Post a reflection on the clinician’s integration of motivational interviewing processes and core skills into his conversation with the client.
Watch the Using Motivational Interviewing Approaches video (RNAO Communications, 2015). Pay close attention to the clinician's use of motivational interviewing processes and core skills as he talks with Nathan about his substance use and misuse.
Describe two examples from the video where you saw evidence of a motivational interviewing process (engaging, focusing, evoking or planning) and explain how they impacted the conversation with the client.
Describe two examples from the video where you saw evidence of a motivational interviewing core skill (open questions, affirmation, reflecting, or summarizing) and explain how they impacted the conversation with the client.
Explain how the clinician’s use of motivational interviewing might impact the next steps in the treatment process.
Full Answer Section
- Process: Evoking
- Example from Video (Hypothetical): The clinician might use a "readiness ruler" or decisional balance question. For example, after Nathan expresses some negative consequences of his use, the clinician might ask, "On a scale of 1 to 10, with 1 being 'not at all important' and 10 being 'extremely important,' how important is it for you to make a change in your substance use right now? And what makes it a [number] rather than a lower number?"
- Impact on Conversation: This technique directly taps into Nathan's intrinsic motivation. By asking him to articulate why change is important to him (and why he's not at a lower number), the clinician helps Nathan elicit his own reasons for change (change talk). This strengthens his internal motivation, making him the agent of his own change, rather than merely responding to external pressure. The "why not lower" part of the question specifically encourages him to voice his positive motivations, amplifying the discrepancy between his current behavior and his goals/values.
Two Examples of Motivational Interviewing Core Skills and Their Impact:
- Core Skill: Reflective Listening
- Example from Video (Hypothetical): Nathan might say, "My friends don't think I have a problem, but sometimes I wake up feeling really guilty about how much I drank last night, especially when I think about missing work." The clinician might respond with a complex reflection: "So, you're getting mixed messages externally from your friends, but internally, you're experiencing some real regret and concern about the impact on your responsibilities."
- Impact on Conversation: Reflective listening is fundamental to expressing empathy and rolling with resistance. By accurately reflecting Nathan's complex feelings and statements, the clinician demonstrates deep listening and understanding. This makes Nathan feel heard, validated, and less alone in his ambivalence. It also allows Nathan to correct or elaborate, deepening the conversation. Importantly, it avoids an argumentative stance, allowing Nathan's own conflicting thoughts to surface and be explored without the clinician imposing a view.
- Core Skill: Open Questions
- Example from Video (Hypothetical): Instead of asking "Do you want to stop using drugs?", the clinician might ask, "What are your main concerns about your substance use right now?" or "What would you hope might be different if you were to make some changes?"
- Impact on Conversation: Open questions invite Nathan to elaborate and explore his thoughts, feelings, and experiences in detail, rather than simply giving a "yes" or "no" answer. This is crucial for evoking change talk. It encourages self-exploration and allows Nathan to voice his own perspective and motivations, which are often more powerful than external advice. It gives him space to articulate his ambivalence and the reasons behind it, which is the necessary step before resolving it.
How the Clinician’s Use of Motivational Interviewing Might Impact the Next Steps in the Treatment Process:
The clinician's use of MI significantly impacts the next steps by ensuring they are
client-driven, sustainable, and aligned with Nathan's intrinsic motivation.
- Increased Readiness for Action: By skillfully employing MI, the clinician helps Nathan move from ambivalence (a state of "stuckness") towards greater readiness for change. As Nathan articulates more of his own reasons and desires, and less resistance, he becomes more prepared to commit to concrete steps. This means that when the "Planning" process begins (either within this session or a subsequent one), Nathan will be more invested in developing and adhering to a treatment plan.
- Collaborative Plan Development: The MI approach ensures that any "next steps" are not imposed by the clinician but are collaboratively developed with Nathan. This increases Nathan's ownership of the treatment plan, making him more likely to follow through. For example, if Nathan expresses a desire to reduce rather than completely stop, the clinician would work with him on that goal initially, rather than immediately pushing for abstinence.
- Reduced Likelihood of Relapse (Long-Term Impact): Because the motivation for change is internal (evoked from Nathan himself) rather than external (coercion or persuasion from the clinician), the changes Nathan makes are likely to be more durable. He understands why he is making the change, and the plan is tailored to his perceived abilities and needs. This supports his self-efficacy, making him more resilient in the face of challenges and potentially reducing the likelihood of early relapse. The treatment process becomes a partnership, building Nathan's confidence in his ability to overcome substance misuse long-term.
In essence, MI doesn't just push a client into treatment; it primes them for it, ensuring that any subsequent steps are taken from a place of genuine readiness and personal commitment, which is crucial for successful outcomes in substance use recovery.
Sample Answer
Reflection on Clinician's Integration of Motivational Interviewing (MI) Processes and Core Skills
(Assuming the clinician in the "Using Motivational Interviewing Approaches" video demonstrates effective MI techniques with Nathan regarding his substance use and misuse)
The clinician's skillful integration of Motivational Interviewing (MI) processes and core skills significantly shapes the interaction with the client, Nathan, fostering an environment conducive to exploring and resolving ambivalence about substance use. Rather than confronting or directing, the clinician subtly guides Nathan, drawing out his intrinsic motivations for change.
Two Examples of Motivational Interviewing Processes and Their Impact:
- Process: Engaging
- Example from Video (Hypothetical): Early in the conversation, the clinician might begin by asking Nathan what brought him in today, or by acknowledging his willingness to discuss his substance use. For instance, "Thanks for coming in today, Nathan. What's on your mind regarding your substance use that you'd like to talk about?" or "It sounds like you've been thinking about some changes lately."
- Impact on Conversation: This approach immediately establishes a collaborative and non-judgmental atmosphere. Nathan feels respected and heard, rather than interrogated or judged. This foundation of trust is crucial, especially when discussing sensitive topics like substance use. By inviting Nathan to set the agenda, the clinician demonstrates respect for his autonomy, making him more likely to open up and engage genuinely in the conversation. It sets the stage for exploring ambivalence without triggering defensiveness.