[Stephanie Garza]

Question 1
I enjoyed watching these videos in contrast to some of the others we have watched that have made me uncomfortable as the interactions seemed forced or even that the clinician was unable to decide which way to go with topics. The doctor was able to talk with the patient and assist her with coming up with options of how to progress with hr goal of sopping smoking and a very fluid manner which allowed it to seem almost organic. I cannot think of anything that I would change in the interaction.
Question 2
I feel that the doctor was able to use the open ended questions which results in a back and forth dialogue where both the clinician and the patient are involved in the dance of conversation, rather than it being a one way street of closed ended questions or a more “lecture” style conversation. I was able to watch her confidence grow as she continued to grow more comfortable with the success that she was experiencing as well as deciding to push it further with smoking less and less.
Question 3
As I stated above, the physician was able to have the conversation flowing back and forth so fluidly that it allowed him to add in some bits and pieces, but more over that she continued to drive the bus and be the one in charge of where the bus was going and how to get there. He was kind and empathetic when they approached sensitive subjects, such as in the first video she discussed her health and how she had not been feeling well for quite sometime and how this scared her. He allowed her space to process this but then smoothly shifted gears to looking at a timeline for her to stop smoking. Because he utilized MI techniques, she was able to approach her goal with feelings of anxiety in regard to quitting itself, but what I did not see was her feeling shame or embarrassment for smoking which can happen if clinicians are using another modality or acting as the “expert”.
Question 4
I think that two of the most important skills to use is empathy and being non-judgmental as this helps disarm folks so that they are able to lay it all out on the table rather than hiding pieces here and there if they feel that they are being judged. I think that this also increase their confidence in addressing said issues as one of the hardest parts of the entire process can be naming what help you are looking for and why you need that help.

[Stephanie Garza]

Question 1
I had a difficult time with this clinician’s approach/use of MI and at times was unsure what he was trying to do. For example, when bringing up AA, he did so more in the way of an expert, rather than asking permission if he could impart some knowledge. Several times it felt awkward with long silence (and not the kind of comfortable silence which lets people respond to a question or idea that has been raised). I also felt that there were points that the counselor was not sure where to head with the conversation, such as when the client was talking about church and indicated that it was not his favorite thing, and the therapists rection to his laughter was (what I felt to be) quite uncomfortable. I did not feel that there was anything that was specifically that went super well. I think that his approach and use of MI was minimal and rudimentary at best.

Question 2
If I would have been in this situation, I would have utilized the opening to discuss AA more when the client brought it up originally, rather than when he went into it more in the second video as there were times that the clinician talked over the client. I also feel that there were some missed opportunities of the clinician where the the client seemed to be asking for more info and if the clinician would have utilized that and asked if it was ok if he shared more about it, I feel that it would have been much more productive.

Question 3
In the role that I have, I supervise a team that meets with clients. I currently utilize MI with both staff as well as when I am meeting with the population that we serve. I find that by having the person that I am meeting with (staff or clients) be the one to set the agenda and then my job is to listen to them and help flush out the information. Most importantly, however, is that I can help them explore their ambivalence in a non judgmental way that in turn helps them open the door even further towards change.

[Stephanie Garza]

Question 1
I find that his reactions would be something that could be seen of many who are mandated to a treatment that they do not feel that they need and are being forced to participate in. After reading the material for this week’s class, I could see him climbing the MI Mountain and starting to come back down the other side due to Terry’s reflecting back to him what he is saying and then subtly leading him to an area where he is able to come up withy his own reasons to being able to commit to change.

Question 2
Ability: 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.
Reason: Well, I want something that will help me with court.
Need: If I don’t stop drinking I’m probably going to be right back in this mess again.

Question 3
Give two or three examples of the interviewer’s use of complex reflective listening and strategic responses to Rounder’s sustain talk. What impact does the interviewer’s use of complex reflective listening and strategic responses have on Rounder’s sustain talk and change talk? Be specific and elaborate.

1.) “Yeah. You’re not here because you think you have a problem. You’re here because they sent you here.” Because she is able to reflect that he does not feel that he needs to be there, he then opens up the conversation further with how this if effecting him financially as well as how he is feeling that his lawyer, who is also a friend, is saying that he has a drinking problem despite that he (Rounder) feels that he has taken care of the lawyer many times in the past for behaviors that included the lawyer drinking too much.

2.) “Do you kind of have the feeling that your wife and daughter are ganging up against you?” Regarding this statement, Terry is able to help him express how he feels that both his wife and daughter are ganging up on him by joining with him and this results in him then opening the door for him to delve deeper into the subject.

Question 4
Give two or three examples of Rounder’s signs of readiness to change. If you were interviewing Rounder and you noticed these signs of readiness to change, what would your next step be in this interview? Be specific and elaborate.

“This treatment center thing- is that here at this facility?”
“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.”
“Yeah. Cause, if I get out of this, if I can save my house and my job I’d better do something that’s gonna keep me from doing this again, don’t you think?”

I would move towards helping him find the questions that he wants answered regarding the treatment so that while it would still be a new and scary endeavor, he would feel more in control with having some knowledge around this. I would summarize his points thus far and reflect those nuggets that he has given of his readiness and the reasons around that.

[Stephanie Garza]

Exercise 1
Despite both clips talking about the same subject with the same information, in the first clip, I felt that clinician is condescending, lecturing, and argumentative. I could see that Sal goes on the defense when she appears to question his parenting (as I feel most people would) as well as attempting to make him fearful that he will die if he continues down this path.
In the second video, she starts by reiterating where he said that he would like to start. She talks about what has happened positively such as him almost quit smoking, cut down on his drinking, etc. She states that the info shows that pets may increase the breathing issues, but then she acknowledges how he keeps making changes and yet he continues to struggle. She wraps it up by saying that whatever happens that it is his choice. He was able to start talking about what would have to happen for him to get rid of Oscar. In summary, the same information but a very different feel.

Exercise 2
Stephanie, I am hearing two very different ideas from you about your 9-year-old and you feeling that you need to make sure his homework is complete. On one side I see that you do not want him to fall behind and you want him to have a positive school experience. I also hear that you don’t want to feel like you are being judged as a parent. Then I hear the other side where you want him to be responsible and self-regulate his own time when he gets home from school which would include playtime and homework. I am also hearing you say that this is a great time to learn this while the “consequences” are relatively minor, versus when he is an adult and doesn’t finish a project at his job and receives corrective action or is terminated.

Exercise 3
Consumer Target Behaviors: Clinician Target Behaviors:
~Eat better ~Better sleep/sleep hygiene
~Get healthier ~Quit smoking
~Exercise ~Exercise
While both categories are similar or have a “wellness” theme, I would want to spend some time looking at 2 of the areas that the consumer has not thought but that lend themselves with overall wellness. The consumer tends to stay up late as this is their “time” and while it is beneficial to have me time, it becomes a detriment when this is happening every night and then there is only 3-4 hours of sleep. I believe that I would offer up other areas involved with wellness and insert my ideas in there. I also find the visual tool of a “menu” would be appealing to this consumer.

[Stephanie Garza]

Hello! My name is Stephanie Garza and I work for a mental health agency where I have been since 21 years. I oversee 13 PNMI group homes for adults with SMI. I took a MI training many years ago and am looking to reacquaint myself with it as I continue to keep adding new tools to my toolbox.

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