[April Archibald]

Question 1:
Generally, I think Dr. Selby’s use of MI skills was effective. He used affirmations where necessary and helped guide Jean to develop her own strategies. Dr. Selby’s use of open ended questions helped Jean identify how she might delay gratification thereby decreasing her nicotine use. I also appreciated the time he took to help her identify the good things about smoking. It seemed as though this was effective in acknowledging the benefit she received from smoking which quickly led her to list the negative consequences of smoking. The only thing I might have done differently in these interventions would be to ask permission to give information more frequently. I would have liked to know how she was feeling about her commitment and the information she heard.

Question 2:
Dr. Selby skillfully used reflections, open-ended questions, and affirmations to help Jean resolve her ambivalence about quitting smoking. He elicited her confidence level in quitting by using the scales. Dr. Selby made mentioned of previous conversations which allowed her connect the changes she had implemented. There are many examples of Jean’s desire, ability, reasons, and need for her to quit smoking. During the follow up, Jean was committed, activated her plan, and took steps by significantly decreasing her nicotine intake.

Question 3:
Dr. Selby effectively asked open-ended questions to elicit Jean’s ideas on how she might change her behavior. The doctor could have easily prescribed medications during the initial visit but this would not have aligned with Jean’s goals. It proved to be more effective to explore Jean’s ambivalence and develop discrepancy so that she could formulate her own plan of change. Jean gave positive feedback stating the sessions were helpful and requesting follow up appointments. Jean’s confidence improved as she followed through with her plan. She seemed excited and motivated to continue her pursuit.

Question 4:
I have enjoyed the material in this course. The videos provided helpful examples of how to implement the Spirit of MI and the various techniques. Elicit-Provide-Elicit is a strategy that I have been using more frequently over the past several weeks. It has been effective in helping clients clarify goals and seek out more information. I plan to continue to hone my MI skills and incorporate them into my work with those that want to change risky behaviors. Overall, this course has given me more information and confidence in helping individuals resolve their ambivalence. Thank you!

[April Archibald]

Question 1
What are your general reactions to these two video role plays of a counselor using MI strategies to help a client develop a change plan to stop drinking? Overall, how effective is the counselor’s use of MI in evoking Commitment, Activation, and Taking Steps change talk? How effective is the counselor’s use of MI to help the client develop a specific change plan? Be specific.

I found myself feeling frustrated while watching both videos. The counselor seemed to have a understanding of the some MI techniques and would begin by implementing a technique but seemed to quickly abandoned it and provide information/education instead. This seemed be the focus of the counselor. Rather than truly hearing what the client was saying, the counselor seemed to be more focused on his own responses. At times is seemed as if the counselor wanted the client to hurry up and finish talking so he could give more information. There were several missed opportunities where the counselor could have asked permission to inform the client or asked the client if he knew more about AA or how it might be helpful. I was also irritated that in some of the spots where the client seemed as though he was going to elaborate, the counselor interrupted him and side tracked the change talk. It seemed in the second video the counselor misunderstood what the client was trying to say regarding attending the party. Some reflections might have been helpful there as well as some open questions or request for examples. Overall the conversation seemed disjointed, confusing, and disorganized and I had to review it several times in order to identify the plan. It seems the only plan that was agreed upon was for the client to talk to his co-worker about AA. There were brief mentions about church and dancing (?) but I was unsure where this was heading. I can imagine the client might have been confused as well. I do not feel as though the counselor’s use of MI was helpful. Some attempts showed promise but overall his techniques did not seem facilitate change talk or planning.

Question 2
What, if anything, would you have done differently if you were the counselor in this role play? Would you have used different MI strategies for change planning? Which ones? Why? Be specific. If you would have used the same MI strategies, how would you improve on what the counselor in the video did? Why? Be specific?

I would do several things differently if I were the clinician. First, I would sit still. The counselor seemed to be very uncomfortable which gave me the feeling that he was not interested in what the client was saying and his movements were distracting. I would ask permission to provide information and check in to see if he had any thoughts about the information or if anything I said gave him other ideas. I might ask if the client wanted to make a list of options and then how successful each option might be. I would follow that up by asking he client how confident he felt he would be in succeeding with the options. I would then evoke a plan and commitment from the client. If the plan was to attend an AA meeting, I would see if we could narrow down the day, time, location, etc. of a meeting he would attend. I would ask how confident he felt about succeeding and perhaps if he saw any obstacles.

Question 3
How do you or would you envision using some of the MI strategies for change planning discussed in this lesson in your own work with consumers/clients/patients?

I use MI frequently with my clients that struggle with ambivalence or feel as though they are stuck. I like to use the scale as I feel as though this is helpful in affirming their level of commitment to change. It often surprises them how motivated they are or how important the change is. Helping them set goals for change adds to their investment, particular if the goal is manageable and attainable. It is rewarding to hear a client at their next appointment talk about how they accomplished their goal or made progress. They are often surprised and pleased with the outcome and reported the plan was easier than they anticipated. This course has been helpful in refreshing some concepts and the videos are a great tool in seeing techniques at work.

[April Archibald]

Question 1
I really enjoyed watching this video. It was exciting to see Jim’s transformation in the video. He began as gruff, stubborn, and somewhat obstinate. Near the end, you could see him soften, hear him become less guarded and more willing to share his vulnerabilities. I thought Terri excelled at remaining calm, despite what seemed like Jim’s attempt to start conflict when he commented about the likeness between his probation officer and Terri. Terri reflected his statements accurately and reframed his sustain talk with ease.

Question 2
Sustain talk:
1. “So a lot of what I’m doing here or you know why I’m coming here.. the 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.”
2. “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. It’s taking a lot of time that I don’t have.”
3. “Well she says she’s afraid that you know I’ll do something to hurt the kids. But I never hurt them kids and never have in my life done a thing to hurt them.”

Change talk
Ability:
“People keep saying that you need to stop drinking and I ain’t never done that either. I think I could. I’ve tried a couple of times and I wasn’t very… I think one time I quit for a week or two just to show people I could stop drinking. I wasn’t too happy. Really I didn’t know why in the hell I stopped anyway”

Reasons:
“You know there was another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again.”

Commitment
“I 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.”

Question 3
Terri’s responses to Jim are neutral and non-judgmental. She reminds Jim that he gets to chose what treatment might be the most beneficial for him.
“Well I think, you know you’re the one that really needs to make that decision about what’s the right kind of treatment for you. I couldn’t decide that for you.”
Terri reflects Jim’s ambivalence about his drinking, iterating his sustain talk, “Yeah. You’re not here because you think you have a problem. You’re here because they sent you here. ”
Each reflection from Terri encourages Jim to explain himself a little more and disclose more vulnerabilities. You can hear him drop his defenses with nearly every statement from Terri. It is clear her reinforcement of his autonomy also helps him move toward change talk.

Question 4
Jim slowly moves toward change talk when he begins asking about his treatment options. “What’s… you said people come here to live. Do you think I’d have to come here to live? ”

I appreciated how Terri pointed out to Jim that he was able to manage his anger in the past which solidified his own concept of his ability to change.
It appears Terri has built enough rapport with Jim that he feels comfortable asking more detailed questions and how he might get the help he is considering he needs. If I were interviewing Jim, I would continue to elicit his understanding of what treatment he might want to pursue. I would provide information about the program, specifically the different options for treatment, reminding him that it was up to him to make the decision. I would ask if he had any questions, how he feels about pursuing treatment, perhaps the pros and cons of such a decision. I might offer him a pamphlet about the program, maybe show him around the facility and allow him to ask questions. I might further ask him to look ahead and envision how his life might be different without alcohol. I would most likely encourage him to take a day or two to think about what he might want to do, further cementing his autonomy.

[April Archibald]

Question 1
The provider in the Non-MI confrontational approach was shaming and judgmental. I came away feeling as though she was a bully, coercing Sal into giving up Oscar without genuinely understanding how difficult it would be to make such a decision. She reflected on what he said but with little genuine empathy. In the second video, Sal appeared to disclosure more about how he truly felt about his health and his goals. He was not as defensive nor did him seem so exasperated. This was most assuredly due to the provider’s reflection and her genuine interest in how Sal felt. She expressed more investment in his health and his goals that in the first video. The second video helps Sal move closer to making a change. The therapist affirms that Sal is in the driver’s seat and even Sal acknowledges how important that autonomy is.

Question 2
I feel ambivalence about putting away the laundry

One Side of the ambivalence
I can easily take my clothes out of the laundry basket and find what I need quickly

The Other Side of the Ambivalence
If I put my clothes away, I will spend less time ironing and my room will be neater

Double-Sided Reflection
April, on the one hand putting your clean clothes away can be time-consuming and tedious. On the other hand, if you put your clothes away you would spend less time ironing and digging through the laundry basket looking for matching socks.

April, on the one hand, you have quick access to your clean clothes in the laundry basket. On the other hand, if they were put away, you would also have the other clothes in your closet to choose from and perhaps not feel so frustrated with your “limited wardrobe”.

April the clean clothes are in a small, neat area that isn’t taking up too much space. On the other hand, the laundry basket full of clothes makes the room look untidy and cluttered. A tidy room will make you feel more at ease and proud of your accomplishment.

This was more challenging that I thought it would be. It was intriguing to explore the various rationales for changing versus status quo. The internal conflict can be overwhelming and frustrating. I have a clearer understanding of how hard to it can be for humans to change behaviors.

Question 3

Consumer target behaviors: Clinician target behaviors:
Decrease my drinking to a set amount/frequency Complete abstinence from alcohol
Attend AA meetings weekly Attend 90 meetings in 90 days
Find ways to address my symptoms of ADHD Discuss ADHD medication with doctor

While there are some discrepancies between my goals and those of my client, our goals are similar. It is clear my client intends on moving in a more controlled and manageable (to them) pace than mine. As a provider I tend to think and plan far in advance and focus on the long-term goals rather than really narrowing down how to address the short-term goals. Ultimately, I want my client to feel healthy and satisfied with their journey. Walking alongside them on their journey will be more productive and effective than pushing them from behind. To align with my client, I will ask them their ideas about how they might moderate their alcohol use. Perhaps they want to enlist family for help. How many meetings are they comfortable attending each week? Are there barriers to attending? Are there techniques they’ve used before to help manage their symptoms of ADHD? Are there others they might use? Do they want to brainstorm alternative techniques or discuss other options?
I once had a judge ask me why I did not encourage my client to stop smoking marijuana. I responded, “because it wasn’t their goal.” The judge was dumbfounded.

[April Archibald]

Hello, my name is April. I am a Licensed Alcohol and Drug Counselor and Certified Clinical Supervisor. I currently work in an outpatient setting. I have worked in the field of addiction for 17 years in both residential and outpatient settings. I look forward to honing my MI skills and learning how to better help those that I serve!

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