’s. I would let her set the agenda for the day, while recognizing that even if I have my own, it is not appropriate for the therapeutic process of MI counseling.

[Adeena Vogel]

Hi! My name is Adeena Vogel, LCPC, and I am a Clinician through SMHC’s Partial Hospitalization program and I also do Outpatient Therapy through Gateway Community Services! I am hoping to learn more about MT and how I can incorporate into the work that I do to better help the clients that I serve!

[Adeena Vogel]

Question 1: My physical experience for this particular exercise was mostly uncomfortable, as I was struggling with a pretty intense stomach ache at the time of the practice, which may have influenced my ability to really focus on the activity. I was able to notice and acknowledge a ton of impulses during this exercise, and I found it difficult to calm my mind from those impulses. Once I felt the pain in my belly go away, I had an itch, once the itch went away, I felt like I needed to adjust my sock. My focus and concentration was unfortunately way off, and although I was able to refrain from acting on my urges, I was not particularly comfortable. Over the course of the exercise, it got easier to push away the thoughts to act on my impulses, and I was able to successfully avoid that. However, my mind bounced from one impulse to the next. I do believe that this is an effective technique to help with things like cravings. In fact, it is a group that we specifically teach at my program to individuals with co-occurring disorders. It is effective to acknowledge the urge and practice exploring the reasoning behind the urge, as a way to avoid acting on those cravings. We practice this technique in the group setting and encourage our clients to utilize this skill when they are not in programming and the impulse and urge to engage in substance use arises.

Question 2: The other meditation practice that I picked was Thought Diffusion. I picked this particular practice because I have always been fond of guided meditation and this one kind of felt like that, in terms of picturing a safe and peaceful environment. For this exercise, I was able to notice that I was far less focused on my physical experience, especially in comparison to the urge surfing (again, I think it was related to the space I was in during the practice). When I was able to actually picture those pink fluffy clouds with my thoughts slowly passing by, at felt at peace, and calm, both physically and emotionally. My thoughts were more quiet. They were there, but because I was able to paint a picture in my head of being in a field, with the sun on my skin, I was relaxed. I believe that this is an incredibly effective intervention. It gives me the space to be kind to myself, and acknowledge my particularly intrusive thoughts, and just let them float away. I have used this technique in the past in the work that I do with my clients. I usually have them envision a space that is calming, grounding, and peaceful for them as a place they can visually go when dysregulated (The “I” in the DBT IMPROVE skills that we use at my program). We ask them to just focus on their safe space when dysregulated and allow the intrusive thoughts to pass. Sometimes we even recommend that they draw out their space to have a physical reference if concentration can be poor.

Question 3: Integrating mindfulness over the past four weeks has been helpful. I have come to enjoy my afternoons where I am able to complete these assignments and feel like I have moments of tranquility (or at least more tranquility comparatively during the work day). I try and incorporate mindfulness into my routine as a way to help connect me to the present moment, especially in the work that I do with others. I want to be able to be kind to myself and acknowledge my “stuff” but allow it to effectively pass so I can be as present and “here” for the work that I do with others. Mindfulness is something that I have already been incorporating into the work that I do with others, in both of my settings of practice. I think it allows that space for people to practice calming those racing thoughts and focus on the here and now. I believe that it is an incredibly effective, and helpful tool, that we like to give to other to help them fill their tool boxes.

[Adeena Vogel]

Question 1: The soft belly meditation was comforting for me today, and I am not sure if it was because I had a particularly difficult day, or more so because it is an effective intervention. Either way, I was pleasantly surprised with how relaxed I became. I noticed during this exercise that physically, my body really truly felt at peace and relaxed. It was almost as if the focus on my belly helped any other deterrents of focus to other parts of my body drift away. I have found that fixating on particular points is helpful in maintaining concentration and focus in my mindfulness and meditation. I do believe that this meditation was effective in enhancing the acceptance of my feelings and sensations in the moment. I was not as focused on the sensations of other parts of my body, but the stomach, and placing my hand on my belly and physically feeling myself breathe in and out, was helpful. I did not feel a need to acknowledge and accept a whole lot of feelings, because in this moment, I found that I did not have a whole lot of intrusive thoughts to accept! Again, it could have been due in part to the day that I have had and fully being able to relax into the moment, but I am going to consider this one a win!

Question 2: I found the Acceptance exercise to be a bit more challenging. I found it more difficult to focus on the words that I was saying and I found my thoughts drifting off more frequently in comparison to exercises that we have done in the past. It was almost as if the saying prompted me to dig deeper into how I was actually feeling in that moment, which took me out of being present, I believe. I would say that this could be an effective intervention if I am in a physical space with no distractions. I do believe that it could be effective for most, but the words really threw me off.

Question 3: I feel like I have already integrated the soft belly meditation in the work that I do with the people that I serve. When I work with kids, I often have them put a stuffy on their belly and have them focus on the breathing that moves their bellies up and down, thus giving their stuffy a ride! Working in a partial program, specifically working with co-occurring disorders, meditation is effective and a skill that we teach here to our clients. The belly breathing can help clients who may feel dysregulated and overwhelmed, and help to pull them back into the moment. I do believe that clients with SUD’s can benefit from having the meditation skills available to them in their tool boxes for when they experience potential urges to use. These techniques can help ground them in the present and prompt them to be kind to themselves in regards to where they are at.

[Adeena Vogel]

Question 1: I really enjoyed this particular activity. At first, it took some time for me to adjust my body to being calm and in a relaxed state. For some reason, I tend to think of my breath as colors, and that helps me focus, and visualize the colors going in, and out, of my body. This was helpful as I breathed into the different parts of my body to bring awareness to them. I noticed at one point, about halfway up my body, my focus shifted when I felt an itch on my ankle. Initially, it was difficult to tune this out, but I really, really tried to refocus my energy and concentration on my belly (the part of the body I was on in my practice). To my surprise, this worked! I was excited about this and then had to shift that excitement back to the exercise itself. I noticed with this how distracted my mind was; every time I heard a noise, I thought about it. But I really attempted to focus on the parts of my body that I was trying to focus on. I tried to think of my intrusive thoughts as passing clouds in the sky. I was kind to myself and able to bring myself back to the activity. I really enjoyed focusing on specific parts of my body, and this was helpful. I think it allowed a space for me to keep my focus more. I do believe that this is an effective intervention to help with concentration, as the physical imagining of my body, in the moment, provided a concise focus for me.

Question 2: Focusing on a single object was a really helpful practice for me. I have some crystals, and I took one out and used that as my object (in taking a mindfulness course in the past the instructor talked about how we are always touching smooth plastic objects, so I wanted to veer away from that). I did notice that observing was a bit more challenging compared to when I actually explored the crystal with my physical senses (touch). Again, with this exercise I did experience external stimulation, specifically noises, that would briefly draw me out of this experience. I found with this particular exercise, however, it was much easier to bring my awareness back because it was a tangible item and I used descriptions to fully refocus. This particular intervention, I believe, would be so effective with a wide range of individuals, including some younger folks. Being able to fully absorb yourself into an object, at least for me, was almost mesmerizing.

Question 3: I do believe that both of these exercises can be incorporated and weaved into the work that I do with individuals. Many of the people I serve experience prolonged and acute feelings of stress and dysregulation. This exercise would be helpful in gently bringing them back to the here and now and focusing on “one thing in the moment” (we teach a lot of Marsha L. here at my program). As I mentioned earlier, I would like to be able to do this activity (focusing on a single object) with clients that does not involve the focusing on smooth plastic; such as something from nature; a rock, a leaf, an acorn, or pinecone. I think that way all of the various senses can really be tuned in to. I think that both of these exercised can help my people refocus and ground themselves to be more present.

[Adeena Vogel]

Week 1: January 20, 2022

Question 1: The method of concentration meditation is one that I practice, and one that is more easily achievable to me. During this practice, I found that I was able to keep my physical body calm, but it also brought more attention to my physical body; prompting questions such as “am I breathing in deeply enough to fill my belly,” and “I must be hungry with the tummy rumbling.” Being Type A, when I first started the exercise, I noticed that I really focused and perseverated on getting to 10 and then starting over. I would say that a few minutes in, and gentle reminders to bring back focus on the number, I was able to better focus on the word “one” in unison with my breath. Not perfectly, but hey, what is perfection any way? I do think that this particular meditation would be grounding, as it specifically prompted me to focus on the number and the counting. This, was helpful for me, however I did not feel totally zoned into full relaxation and the novel idea of “zen.” Primarily, because I was hyper focused on the counting. Helpful for grounding, yes, but not so much a stabilization of my mind.

Question 2: I wrote my response to the concentration exercise, before moving on to the mindfulness one, convinced that I would be better at concentration. However, with this exercise, I felt that I was able to focus more (maybe it was because I was already in a relaxed state following the first practice?). I have practiced this before, and try to practice regularly (at least, for spurts of time, I know, not helpful). I like the physical experience of noticing and feeling my belly rise with the inhales and deflate with the exhales. It is actually a technique I teach to kids sometimes; put a stuffy on your belly and with your deep belly breaths, you can give him a ride! I also shifted my mind to focus on the idea of “colors” of my breath. I imaged that I was inhaling green and exhaling blue, and that technique helped keep me focused on the breath and the awareness of it entering, and leaving, my body. With this skill, I believe that it was less effective than the concentration medication at making me more aware of the habits of my mind. I was focused on several things for this exercise, which kept me distracted in a good way. With the concentration method, I noticed many fluffy, interesting, and naturally important thoughts rush through my brain and I had to exert mental effort to JUST focus on the counting.

Question 3: I really appreciated both of these exercises. I am honestly vacillating between which one was more helpful and effective for me, because I do believe that both can serve a purpose depending on my needs. Both exercises brought something specifically into my awareness, concentration was the numbers and mindfulness was the actual process of inhaling and exhaling in my body. Both helpful. I did find that I felt more “rigid” in the concentration exercise because boy, did I want to get to 10 (and get the A+).
I have used meditation in the past in the work that I do, specifically when working with populations that are in a heightened state, or have the tendency to quickly get into a heightened state. I like to have my clients practice meditation when they are calm and regulated, so it can be a skill that they can access when they may be experiencing dysregulation. As I mentioned earlier, I do believe that the counting practice will be beneficial in working with clients who struggle with remaining grounded. This one seems like it can be very simple and objective for the populations that I work with. I think the Mindfulness practice can be more advanced, but a wonderful skill to be able to pass on to those that I serve.

[Adeena Vogel]

Hello, everyone! My name is Adeena Vogel and I am an LCPC. I currently work full time at SMHC’s Partial Hospitalization Program and part time as an Outpatient Clinician through Gateway Community Services. Mindfulness is a huge component of the work that I do and I am looking forward to learning new ways to integrate it! I am very much looking forward to learning new skills that I can pass on to my clients!

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