Reflection on Motivation Interview for Behavior Change - Coursework Example

Critical Reflection Motivational interview leads the client to make a voluntary change and has a high regard for the client’s autonomy. The role of the counselor is to help him make a decision without imposing anything on the client. The therapy should make him feel good about himself, accept his shortcomings as a human being and have a confidence that he can become a better person. . The client in the above case was a smoking addict but was not willing to admit it. He had come to the session on his wife’s request. That gave me a clue that he cares for his wife and most probably his children , Since he was not admitting that he has a problem and was not opening up, I had to encourage him to talk more and get him on my side as a friend. Initially he kept replying in monosyllables to all my questions (question and answer trap ) but I took the lead from the fact that the wife could motivate him to come for this interview so he must be having a very good relationship with her. Although my guess was right. And he came in a positive frame with the mention of his wife but I felt later that I should not have mentioned the inputs given by an external source. This could have had a negative impact. I should have shown more sensitivity in talking about other issues.( Item 2, BCCI form) I gave him an indirect compliment to make him feel good and open up more. Although that helped in the conversation to flow but he still denied having any problem. As a practitioner I had to encourage him to talk about current behaviour or ststus quo. That confirmed my earlier guess that he needs to be motivated through his emotional bond with his family. As a counselor I should have avoided direct questions but I did ask him straight forward that does he smoke too much and before this I had made another mistake by using the word “problem”. This is taken as labeling in MI and should be avoided. That was trespassing on client’s autonomy .and hurting his confidence . That is why I had to face his resistance. But since by then he had opened up and become friendly with me, he did not mind and we continued. I guided the conversation to direction where he himself accepted that he is addicted to smoking, I could realize he accepts the fact that he smokes but he is trying to hide behind logic and give arguments like every body does it. I was showing empathy for him as I was supposed to do as a counselor. I did not contradict him but being on ‘his side’ brought me closer to him. Here I think I did well as I could succeed in making a closed person open up and also laugh with me. I followed empathic listening as mentioned in the BCCI form. Once I made friends with him, I got more authority to talk to him on his problem.but sometimes I deviated from the MI style and I did not follow empathy with a non judgmental listening and providing just episodic summaries I remembered the guiding principles and I had to ‘develop discrepancy’ because the client rather than the practitioner should present the arguments to change. The practitioner should only encourage him to talk about change. ( item 4, BCCI form). I got myself accepted by him as a friend on ‘his side’, but at the same time I kept doing my work as a counselor. I was asking him more specific questions. This helped me get the details of his ‘typical day’. By the end of the typical day, he had almost accepted that he is an addict. After he accepted is that, I was looking for a motive that would encourage him to change. My role was to guide him towards a solution.(BCCI form) Here he was very resistant and I guess I could ‘roll with resistance’ well. I had got vital information in his ‘typical day’. I knew that his friends were all smokers and I also got to know his attachment to his children when he mentioned that he picks up and drops his children. This showed his love and his sense of responsibility towards his family. After the ‘typical day’ I used the one of tools in MI and tried to get him to talk about the good and the bad things about smoking. Here I brought in the children who were at risk due to his smoking I know that was my mistake because as a practitioner I was not supposed to suggest or give advise and that was better to ask questions to elicit how he thinks and feels about the subject. I should have asked the client to interpret personal meaning.. and reflect ( Rollnick et al 1999). For making him motivated to change the best thing was that I developed discrepancy .The discrepancy between his present behaviour and important personal goals motiviated him (Miller &Rollnick 2002). This emotional input had an effect on him and he started to think but still he was not ready to quit his habit. As a counselor I had to ‘roll with resistance’ and show ‘self efficacy’.Since the ability to change is related to self efficacy so if I could use the two possible futures which is one of the tools of MI, it could have been helpful but I didn’t. So I tried to help him with the ambivalence and asked him leading questions. I think here I was a little repetitive and we were not proceeding further. Later when I talked about his past achievements, I had better success. I could have done it earlier to get him out of his ambivalence and help him to make a decision to change. I asked him questions to help him see the good and the bad side of his behaviour. Here I think I was successful as a counselor as I could move him in a positive direction. Although he had admitted his wish to change, he was not confident whether he will be able to change. Here I was in MI mode and I tried to draw inspiration from other people known to him who had quit successfully. It worked as he came up with some names and also saw a ray of hope for himself. Since quitting smoking is a change in lifestyle, I suggested making many changes in the daily routine. It was my mistake because as a counselor I was not supposed to give suggestion . that is why I faced his resistance and he did not admit to quit it altogether, he wanted to ‘reduce’ which I did not think was the solution. But as a counselor I practiced ‘self efficacy’ and made him talk about other people who had quit. He got the point and agreed to ‘try’ quitting. I did well in practicing self efficacy because a person’s belief in the possibility of change is an important motivator. For example, when he said: I think I will be able to cut down my smoking, I was a poor performer in practicing persuasion. I had to develop his confidence. Here I used his past success as an example. I think this worked as a miracle. In my whole interview, I was most successful while using two techniques Confidence building by talking about his past success Emotional decision making by talking about the family Once his confidence was up, I looked for any possible obstacles and guided him to talk about the impact of keeping company of the smokers. He agreed readily and found a solution himself. This again was not a positive point for me as a counselor as I got ‘him’ to make a decision that ‘I’ wanted him to make. As a MI style practitioner I should have encouraged him to speak about both the possibilities himself and make his own choice.. Next, I wanted to ensure that he sticks to his decision by sharing it with friends and family. I mentioned it with humour and I got him to agree. In this process of interview, my sense of humour and friendly approach were very helpful to me. But sometimes I was getting stuck at one point was not able to move forward faster. I think I should have talked about his past success much earlier in the course of the interview.and I did well in overcoming some short term obstacles with some questions like :”could stop you” … But towards the end I was able to make him feel more confident and the same resistant person readily agreed to come for another meeting the following week. This was a success for me but at the same time, I think I failed to ask his ‘permission’ before offering any suggestion. As per the BCCI handout, the practitioner should ask questions to elicit how the patient thinks and feels about the topic and respect his choice and behaviour change. According to Miller and Rollnick (2002), “asking permission enhances the person’s autonomy and communicates: respect, choice, and collaboration”. I should have been more careful in this regard. But I was more careful regarding the follow-up schedule at the end of the interview and I gave the client autonomy to decide when he would like to see me again. I was a good listener and that helped. I used summarizing and restating techniques effectively. I was sensitive and showed empathy but I should have been more careful with client’s autonomy and remember to ask permission before offering help/suggestion and not to ask very direct questions. I was in information providing stage , I should have presented information in a neutral manner and keep to facts but I used my interpretation of them. According to Thomas Gorden one of the obstacles from the 12 factors is asking question like ”To be a good father you will have to give up smoking.” It could have been very useful if I used it for exploring motivation and confidence by using the scale form ,( on a scale of 1 to 10 where ….) which I didn’t . I used good technique in asking him how will he feel if he could succeed to quit. Such questions are motivators and do not impose suggestion. I should have used them more often. I should have practiced reflection and summarizing more to roll with resistance. I think with more practice I will be able to improve more. Read More