[Caj MacDonald]

Question 1
I found the provider to be compassionate and respectful throughout their sessions. He started each session with an open ended question that invited her to share and allowed him to understand where she was in regards to her readiness for change. I felt the consumer was very invested in change (albeit hesitant about her confidence level) and the provider was affirming and reflective in each session allowing her to explore a change plan. I liked the provider’s non- judgmental style and the frequent reflections he offered in each session. Overall there is nothing I can suggest to improve on in these sessions.

Question 2
The provider’s specific questions helped clarify the consumer’s reasons for wanting to stop smoking and highlighted the discrepancy between her goal and her current behavior. It was also effective when he asked her to identify and elaborate on the pros and cons of her smoking. The provider responded with many reflections as well as often summarizing what he had heard which allowed multiple opportunities for the consumer to hear the feedback. It was also helpful to focus on the importance level and her confidence level in making this change. Identifying her “first small step” of simply tracking her usage for the next week seemed like a reasonable and achievable goal which would increase her confidence. Again, the provider’s open ended questions, reflective listening, affirmations and summarizing were all well delivered in a non-judgmental manner.

Question 3
Again, I feel the provider did a thorough job of asking targeted (yet open ended) questions to elicit information in each session. His attention to the consumer was evident in his reflections and summaries. The consumer presented as invested in the first session which I suspect helped the dialogue flow smoothly. It was obviously a change she had given great thought to and she was able to contribute a lot of insight into the sessions. I did not observe as much informing in the sessions as I would have anticipated in a primary care setting. I wonder if the consumer’s motivation and insight had an impact on how little information the provider shared.

Question 4
I have really enjoyed the opportunity to refresh my knowledge of the components of MI. As I read the material and watched the videos I was often reflecting on the students I am or have worked with. While I would like to think I am being true to MI I realize that there are times when I am too quick to offer information or suggestions and at times I struggle with the righting reflex. Many of the students I see are encouraged by others to attend and are often sent with the referent’s goals in mind. I want to be sure I am listening for the student’s change talk as I know it can differ from the adults in their life. I want to make sure I am be mindful of using OARS and inquiring into the importance and confidence levels with each student.

[Caj MacDonald]

Question 1
I found both of the videos clunky and challenging to follow. I felt the clinician talked too frequently, used too many closed ended questions and cut off the consumer when he was sharing his thoughts. I found myself wanting to know what the consumer would have said had he not been interrupted. I also questioned the consumer’s readiness for change even after both videos.

I do not feel the MI strategies used to develop the specific change plan were very effective. As the listener I wasn’t very clear on what the plan was at the end of the video. The consumer indicated he, too. might be uncertain as he noted “I don’t know what I’ll do” and “I’ll ask him (coworker) if he is there (or if it’s at an appropriate time).” There was a great deal of focus on utilizing the support of AA, but the success of that seemed to lie with the coworker and it isn’t clear if the coworker is even able to provide the support or direction needed. The clinician assumed “You can expect him to be supportive because he’s been there before.” In the second video the consumer again referred to not really understanding the process of AA (regarding the meetings) and noting he would watch the game “somewhere safe,” but there was no follow up on clarifying these comments. It also ended without a clear summary (verbally or in writing) .

Question 2
I feel like there should have been more focus on evoking the CAT steps as the consumer still seemed a bit unsure or hesitant at the end of the first video. The clinician summarized “So the goal is not drinking,” yet the consumer didn’t fully endorse that statement. The clinician also added “So you are highly committed,” but again I didn’t necessarily hear that. There were several parts where I felt open ended questions would have been helpful to better understand the consumer’s position. I also noticed the clinician provided a lot of information when it wasn’t requested yet he did not respond to openings such as “I don’t really know what help is available.” The clinician made some assumptions about the role of the church and the willingness of his coworker to assist with AA which I wonder if they were accurate. There was a lot of focus on reengaging with the church (which I wasn’t convinced was a strong possibility), dancing (no elaboration on what that meant) and AA (which I feel the clinician almost tried to talk him out of at times).

I would have used more reflective listening, open ended questions and summarizing during the change planning. I felt like the consumer stated a need (I have to make a change at some point), but the process needed to be slowed down to further explore this. I would want to focus more on clarifying the goal (what would it look like) and specifically what the consumer would like the change to be. In considering options I would explore how effective the consumer sees
each strategy to be and how confident he feels in trying each one. Again, I don’t feel this was fully discussed in the videos leading to possible challenges with his success. I would also focus more on summarizing the plan for clarity both verbally and in writing. The clinician did ask for follow up later that day, but I would also want to explore/utilize the support of the wife which the consumer mentioned several times.

Question 3
In the population I work with others often set goals and expectations for the teens (parent, teacher, peer, etc) and this is often a source of conflict. I have found teens to be very willing to make changes in their life and they often have a great deal of insight on this. I will continue to focus on supporting them as they work to define their own goals, identify various options and problem solve each strategy. I need to be mindful of waiting for permission before providing suggestions or information. In a recent session I offered an option too quickly (and without permission) in regards to a student wanting to stop vaping. I informed the student of a community resource, but it was clear from the reaction that my timing was off. Just like adults, teens aren’t necessarily looking for advice, but a sounding board as they consider changes. I also need to remind myself that change doesn’t happen in a linear fashion and that revisiting the change talk is part of the process.

[Caj MacDonald]

Question 1
When I initially read the vignette involved a mandated client I anticipated a tenuous interaction (at least at the start of the session).  Because Terry was quick to acknowledge Rounder’s disinterest in attending I suspect it helped diffuse his potential frustration and resistance.  Terry’s responses were genuine and helped to invite Rounder to share. Terry respectfully listened which allowed Rounder to disclose more than I expected.  Rounder also presented with more insight and openness for change than I anticipated in a first session.

Question 2
Examples of Sustained Talk

I drink a little bit, but work hard.
Only reason I’m coming here is so I can maybe save my driver’s license…
None of this makes sense. I don’t know what the hell she means I need help.

Examples of Change Talk
I want something that will help me in court. (Desire)
I wouldn’t mind coming here to live. (Activation)
If I don’t stop drinking I’m probably going to be right back in this mess. (Reason)

Question 3
Well again I think that’s something you need to decide…what kind of treatment you want. (strategic response)
You are not here because you think you have a problem. You’re here because they sent you here. (reflective listening)
It almost sounds like you don’t even know whether you could stop even if you wanted to. (strategic response)
Terry’s use of complex reflective listening and strategic responses acknowledges Rounder’s history and where he is in this process. I believe he has felt heard and perhaps understood. As a result It has provided him the safety to share a variety of emotions (anger, sadness, worry) and explore his ambivalence. Despite his gruff exterior I hear some prior insight and awareness in Rounder’s responses. The interviewer’s style invited that side of Rounder to be heard.

Question 4
This treatment center thing is that here at this facility? What do you all do?
How long do you think I would be here?
As long as I am putting all of this money into it I’d like to come out with something.

At these signs I would summarize his change talk (being sure to answer his stated questions on the facility) and ask for his direction on the next step ex: review program brochures, schedule a tour, schedule follow up appointment to allow time to process).

[Caj MacDonald]

Question 1
I felt physically uncomfortable watching the vignette with the confrontational interviewing style. Sal is defending himself throughout the interview and his frustration builds as a result. He initially expresses confusion about why now his pet would be negatively impacting his asthma, but there is no opportunity to pursue this. The therapist jumps to discussing putting his pet up for adoption which increases the disconnect. I also feel the therapist shames Sal about not having read the informational brochures never inquiring into what may have prevented him from doing so. This vignette felt more like a parent berating a child rather than a therapist counseling a client. The interview in the Spirit of MI is much easier to watch and the conversation flows more smoothly. From the opening line Sal’s agenda is acknowledged. Sal is given the opportunity to talk about his confusion, sadness and hopes (for son to grow up with the dog). This non confrontational interview is more likely to lead to change because it allows Sal to explore his various experiences/history, changes he has been making (and receive affirmations for) and also self identify what he would look for to indicate a change is necessary.

Question 2
I feel ambivalent about exercising (walking) on very cold and windy days. I dislike being cold and having to bundle up isn’t always comfortable. My exercise routine is important to me and I feel better when I exercise daily. Caj, on one hand exercising on cold days can be physically uncomfortable and having to bundle up adds another layer of challenge. On the other hand your daily exercise routine is important to you and you feel better when you exercise. This activity is helpful as it allows me to acknowledge the challenge (the cold weather and bulky outfits) while also reminding me of why exercise is important to me (my mental health). If I only focus on the negative or the obstacles to something I am unlikely to make much progress. When I remind myself of the rewards for doing a specific behavior it helps me get up off the couch, grab my jacket and get walking!

Question 3
Three possible consumer based target behaviors may be discussing increasing irritability with others, wanting to have fewer detentions/school consequences and wanting to pass classes. Three target behaviors on my agenda include talking about possible depression, exploring challenges impacting consistent attendance including sleep routine/self care and impact of substance use on mood, focus and productivity. The righting reflex is around the role of substance use in the student’s life including connection to mood, subsequent consequences and academic challenges. In regards to setting the agenda I might acknowledge the student’s personal goal of graduating on time (with peers) and ask what they would like to talk about in regards to reaching that goal.

[Caj MacDonald]

Hello. My name is Caj MacDonald and I am a clinical social worker in a high school. I also hold a CADC license. I have been working with teens for over twenty five years in the public school setting. I am looking forward to refreshening my knowledge of MI and strengthening my skills to use in my practice.

[Author]

Posts