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Question 1: I really liked the way he listened, both reflective listening and offering encouragers while she spoke. He also used a lot of summarizing after she spoke. He overused an affirmation, able to stop while in the hospital, but was clearly trying to focus on what she could do vs. the challenges. Probably the most significant thing I would do would be to spend more time exploring the challenges to quitting that the patient is aware of that seemed to be glossed over by the interviewer in favor of keeping things positive. I would have balanced all the focus on the challenges with more exploration of desire, reasons, and need to quit.
Question 2: He used reflective listening several times such as “make sure I understand…” He asked about the positive aspects of smoking before asking about the negative. This is the main way I saw him work to resolve ambivalence, which she didn’t have much of, and develop discrepancy. He initially used the 1-10 scale around how important it is to quit and then again for how confident she is about her ability to quit. He then reviewed the confidence scale in a later session.
Question 3: He appropriately used asking, listening, informing around exploring medication interventions specifically “what are your thoughts about medications to quit smoking?” She responded “ I was thinking maybe we could discuss that again because I still need some help.” He listened here, but I also got the impression that they had a prior conversation where perhaps she declined medications. In an earlier video she expressed having tried the patch already but it wasn’t explored that much then. After her one sentence answer giving consent he used informing to give the extensive array of medication options available to support quitting. The patient reacted negatively to the gum for disgust reasons, I didn’t get a clear understanding of why the patient rejected the Zyban, but just honed in on the newer medication. Over all the videos there wasn’t a whole lot of resistance to the physician and so the MI used seemed more subtle than earlier videos and more focused on the positive and commitment aspects. I didn’t see the reaffirm commitment used a lot or expressing commitment to another person, though for a moment when talking about medication I thought that’s what he was doing, he was actually just checking if someone could watch out for her around dangerous medication effects.
Question 4: One thing that stands out is my apprehension about using 1-10 scales, but it was really interesting to take their number response and ask why it wasn’t a lower number, setting them up to focus on why it’s important to them or why they are confident. I think the repeated use of it in the videos got me thinking about how it could be a useful way to focus their thoughts on change. I feel I was already reframing resistance with reflective listening. Another thing that stood out to add to my work is to explore arguments for not making the change first before exploring change statements. I work in a person-centered framework to start which is in alignment with MI principles and techniques, but I can see the opportunity to be much more strategic with my interventions in ways that can help clients become clearer about and meet their goals.
1. My general impression of the role plays was that there was something missing. Perhaps because they were role playing vs. an actual client. That being expressed, what threw me off in the first video was the counselor proceeded on as if there was a strong commitment, yet the words the client was using didn’t reflect that: ‘have to make a change at some point’ or later in the conversation ‘not drinking has to become the um goal’ seemed more in the activation stage with some resistance. The counselor seemed effective in using SOAR, by exploring the AA option, moving to the plan to ask the coworker at lunch about AA, and expressing commitment to his wife and follow up with a call once he’s done that. That section seemed effective, just for me it seemed to skip a step of building discrepancy to deal with resistance.
2. I would have used more reframing resistance or rolling with resistance early on when I heard the two previously mentioned comments about the need to change ‘at some point’ or ‘has to become the goal,’ as those suggested the client wasn’t ready to change yet, only to explore what changing might look like (though in the second video the client acted like the change decision was made for now vs. it being a future decision). I would have wanted to work more on building discrepancy. I would have used the same MI strategies for change planning. I might improve upon it by exploring more thoroughly the different options for change. Even though the client jumped on to the AA option without resistance and it seemed like a good fit, I would have liked to have seen a bit more exploration of inpatient, IOP, and outpatient options and more explicit consideration of how AA could be especially helpful supporting the client socially replacing time/events usually spent drinking with people.
3. I could see myself working with SMART – specific, meaningful, accessible, realistic, and timed goals – I could really get into exploring this with clients. I can also see myself working with SOAR through exploring what change would look like, steps to take, supports and obstacles. I would have a more difficult time using a scale of 1-10 with the client, though it may be more accurate for them to give a scale number than for me to try and read how they express commitment to a course of action. This question reflects the section we are on in envisioning how I might change my interactions with clients based on the new information/interview strategies MI has to offer.1. My general impressions of the interview was that the Rounder may not have been an actor. It felt very real, and the interviewer Terry Moyers appeared to do an amazing job at really being with the Rounder where he was at with a non-judgmental stance. I had the feeling that Terry Moyers had been doing this a lot over a long time, as she was so quick and skilled in her responses to him. As someone new to Motivational Interviewing, I might have to memorize some response fragments that would fit different interviews to get on the same playing field as her. She really matched where he was at. The beginning where she really addressed head on his apprehension about meeting with her and reflected/validated where he was at seemed to really allow him to explore a lot in a short time.
2. Sustain talk: only reason I’m coming here is so I can maybe save my driver’s license so I won’t lose my job and so I won’t lose my house. It’s not because I want to do any of this crap you know.; It’s nothing for me to sit down and drink a six-pack or two of beer and still be able to function.;Really I didn’t know why in the hell I stopped anyway.
Change talk: I wouldn’t mind coming here to live (Desire); If I don’t stop drinking I’m probably going to be right back in this mess again. (Need); As long as I’m putting all this money into it I’d like to come out with something.(Desire and Activation – is it both sometimes?)3. So drinking kind of helps you relax and, you know, cope with your life.(complex reflexive listening) The impact of this was to allow Rounder to go into exploring legal/jail problems with his temper and it’s relationship to alcohol use. He seemed more guarded and protective of his drinking before that.; It almost sounds like you don’t even know whether you could stop even if you wanted to.(Strategic) This was well placed and to great effect where Rounder was confronted by the question of if he could stop drinking or not, and most importantly his strong sense of self as someone who can do most anything, but what about this. Sounds like you guys have a good time.(Complex reflective listening) I like the clear reflection of his feeling of it being fun drinking with friends. I think this reflection was important for him even though he went into sustain talk or reasons it would be difficult to quit drinking and be around friends. It seems important to really acknowledge openly the positive to contrast with the negative later in the interview. It also really helped him to see where he was at and what challenges he faced.
4. I wouldn’t mind coming here to live – I might want to explore, maybe conjecture it seems really important to him to change where he would be willing to come live here to assure success vs. engaging in treatment less. If I don’t stop drinking I’m probably going to be right back in this mess again. – My impulse here would be to want to explore his admission that he is likely to have more problems if he doesn’t change, specifically to cultivate a self understanding of reasons to change – I don’t know if it would be most helpful. The interview seemed so successful and the interviewer so skilled, it is hard to suggest any improvement, much less anything different. As long as I’m putting all this money into it I’d like to come out with something. – I might want to focus on the something he wants to succeed at to really highlight the change he wants and his sense of being able to do anything he puts his mind to, maybe ‘it sounds like you really want to make a go of this, make it worth your while?’
Question 1
Initially I cringed at the interviewer even considering him giving away the dog, like asking someone to give up one of their children. Sal responded to the confrontational style by getting stuck whereas with the Spirit of MI style he seemed to be able to gain clarity around where he was at around caring for his asthma and what he might be willing to do. Definitely with the Spirit of MI style Sal was moved closer to actions he was willing to take to improve asthma by becoming aware of his line where he might consider giving the dog up.Question 2
I feel ambivalent about the foods I eat and motivation for eating them.One side of the ambivalence: I feel sick or tired when eating starches and sugars or larger amounts of food than I need and feel it is harming my body and ability to live longer and with less pain.
The other side of the ambivalence: My wife and daughter like eating starches and sugars and larger amounts of less nutrient dense foods, and to change would mean giving up that connection to them, the ‘breaking bread’ together, and would complicate meal preparation, potentially shaming them for their choices, or rejecting my daughter as she learns how to cook a meal each week which usually includes mac n cheese.
Double-sided reflection: On the one hand you feel sick and tired when you eat the same as your family. On the other hand, eating foods that work with your body is less painful. On the one hand you feel you want to change your eating to be healthy and live longer. On the other hand you feel willing to sacrifice your physical health to feel connected to your family. On the one hand you feel sick and in pain eating the same foods as your family to stay connected. On the other hand living longer and in less pain may allow you to live longer and have a longer time connection with them.
Question 3
Consumer generated target behaviors: Decreasing cannabis use by more than half. Exercising any time cravings arise. Prepare more healthy meals at home vs. restaurant food.
My agenda target behaviors: Try taking a month break from cannabis. Establish a daily brief exercise routine. Try a different recovery support group each week. There is a discrepancy in approach to cannabis where I would ideally like the client to have experienced abstinence to know they could live without it and then have it be more a choice to use a smaller amount.
Righting response might be something like why are you holding on to using cannabis vs. a more MI agenda setting discussion of it sounds like you value cannabis use and want to maintain a relationship with it different than you have now. What are the ways you find it useful or valuable in your life?
