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Question 1
What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
In watching this video, the conversation between the provider and client felt natural, respectful, and guiding. Overall, the conversation felt collaborative and open. At no point during the video did the feeling of judgement or resistance feel present.
Question 2
What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
The provider does a fantastic job asking open ended questions and then confronting both sides of ambivalence. Through this process, the client is able to work through the conversation without feeling “judged” which lessens the opportunity for resistance. The provider also utilizes reflection, especially double sided reflection to amplify the dilemma that the client is faced with. I really enjoyed watching this exchange, especially how the provider then helped the client explore small steps towards change and what the client may feel comfortable with. The client knows that they need to quit smoking, the provider does not need to state this or the reasons why, but rather assist the client in processing and working through these feelings towards small changes.
Question 3
Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
Despite the short time frame, the provider is clearly able to engage the patient in a conversation that focuses on asking questions to help the patient understand what difficulties arose over the past week. The provider again, utilizes reflection to clarify and summarize what is being shared. This allows for the conversation to evolve into this exploration of what the patient might be willing to try for the upcoming week. There is no “why don’t you try this, or “you should”, but rather focusing on what the patient may feel comfortable working towards. Again, this process really minimizes resistance, encourages transparency and reflection.
Question 4
Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
Throughout this course, there are many times when I found myself making a “mental note” to try this skill with a certain client or family. In the program that I work within, we often are working with at risk youth that are frequently engaging in some pretty challenging behaviors. These skills can certainly assist in conversations with this population to help place them in the driver’s seat of the decision making process regarding change (something that is often lacking with teens) and to help them feel empowered to make change on their own terms.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.
In the first video, the individual does a fantastic job of engaging in some change planning and presents ideas such as going to church or dancing. At this point, the MI counselor could have done a better job in sorting through these potential options and amplifying the individual’s desire to change. Additionally, the MI counselor presents the idea of AA without first asking the individual for permission to share a suggestion and then at another point in which I am assuming was an attempt to come alongside the individual, begins talking about how at times there can be “heavy drug users” at AA. These comments appear to be a bit unwarranted for the conversation-the individual was not asking what to expect at AA and even shared that he had a friend that went to AA. A better option might have been to spend more time exploring the individual talking more to his friend about AA and maybe exploring attending a meeting together. In the second video, we see this explored a bit more and the MI counselor digs deeper into exploring the individual’s commitment to change. A plan is arrived at, but to be honest, more could be done to explore this plan. For example, part of the plan was that the individual would connect with his friend after leaving the counselor’s office, but this will be in the work setting which the individual didn’t appear to be too comfortable with. The MI counselor could have worked a but more with the individual to better understand how he would like that conversation to occur. In a few cases, it felt as though the MI counselor was leaning into the “expert” rather than really approaching the conversation from a place of curiosity. Additionally, there are opportunities for summarizing and reflecting that are absent. For example, when the individual is speaking about the football game and not attending. The MI counselor misses the opportunity of reflecting this back to the individual, missing an opportunity for a potentially powerful dialogue.
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?
If I were the counselor in this role, I would likely approach the conversation with more open ended questions. Fore example, in the second video, the counselor expresses his concern about going to a party and rather than ask the individual what they would like to do, the counselor again shifts to the expert and takes the stance that the individual should not go. If I were working with this individual, highlighting when CAT statements are made as well as reflecting back more frequently. Additionally, it could be helpful to utilize more strategic responses to better come “alongside” the individual to again amplify their personal autonomy to change and that we are “here for the ride” and they are in the driver’s seat. I feel that at any moment during the MI counselor’s conversation, it could have been easy for the individual to lean back into resistance and the status quo given the nature of his approach.
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?
Utilizing MI strategies could play an imperative role in the work that I am accustomed to. For example, in the past I have worked with youth involved in the legal system, often engaging in risky behaviors such as substance use. In working with the adolescent and young adult population, these individuals truly need to know and feel that they have the power to make the decision to change on their own. Utilizing MI strategies with this population allows the youth to engage in change talk, planning and critical thinking from a nonconfrontational standpoint. By removing any sort of opportunity for resistance in the conversation and allowing the individual to remain in the driver’s seat, highlighting that they have the power to make this decision for themselves leads to better opportunities for sustainable change, and ultimately outcomes.Question 1
What are your general impressions of and reactions to the MI interview of Terry Moyers and the “Rounder?”
I really enjoyed the MI interview with Rounder and felt that it was an accurate depiction of a conversation that might occur when an individual is mandated to engage in services but may not yet be ready for change. Throughout the interview, Terry does a fantastic job at reflective listening, reframing, and highlighting Rounder’s autonomy throughout the conversation. This strategy allows for Rounder to feel little need for “resistance” to the idea of change and begins to explore why change may be something he could entertain. By remaining neutral, Terry allows Rounder that space to process and engage in a conversation that explores change from the standpoint of a potential option and not a “must”.
Question 2
Give two or three examples of Rounder’s sustain talk and two or three examples of Rounder’s change talk, and identify whether each is a Desire, Ability, Reason, Need, or Commitment, Activation, or Taking Steps type of change talk.
Sustain Talk:
Example 1: “The only reason I am 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”-Need
Example 2: “I drink a little, but I work hard”-Reasons
Change Talk:
Example 1: “I wouldn’t mind doing some of this stuff if there was anything in it for me…” -Commitment
Example 2: “I wouldn’t mind coming here to live…”-Activation
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.
Complex Reflective Listening:
Example 1: “So it seems to you like I might try to push you around and make you do a whole bunch of things you don’t want to”
Example 2: “I’m hearing you loud and clear that being here is not something that is really a high priority for you”
Strategic Responses:
Example 1: “So drinking kind of helps you relax, you know, cope with your life”
Example 2: “So you’re kind of wondering what it would even be like here”
The impact of Terry’s use of reflective listening and sustain talk is clear. Throughout the conversation when resistance is present, Terry highlights and/or reframes this thought. This diffusing of resistance by remaining open and coming alongside in many ways allows for Rounder to have a safe “sounding board” to contemplate change.
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.
Readiness to change:
Example 1: “You know another thing I was thinking about. If I don’t stop drinking I’m probably going to be right back in this mess again”
Example 2: “…if I can save my house and my job I’d better do something that’s gonna keep me from doing this again…”
If I was conducting this interview, I would begin to try and engage Rounder in some envisioning talk and explore how life might be better, or any advantages to changing and key in on his previous statements of keeping his license, job and house and maybe getting to spend more time with his grandkids. Additionally, exploring what changes Rounder may be ready to make and testing his willingness to experiment with change.Question 1
The differences between the two videos is compelling. As we see within the first video, the provider takes control of the situation and approaches the conversation from a place of “knowing what is best” for Sal. This in turn, creates a scenario in which Sal feels the need to defend his position, squeezing out any opportunities to explore why Sal has not yet made changes to improve his life. Additionally, the provider begins to attack his values and questions his commitment to his family and health. In the second video, the shift is clear. By approaching the conversation from a space of curiosity, the provider creates an open and safe environment that allows Sal to rest his defenses and truly begin to explore some of the reasons for ambivalence. Sal remains in the “driver’s seat” through the entire conversation. Through this open dialogue we discover what efforts Sal has taken thus far and recognizes this progress. The provider names what Sal might be feeling regarding the changes allowing Sal to feel understood and then provider gently provides some education and allows Sal to make the choices that he feels may be best for his life. Throughout the second video, Sal’s values are understood and respected.
Question 2Behavior: Procrastination
Ambivalence:
“I work well under pressure”
“I do not know how to work differently”
“Procrastinating makes me feel in control of my time”
Other side of ambivalence:
“I often stress about the things that I procrastinate”
“Procrastinating makes me feel rushed to meet deadlines”
“Procrastinating impacts my work quality”
Double sided reflection:
1. You mention that you work well under pressure and at the same time, procrastinating can create additional stress in your life.
2. You mention that you do not know how to work differently and at the same time, when you procrastinate you feel it impacts your work quality.
3. You mention that procrastinating allows you to feel in control of your time but at the same time, procrastinating causes you to feel rushed to meet deadlines.
This exercise really encouraged me to explore my ambivalence about procrastinating on a deeper level. This practice allowed me to explore the topic from both sides of the argument. The reflective listening responses allowed me to better understand the consequences of my actions in a very nonconfrontational manner which allows for a deeper reflection to occur because the need to defend the position is absent.Question 3
Client generated:
1. I want to get a job.
2. I want to stop getting in trouble with the law.
3. I want to stop drinking.
Provider target behaviors:
1. Client needs to complete high school.
2. Client needs to resolve legal issues.
3. Client needs to stop drinking.In reflecting on the two lists, though the differences may not be that obvious, the provider holds the knowledge of the resources and “steps” and approaches from a place of “expert” rather then curiosity. This is evidenced even in looking deeper at the language used, for example, “client NEEDS…”. In completing this exercise, the “righting reflex” definitely came into play. For example, the client would like to obtain a job and as the provider, my reflex is to shift the client’s view to completing school first, as this would offer more opportunities for employment. To approach a conversation with the client utilizing MI strategies, the agenda setting tool would allow the client to remain in the driver’s seat and allow the individual to choose the direction of the conversation. For example, the provider could use a visual agenda with a few different topic areas related to vocational areas and allow the client to pick the area(s) that they feel most comfortable discussing. This process allows the provider to remain a tool in the client’s process rather then the provider directing the process for the client.
