Forum Replies Created
-
Posts
-
1. My general reactions to the videos are that the physician did a really great hob using MI strategies to address the smoking with his patient. Throughout all of the video, the physician utilizes reflective listening, open ended questions, and allowed the patient to not only lead the conversations but also identify for herself what she wants treatment to look like moving forward in an effort to get the best results. By doing this, the physician was able to elicit more confidence from the patient about her willingness and ability to quit smoking as the conversations progressed. Throughout these conversations he also emphasized and encouraged self choice by having the patient identify small goals, elaborating on them, as she began to slowly see progress and develop more confidence to ultimately develop a larger goal of quitting smoking completely within 30 days. I don’t believe I would have done anything differently… instead I think these conversations really showed the effectiveness of MI strategies and the success and growth of confidence when the conversations are client/patient focused and the questions are open ended.
2. The physician helped this patient resolve her ambivalence about quitting by encouraging her to dictate how her treatment goes, set small goals for herself that do not seem overwhelming or forced, and emphasizing personal choice and control. I liked how he used reflective listening to repeat back what she had stated in an effort to elicit more information and have her elaborate on why she may feel the way she does; which helps get to the root/cause of the behavior which is crucial towards addressing how to change it. These videos were great examples of how effective MI can be when addressing a variety of change behaviors because it allowed me to see the progression of confidence… I think lack of confidence is one of the largest deterrents to change, especially with my own clients. So the whole point is to let the client decide for themselves what they feel capable of doing, elaborating on that, encouraging efforts, and eventually when they start seeing progress for themselves, their confidence grows to a point where they feel able to take on larger goals.
3. The physician effectively adapted MI to the interventions in a primary setting because he allowed the conversations to be patient focused and led. He did so by his repeated and consistent use of asking, listening, and informing. Throughout all of the conversations, the physician asked open ended questions about what the patient wants to identify as the behaviors she is struggling with. The physician also effectively used the strategy of “informing” throughout the conversations but not in a forceful manner that might deter progress… instead he asked to share with the patient and only during times where she had introduced a level of willingness to explore further options into the conversation. I liked how he also left room in the conversation for the patient to identify why she feels the need to smoke and the underlying reasons (i.e. the benefits of it- makes her feel good, uses it as a way to socialize, relaxes her, etc). by doing this, I think it allowed the patient to be more open to exploring solutions. The patient responded positively to the physician’s approach and it is shown by her repeated willingness to continue engaging with him and allowing him to play a role in her treatment and next steps. All of these conversations depict a patient who is working through her ambivalence to change the behavior of smoking, grow in confidence, and open up to different treatment options for a higher likelihood of success.
4. I found this course incredibly informative and helpful. The MI skills and foundations covered in this course has allowed me to take on a different perspective on how I speak with my clients and how I address change behaviors. Moving forward, I can see myself completely changing the approaches I take towards conversations with my clients about changing certain behaviors. I work with youth in the state who have mental health diagnoses and also involvement with the department of corrections… this population is accompanied by a lot of ambivalence as well as health-risk behaviors. This course has challenged me to take a look at my own approaches with these kids and allowed me to see that I may be seeing more ambivalence than I am progress/outcomes because of my own conversational methods. I plan on implementing the MI approaches and skills I have learned throughout this course to adjust the ways I have conversations with my clients and make sure that each conversation moving forward is: client focused and led, full of open ended questions, reflective listening, and grounded in the spirit of MI in order to give my clients a sense of control over their own lives and choices and encourage a growth in confidence.1. As I have seen other members of the class state; I feel that these two videos were sort of hard t follow in some ways. My general reactions is that the basics of MI are present, but the clinician does not do enough eliciting as he could be to support the client with identifying and committing to a change plan. I think there were a lot of components of the clinician’s interviewing that were effective but also a lot of components that could use some improvement. For example, what the clinician does well that I observed was: introducing timelines to the conversation (i.e. asking the client for a deadline of when he plans to act on an action step he has identified in his change planning), recapping the conversation to steer the conversation in a direction towards commitment, and asking the client to identify the barriers to progress and how he plans to overcome these barriers. However, areas of improvement I observed were: the clinician did a lot of interrupting, not a lot of open ended questions (and the ones he did use were repeated throughout the entire interview), and providing education without asking if the client was interested in this perspective. Generally, I just think the clinician did a lot of the talking which put the client in a position to do a lot of agreeing and brainstorming but not a lot of committing or being specific about the change planning. Both interviews felt like a lot of brainstorming without the specifics on how the client would follow through.
2. If I was the counselor in the role play, I would utilize more of the SMART method outlined in this lesson. In order to do this, I would open up the conversation more to the client and spend more time asked him open ended questions about what HE thinks might work for him and less about what has worked for others in the past (as the clinician does by referencing AA multiple times). I would also encourage the client to identify specifics of what steps he wants to take and WHEN he is committing to take these steps as a way to increase the likelihood of the change he has identified wanting to make. Generally, the things I would have done differently to improve on what the counselor in the video did would be to: use more open ended questions, asking key questions towards commitment, less interrupting, more focusing on what the client has identified as effective and elaborating on HIS options, more specific planning, writing down the action steps of the change planning so that both myself and the client have a copy to refer to, I would ask for more permission from the client before offering up educational pieces or input, and lead the conversation in a direction that would allow/encourage the client to identify more specifics regarding the change plan.
3. I imagine myself using most, if not all, of the MI strategies from this lesson in my own work with my clients. A key component of my role working with clients and supporting them with identifying their overall goals, outlining the action steps towards achieving those goals, and connecting them with supports and resources within their community they can access to work towards these goals. However, as eager as many of my clients are to achieve their goals, I see a lot of ambivalence when it comes time to address the “change” that is needed in order to work towards their identified goals. The strategies discussed in this lesson such as the SMART method will be helpful to utilize with my clients as a way to get them motivated towards the change they have identified, put them in the “driver’s seat” of that change plan, and getting them to identify for themselves what they feel would be effective-rather than feeling like they are being forced into a lifestyle change. Many of my clients are so accustomed to being told what to do or being told by providers what they SHOULD be doing… my goal is to implement more MI strategies into my work with the youth to elicit excitement, motivation, and autonomy in their lives so that they can feel in control of what they want their life to look like. I also think that by doing this (implementing these strategies), the change planning will be a lot more effective in the long run and I will be able to see my clients continuously make more progress towards their goals.1. General impressions of the “Rounder” approach is that it seems to be more effective than many other interviewing styles I have seen… mainly because the open ended questions that are asked allows for the person being interviewed (Jim) to explore their own ambivalence to certain behaviors. I noticed that at the beginning of the interview, Jim seemed very irritated to be there, ambivalent to any talk of change, and somewhat closed off. However, towards the end, the tone of the conversation changed and Jim seemed to be more open to exploring his “unhealthy” behaviors and possible solutions he would feel comfortable with pursuing.
2. Examples of Rounder’s sustain talk primarily take place at the beginning of the interview while Jim shares why he is there and what has been going on recently. Coinciding with the examples of sustain talk are statements that are blaming towards others and Jim not acknowledging his responsibilities or taking accountability for his actions. Examples of this sustain talk are in the beginning when Jim talks about how his daughter expresses her concerns about his drinking but Jim is in denial about this and immediately turns it around to acknowledge the fact that he has “always bailed her out”. This shows an unwillingness/not wanting to change this behavior and instead, emphasizing what is wrong with others’ concerns about the drinking. Another example of the sustain talk is when Jim talks about how annoyed/irritated he is with having to engage in these services and that he is not here because he wants to be but because others are stating he has behaviors he needs to change. Another statement that stuck out to me was when Jim was trying to downplay the drinking… for example he was telling Terri that the drinking is not as bad as everyone things because he “drives short distances” and only “drinks a little bit”. This seemed like the turning point in the conversation when Jim almost started to acknowledge the behavior itself but was still declining the “problems” with the drinking. Rounder’s change talk starts to become more apparent towards the middle/end of this interview as Jim starts to open up about exploring changing his behaviors and solutions to it. For example, Jim says “People keep saying that you need to stop drinking and I aint never done that either. I think I could.” This is an example of Rounder’s ability step of change talk. He begins acknowledging that he COULD stop if he really tried but claims that he is ambivalent to stopping. Another example of change talk is when Jim states “I wouldn’t mind coming here to live” in response to the idea of the treatment facility. This is an example of desire as Jim begins to open up about the possibility of pursuing a solution/change to his drinking. And lastly, when Jim acknowledges that if he does not stop drinking, he will be in this situation again and states, “as long as I’m putting all this money into it I’d like to come out with something.” Which is an example of commitment as well as reasons because Jim is showing that there is something to gain out of changing this behavior and is willing to put in the money and work into committing to trying.
3. The interviewer uses a lot of reflective listening during the interview which is shown by her repeating what he says back to him. This allows Jim to hear what he just said, maybe in a different phrasing, and continue to elaborate more on that thought. I think the interviewer does a lot of reframing during this interview especially when Jim has statements of ambivalence towards changing his drinking behavior or his ability to. For example: the interviewer repeats back what Jim has already shared in the interview pertaining to his previous progress when he has attempted to stop drinking before by saying “right, you were successful in changing that in the past and sound like you’d kind of like to be successful changing this.” This allows Jim to steer the conversation in the direction of change based on information he already had shared with her earlier in the interview that evoked a sense of change. Throughout the interview, the interviewer continuously repeats back and focuses on Jim’s statements towards changing his behavior to evoke more from Jim about his thoughts towards what he feels he could change and how.
4. One example of Rounder’s signs of readiness to change is when he states “cause when I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?”. This statement is an example of envisioning and change talk as Jim begins to acknowledge how the continuation of his drinking will affect his future and what his future would look like with and without the drinking. Another example is when Jim begins asking the interviewer questions about if ambivalence is “normal”. This kind of talk is an example of questions about change and overall, deceased sustain talk. Towards the end of the interview, Jim stops denying and defending his drinking and instead transitions into a state of mind where he is open to exploring ways to change the behavior, asking the interviewer what to expect, and sharing that he is aware of the need for change but ambivalent about how to go about it—but still willing to explore ways, such as the treatment facility. If I was the interviewer and saw these signs of readiness, my next step would be to summarize the change talk elicit a commitment to change by asking Jim to express his commitment to change. I would highlight what he shared throughout the interview that involved acknowledging a willingness to change and being open to exploring changes. By focusing on these pieces and asking for him to express his level of commitment to this change (i.e. what is the next step for you) it allows for Jim to continue in the direction of being motivated to change/take action.Question 1: In the confrontational video, Sal seems overall disengaged from the conversation. When he does speak, he is more prone to a “defensive” approach where he seems like he feels the need to justify his feelings about the situation. Sal also seems to become increasingly frustrated/agitated as if he feels he isn’t being heard or understood by the interviewer. During this video, Sal expresses that this is “too much” which leads me to believe this approach is causing him to feel overwhelmed and stressed out which causes him to shut down. Another observation is that Sal does not lead the conversation in the confrontational video. He sits and listens to the interviewer and speaks when he feels the need to justify or defend himself which brings on a more “hostile” tone to the interview and he is not offering much information.
In the second video, the Spirit of MI interview, Sal’s tone is very different and much more positive. In this video, Sal leads the conversation. The interviewer prompts open ended questions which Sal seems to offer more information in response to than in the first video. Sal seems more comfortable answering and offering up personal information with this method. Another observation is that Sal is more agreeable and engaged in this video. He is willing to explore different options, share his thoughts and feelings about the situation, and move towards possible solutions that he has identified he might feel comfortable with.
Ultimately, the Spirit of MI style helps Sal move much closer toward some kind of action to improve the management of his asthma because he is in the “driver’s seat” of the conversation. He is asked open ended questions which allows him to have more control over what he chooses to share. With this style, Sal seems to be much more engaged with the interviewer and offers more information regarding his situation which leads to him exploring/identifying different solutions he would be comfortable pursuing to address the situation. This interview, overall, seemed to be much more positive and productive because the interviewer took time to listen to Sal’s perspective on the situation and less time putting him in a position where he felt the need to be defensive or disengage (as in the confrontational video).Question 2: Behavior: procrastination:
i. “It allows me to prioritize other tasks”
ii. “It helps reduce stress momentarily”
iii. “I work well under pressure anyways and always meet the deadline”i. “It also causes more stress when I have to prioritize the things I procrastinated”
ii. “causes me to feel less organized”
iii. “makes me feel like I have to rush those tasks to get them done and might reflect in the work”
c. Double sided reflection-
“On one hand, procrastination allows you to take the time you need to focus on some other tasks/responsibilities that you feel are more pressing. On the other hand, when you do have to come back around to the other tasks you procrastinated, you tend to feel disorganized which can cause you a lot of stress.”
“On one hand, putting some things off makes you feel like you have more time to relax and feel less stressed when you know you will get to those other things later. On the other hand, when you get around to those things again, you may be feeling more stressed about those specific tasks than you did the first time around.”
“On one hand, procrastination isn’t that big of a deal to you because you have always done well working under pressure and putting certain tasks off just provides you with that added layer of pressure you thrive under. On the other hand, even though you do well under pressure and always meet the deadline, procrastinating puts you in a position where you feel you need to rush to get it done which you worry affects the work”.
This exercise challenged me quite a bit. It kind of forced me to look at things from both sides and reflect on the pros and cons of a topic which is sometimes difficult to do. This allowed me to look a little deeper at this topic and weigh out which “side” of the topic I felt caused me the least amount of stress or better feeling overall. However, it also allowed me to see the struggles with ambivalence because each side of the statements identified some of the habits I might be used to and the “decision” about which approach might be best may result in changes in lifestyle habits which I think can be daunting to many. The exercise also sort of helped me identify the difference between a comfort zone and a preferred outcome; which again, requires lifestyle changes.Question 3: Target Behaviors:
Consumer:
i. Cut back on smoking weed and vaping
ii. Go to school more often
iii. Get my diabetes levels lower throughout the day/more consistently
Provider agenda:
i. Cut back on smoking weed and stop vaping
ii. Go to school daily
iii. Take prescribed diabetes medications routinely to keep levels safe at all timesPrimarily, the discrepancies among these two lists lie in the expectations. The client may be open to cutting back on smoking weed and vaping but I (as the provider) am tempted to want this youth to stop vaping completely due to health concerns. The same with the schooling… the client might identify that he wants to try going back to school a few times a week but I am tempted to advocate for him to begin going back to school every day so that he can be accessing developmentally appropriate academic resources.
These discrepancies challenge me to look at my own perception of what “healthy behaviors” might look like to me versus this client and remind me that I am not in the “driver’s seat” of this youth’s life; they are. In order for there to be change, the client needs to be the one who identifies what they want that change to look like, otherwise, they will feel like they have no control or choice in their own life. As the provider, I need to always step back and remind myself that my job is not to determine what is “best” for the client, but to meet the client where they are at and support them reach their identified vision of what is best for them. In order to do this, I can use the MI Agenda Setting strategy because it allows me to outline (generally) different topics or areas of the client’s life that they may want to identify wanted changes in or struggles with. The agenda allows for both myself (as the provider) and the client to start the conversation on the same page but allow for the client to take the conversation in the direction they feel comfortable with which will result in more open conversation, more comfortability, and more “buy in” to the proposed lifestyle changes.
