I prefer to do a motivational interview (MI) with my client, who was referred to me due to driving under the influence of smoking. In addition, motivational interviewing is a client-centric directive approach to increasing internal motivation for change through finding and resolving ambivalence. My agenda in the 8-minute video section is to understand the client’s internal references and express their concerns and try to build discrepancy between his behavior and life goals. My patient’s name is David who is a 36-year-old male journalist who has a demanding job that involved in long-term work. He has been smoking since he was in university and now smoke within 30-40 cigarettes a day. For smoking and drinking, he loves to conversations with friends because it helps him relax, according to his statement. He has attempted to stop smoking at an event with limited success because he suffers severely from nicotine withdrawal. His father recently died of lung cancer at the age of 68 after extreme smoking. Donald was suffering distress and pain in the final stage of the cancer. David is concerned that if he continues to smoke like this, he will end up with lung cancer like his father (Moyers et al. 2016).
At first, I noticed that, from the nonverbal expression of client, he expressed some reluctance to participate in this counseling session. From this, I know that the client comments on the “Stages of Change Model” concept at a pre-contemplation stage that the client does not happy with his present smoking behavior and the positives more than the negative one. At this stage of change clients will ignore or reject harmful actions. However, I set aside reminding myself not to be judgmental and attempt to clarify more into the response of the client (Magill et al. 2018).
The patient was in the pre-contemplation state, so he did not want to be involved in different situations, believing that there was no need to change his smoking habits, after reflection the patient was pressured to accept the change with increasing pressure. The desire for change. It seems that there is an increase in determined resistance from the patient that is a direct result of me reverted back to the problem of smoking, so it is likely to say that in this situation due to my desire to “right” the condition. My idea is that the situation is getting worse, generating tension that is not effective for the patient. I think it may be a better way to solve this problem with acceptance and understanding that it is not the right time to discuss smoking cessation because the client has another ongoing stressor. By looking at and talking with the client about his current socioecological and biopsychosocial stressor, I can provide further insights into what can inspire the client, thus providing a clear assurance to assist in developing my objective of the discussion about smoking cessation (DiClemente et al. 2017).
The patient's own motives for change are often unlikely to change, but there is no indication in this scene that the patient is indicating that he or she wants to change smoking behavior, yes, he has mentioned that he has given away in the earlier. However, I attempted to make that area this is met with the resistance. Rather than tiresome to cause why this person isn’t driven, I should have explored what it is closely that motivates him, despite his current situation. This is an opportunity to grow because the client showed his concern for his children, it is now a more important concern and his habit of smoking (Miller and Moyers, 2017).
The client’s confidence seems very low in the current situation, but I can measure the true thematic rating on the level of his confidence by asking this simple question “to rate from 0-10 how ready are you…”. It gives me a springboard that needs to be investigated for more inspirational reasons. In other words, through asking open-ended questions like “What do you want to achieve? Or, “how important is this for you?” it gives more about the patient’s motivation by identifying his goals. My focus is on talking about quitting smoking and regrettably, I didn’t pay much care to signs; determining what concern and interest the client is now experiencing. There is a small area marked by an ambivalence that some people are treated like normal in MI (Shingleton and Palfai, 2016).
At the start of the 8-minute video section, I explained to the client that I knew the source and asked the client to consider this session as a casual conversation rather than a counseling session. The reason I do this is to make the client comfortable and open, so that I can understand their feelings and thoughts from their point of view without judging or criticizing without knowing the client’s internal references otherwise. The client replied with a short reply "I will try". After the client’s response, I can tell from the expression on his face that he has transformed from a “reluctant” look to a more “open” expression. It specifies that the client is willing to take more or less protective measures during the session. I expect this response as MI essence of counseling says there should include autonomy, collaboration, and evocation, so therapy should be a joint effort against one that I can control, set different “client-focused approach” (Frost et al. 2018).
I share my perception of this personal experience of telling a patient to focus on their own problems and recovery, it would have been easy for me to have been relaxed about the conditions causing to the admission, assuming what the client was telling me in a non-judgmentally. Providing a brief reflection, I paraphrased what the client had told be asking for confirmation that I have a knowledge of the present condition that benefitted me to contextualize and use the client’s own standpoint. I listened for ‘change talk”, but I can’t take action to explain ability, desire, need, reasons, commitment or taking a step to instigate change, so the client may not have prepared to involve in MI, but it is a brief meeting of 8 minutes, providing me a better idea into the present condition of the client. The client is unable to express his true beliefs due to lack of understanding, fear, or increased anxiety because of physical illness or the extensive effects of his partner’s unfaithfulness (Frost et al. 2018).
In a word, the motivational interviewing practice allows me lead client-centric way to have a direction through enabling the client to identify that change is possible, and has the innate ability to make the necessary changes. I understand that implementing this model requires practice, testing and strategy and awareness for myself. Besides, I think the only real way to explain this phenomenon is to acknowledge how physicians present themselves and their motivations when using these techniques. Using motivational interviewing, the client's responsibility is to resolve his ambivalence exploring sincere motivation to change smoking habit, not physician to suggest or impose change. The counseling approach is usually a gentle and calm style that sets a status as a working relationship partnership (Rehman et al. 2017).
During the 8-minute section, I used an efficient reflective listening skill that is one of the four approaches to MI, including listen reflectively, affirming, open questionnaires, and summarizing. In this way, reflective listening enables me to express empathy and enable me to verify I have interpreted the word correctly rather than assuming. It is an ethical communication style that should be used through the entire MI process when building relationships between me and the client. Besides, my voice tone is real for the situation, there is no any kind of speech or sarcasm that will make the client feel uncomfortable or increase resistance (Colvara et al. 2018).
The MI techniques used in the 8-minute section are “The Good Things and The Less Good Things” or counter strategies and techniques that help to create a rapport, provide important information about the content and prepare the evaluation. I started asking client about his some “good things” about his smoking behavior. In expressing the question, I use non-verbal action like hand movements that benefit me to control or regulate the flow of speech. The question is again asked openly and other MI methods. It inspires my client to be able to speak reflectively. When clients say “good thing” about smoking habit, I kept non-verbal behavior and eye contact, like nodding of my head to tell my client that I am listening to him emphatically. These methods enable me to clarify my ambiguity and make decisions about clients about his smoking habits. I think I showed some good attributes to listen in an emphatic manner. My posture and body language are open, attractive and acceptable. I’m self-contradictory or self-conscious and verbally using the right pitch and tone, but as mentioned earlier, I found some important signs and feel that I don’t “roll with resistance”. However, it should be remembered that psychiatrists do some work in the environment, such as create less time limits and more chances to make an increased MI working relationship with the client (Colvara et al. 2018).
Colvara, B.C., Faustino-Silva, D.D., Meyer, E., Hugo, F.N., Hilgert, J.B. and Celeste, R.K., 2018. Motivational interviewing in preventing early childhood caries in primary healthcare: a community-based randomized cluster trial. The Journal of pediatrics, 201, pp.190-195.
DiClemente, C.C., Corno, C.M., Graydon, M.M., Wiprovnick, A.E. and Knoblach, D.J., 2017. Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors, 31(8), p.862.
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R.E., Dombrowski, S.U., Williams, B., Cheyne, H., Coles, E. and Pollock, A., 2018. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PloS one, 13(10), p.e0204890.
Magill, M., Apodaca, T.R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R.E., Tonigan, J.S. and Moyers, T., 2018. A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of consulting and clinical psychology, 86(2), p.140.
Miller, W.R. and Moyers, T.B., 2017. Motivational interviewing and the clinical science of Carl Rogers. Journal of Consulting and Clinical Psychology, 85(8), p.757.
Moyers, T.B., Rowell, L.N., Manuel, J.K., Ernst, D. and Houck, J.M., 2016. The motivational interviewing treatment integrity code (MITI 4): rationale, preliminary reliability and validity. Journal of substance abuse treatment, 65, pp.36-42.
Rehman, H., Karpman, C., Douglas, K.V. and Benzo, R.P., 2017. Effect of a motivational interviewing-based health coaching on quality of life in subjects with COPD. Respiratory Care, 62(8), pp.1043-1048.
Shingleton, R.M. and Palfai, T.P., 2016. Technology-delivered adaptations of motivational interviewing for health-related behaviors: A systematic review of the current research. Patient education and counseling, 99(1), pp.17-35.
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