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Question 1
I thought the physician did a good job in utilizing MI techniques to interact with his patient. He created a non-judgmental space and truly rolled with any resistance she brought up. He had great reflections and was able to state back important details to the patient. This showed excellent listening and care. It appeared as though the patient noticed this and felt safe to continue to come back and talk with her doctor. One thing I would do differently is to go deeper into the open ended questions. It did appear that he was supportive, but I would like to have seen the physician dive deeper into the patient’s reasons. I would have used more “DARN” talk to help create commitment with the patient.
Question 2
Overall, it seems as though the physician helped this woman resolve her ambivalence quite well. Progress began quickly, but the goals were SMART. He asked for specific and measurable outcomes, to which the patient provided. Each week he did affirm her for when she made progress – although there could have been more affirmation. It seemed that he had a good combination of listening and giving input. This seemed to help resolve the ambivalence the most, as it showed care and provided education. Specifically when talking about the medication, the physician had a good guiding approach. This helped to increase the patient’s confidence that she could continue to take the steps needed to quit smoking and that she had option for additional support with medication.
Question 3
This physician did an excellent job of utilizing MI in a primary care setting. Obviously, his interventions were short by nature, but none the less, proved their effectiveness. The patient appeared more open and honest each time she met with her doctor. The patient also made progress and was happy to report on the progress each time. The physician set the stage well at the beginning by allowing the patient to state her concerns, while affirming (reflecting) what would be challenging about quitting smoking. He did not push her to quit after the first visit, but allowed the patient to lead based on her comfort level. Over time, this is obvious that the patient developed more confidence and even sought more information. By the last visit, the patient was informing her doctor about the supports she has in friends and family to help and was beginning to gain confidence in herself. This video series helped to identify different phases of the guiding practices used in MI.Question 4
This course has filled in quite a few gaps of what Motivational Interviewing is and how to use it with clients. The acronyms have been a helpful was to remember terms and are practical in real life conversations with clients. I often work with clients who are ambivalent about change and frequently are determined as non-compliant. I believe these new skills will allow me to see a broader perspective of the change process and to work more patiently with clients. There is a distinction between working harder – as it is shown that even brief interactions can be meaningful. More targeted work that allows the client to feel heard and affirmed is the goal moving forward. I plan to use the OARS in basic conversations and build off of that to see more into a client’s desire and ability. From there, engaging in a commitment that is realistic to the client will help the client move toward their own goals.
1. I did enjoy listening to this conversation and appreciate the practical application of the material. It is, of course, always different to hear a conversation between a client and provider, rather than reading examples. This helps to tie it in and provide insight into when to use reflections and how to embody the goals of MI in work. Jim came in with a lot of sustain talk, and the provider was really understanding of that. When Jim challenged her about giving up her job, she replied that she understood how hard that would be for her, and therefore for him to give up drinking as well.
2.
Sustain Talk: ”Yeah I’ll be honest with you. There’s no need in me lying to you because you know unless you go down and tell the court that you know I’m not motivated to be here or anything, but I don’t like any of this I’ll be honest with you.”
“Yeah. And I’m about up to here with this kind of stuff. I hope you know that.
It probably isn’t your fault but that’s just kind of the way things have been going, you know.”Change Talk:
” wouldn’t mind coming here to live, but I wouldn’t want to be in one of them places where you sit around in pajamas a bunch of longhaired hippie types crying and bitching and stuff like that. That ain’t my style you know.” This almost seems like a commitment, but it may be desire.“As long as I’m putting all this money into it I’d like to come out with something.” (Reason)
3. The interviewer uses complex reflections quite a bit based off of the statements Jim is saying. My favorite example is at the end, when Jim is starting to say that he feels torn about wanting to change, but not wanting to give up friendships and his way of life. The interviewer restates this to him, and it seems that this is a turning point for Jim. It is here that he admits he feels two ways about it, which the interviewer also states back to him.
“Well 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 like a crow, there’s a bunch of crows flying around pecking on you about this thing about your drinking…What would you like to do with the time that you spend with me here? What would be helpful for you?”
In this quote, I really liked how the interviewer used Jim’s own language to restate it back to him, while also stating out loud some of the undertones of Jim’s language. This allowed for honesty and openness, and shows Jim that he is not being judged in this space.
4.The first sign of change that I saw was when Terri asked him if he even could give up drinking. This led Jim to talk about his strengths and he seemed to gain a sense of accomplishment there. He has done hard things in the past and been successful, such as giving up fighting with others. He is reminded of how capable he is and there is a sense of pride restored to him. From here, I would continue with complex reflections, and possibly even add a twist if we hit more sustain talk. The next example of change talk that I saw was when Jim discussed court. Jim has a need to keep his license and job, which helps his desire to talk with Terri. This is an initial area that allows Jim to think about treatment.
Question 1
After watching both videos of Sal responding to the two different styles of MI, I was able to draw conclusions that will benefit my future work with MI. Initially, Sal came into both meetings seemingly willing to work with a clinician and hoping to process new health information. I grew more disappointed in the first video, as Sal was shut down for not reading enough information and his progress and vulnerability went unrecognized. Sal responds much better in the second video, as he is given autonomy over the conversation. Sal is able to direct the conversation more and list his concerns. This is a complex situation for him, and is tied to many emotions with his family, child and dog. Sal ultimately responds well when his efforts to improve his health are recognized, he feels heard with accurate empathy and is given the ability to make his own choices, with support.Question 2
Behavior: Spending too much time on social media.Ambivalence:
1. I enjoy keeping up with friends from different places and life stages.
2. It helps me decompress after a long work day or allows a distraction when I am overwhelmed.
3. I like to wake up and fall asleep to something that provides news, updates and often helpful or funny content.Other Side:
1. Social media gives a limited and unrealistic view of people’s lives and takes time away that could be spent engaging more meaningfully with people I care about.
2. Social media is a distraction that does not always lead to mindfulness or long term stress relief.
3. News and content is very filtered by social media and often lacks depth.Reflection:
1. You mentioned that you value keeping up with people that you don’t see everyday, but don’t feel that the time spent on social media leads to deeper connections or accuracy about someone’s life.
2. You describe feeling overwhelmed and using social media as a way to take a break, but you also recognize that it does not always have the benefits for reducing stress that you are seeking.
3. You like to have information all in one place, but also wonder if it is the best way to receive updates.This exercise was helpful both for myself and for allowing more concrete ways to practice MI with clients. This helps to simplify the concept of ambivalence, while also allowing for accurate empathy. I felt that I have a deeper understanding for myself of why I use social media, but also how it does not always work to help meet my goals.
Question 3
Client:
1. I want to use hard drugs less.
2. I want the school to stop getting me in trouble.
3. I want to get a license.Provider:
1. To work with the client on developing goals that engage with harm reduction and work to resolve ambivalent thoughts slowly and in small steps.
2. To work with the client to identify the how and what of the problems at school, instead of the why.
3. To break down the steps of getting a license with the client.This exercise was so interesting! I feel that I instantly want to jump to the “righting reflex” and to simply tell the client how they can meet their goals. Although my intent is honest, this does not foster their autonomy and more so creates more conflict in our time working together. I think adding parts to our already existing plan will help to enhance the agenda setting and offer the client more say in how the time is spent. Instead of me deciding what we do and talk about in our sessions, it can be more beneficial to have the client choose their topic.
