Forum Replies Created
-
Posts
-
1). The doctor was really listening intently, interjecting at appropriate times with reflections and summarizing of what the client was saying. It felt, at times that she was really driving the session and coming to her own decisions quickly. I wouldn’t change anything other than I might use a visual for the scales so that when she identifies where she is on the scale she can actually see it.
2) He used alot of open ended questions (which I liked), often reflecting and summarizing (to be sure he was clear on what she was saying) what she was saying back to her, showing that he was indeed listening to all of what she was saying. By asking her what her thoughts were on the “good” reasons for smoking and the “not so good” reasons, she was really able to come to breaking down her ambivalence and gain more confidence in her ability to identify what she felt confident she would work on and put things in motion for herself. He always kept the conversation focused on her and did not act like he was the “expert” and tell her what she needed to do.
3) He revisited her confidence level asking her where she thought she was now vs. where she was when she first identified her confidence level. By reviewing all the of the steps she has already taken and continue to use, he is listening to what she is saying and can then offer her more options, when the topic of medications comes up he is able to provide her with thorough information about what the options entail so that she comes to the the determination which option she feels is best for her and is willing to try. The “patient” is very responsive and seemed more ready at each session, coming into the last session (video) already having her goal in mind and how she was going to work toward that.
4) I am not a therapist, and since my job is Intake and gathering information I unfortunately don’t get to spend much time with the people I get to meet with. I would take more time in my initial (and only) meeting with people to support them in identifying the goals they want to work on and why they want to work on them by listening a bit longer, using more reflection and summarizing (which is something I don’t do enough of) and asking more clarifying questions when needed. Since I do like the use of scaling, I can use that more in my intake with people.
I do feel like alot of what is used in MI coincides with the psychosocial model of working with people, keeping it client centered at all times is very important so that the client does not feel like it’s the goal of the provider and not their own goal. I also feel that revisiting the positive changes (no matter how small) is also good to review with the client to keep the momentum of change going.
1) Honestly it was very hard to stay on task with the videos. To me it felt like the provider was the one making the suggestions and driving the “plan”. The provider did do a lot of reflection back to the client and asked some (not alot) of open ended questions. But I also feel he could have done more around just listening to the client. It felt more like the client was just going along with things even though some of the time he was making statements that would show a desire to change and begin the planning process, and committing to some step/actions. Overall, It made me feel like he would come back to the next session having to say ” well I didn’t do anything I said I would” He didn’t really seem like he was too into the AA idea and seemed ambivalent around that option. Clinician didn’t seem to address that.
2) I would ask a lot more open ended questions ( I don’t like closed ended questions as I feel they don’t give you enough information or real direction in a conversation) wanting the client to convey his thoughts and ideas/concepts/options for steps toward the client’s own goals. Questions specific to what options he has tried before, what (if anything) has been successful in the past. I would summarize a bit more frequently to be sure I am understanding of what the client is willing to commit to. Asking the client if I could provide some clinical information about treatment options.
3) my work is in intake with the agency I work for so I am in a gathering of information more than I am in an ongoing type of collaboration with clients. Need for change seems to fall under that, as I am asking about goals and resources needed and supports, and how our program can support them with their goals. I look for clarification alot, asking for more details and reflection and summarizing of what they have told me to be sure I understood correctly.Question 1: My general impressions were that she was very calm and relaxed in her presentation. She showed reflective listening and asked a lot of open ended questions, which eventually led him to his own conclusion about needing to do something about his drinking so he didn’t end up back where he is now.
Question 2: two examples of sustained talk; Rounder made several statements during the beginning of his session about how he used to drink and fight when he was younger and that he has changed in the last 10 yrs, statement: I’m not like one of those bums you see laying down there by the bus depot on the lawn selling his blood and stealing hubcaps.(Reason) I’ve never stole anything and I’ve worked everyday since I got a social security card. (Reason) These statements show his “belief” that drinking hasn’t been a problem if he can do these things. And does not actually take responsibility. two examples of change talk; his questions/inquiries about the treatment center (desire) & if I don’t stop drinking I’m probably going to end up right back in this same mess again (activation)
Question 3: one example of the interviewer using reflective listening: Let me ask you this. Since you’ve been forced to come here and since you’re feeling like everyone’s kind of pecking on you….What would you like to do with the time that you spend here with me? What would be helpful for you? This makes Rounder think and consider what goals he might want to work on. Moving him toward change talk. Another example: It sounds like if you look ahead and take a look at ryou drinking and see where you’re going to go with that, you’re kind of worried about that? Rounder’s response of doing something that is going to keep him from doing this again continues the process of looking ahead and moving toward commitment, activation, and taking steps.
Question 4: An example of his readiness to change is his statement inquiring about the treatment center and what they do there shows a desire to at least get some information about it and his statement about coming here to live shows commitment and activation. as the session winds up he continues to make statements that bring him closer to taking steps to change. As the interviewer I would ask him if he would like more information (handouts, etc) about the facility/program and plan to talk more about it at the next session therefore setting it up to move forward with the conversation of treatment, and giving him time to think about it as opposed to feeling pressured to make a decision in that moment at the end of the session.Question 1: in the non-MI approach, Sal has become defensive, irritated and a bit angry and pushes back, almost feels insulted, and his body language is more animated (hands and arms moving about) in the MI approach, Sal is more relaxed (leaning in) expresses his ideas and feelings more openly, the MI style is more helpful as he seems more comfortable with the provider and seems to come to the understanding of how his asthma has been impacting him and acknowledges the changes he has been making along with what other possible changes he could make to improve the situation.
Question 2: changing eating habits- 1)feel better/it’s alot of work 2)lose weight/love my junk food 3) less gut pain/just want to have fun and not think about it; “On one hand you’d like to feel better and see the benefits of changing your eating habits. On the other hand, it’s a struggle to have to constantly be thinking about it and don’t want it to ruin your fun.” “On one hand you like the idea of losing weight. On the other hand you feel overwhelmed that it is a lot of hard work” “On one hand having let gut pain would be great. On the other hand eating what you want is something you find enjoyable” My general reactions to this exercise is that it is making me focus on what I would like to change and how it could/would impact me. It is making me think more about how I could change it (ex. working with a dietician, personal trainer, etc).
3 generated target behaviors: quit smoking, getting to emails in a timely fashion, speaking up more in meetings. Own agenda target behaviors: listening to others better, tone of emails, calling out frequently. My list was a bit more negative in what behaviors I identified. Righting reflex: to offer advise by offering suggestions. I may start off with asking what they would like to focus on first and ask more open ended questions about things they have tried, and had success with, to improve the behaviors, and what they think led to going back to previous habits. Along with their thoughts on ways they haven’t tried.Hi My name is Liz Riddell. I have worked for the same mental health agency for 27 years. I am currently the Intake Coordinator. I have recently obtained my CADC and currently have an MHRT/C, and conditional LSW. I have not had much practice with MI and hope to be able to improve my knowledge and skills around MI. I am always looking for new tools and ways to improve myself in order to help others.
