Maina Peter

 MI Approach: Role Play College: Course: Instructor For this project, I interviewed a friend from the church. She has been struggling to do things to perfection, and according to her, the people around her have noticed that she has an almost ritualistic schedule for everything she does. She feels that she is missing out on life and wishes to be more flexible and spontaneous in her life rather than rigidly following a timeline for everything in her life. Interventions Engagement/Building Rapport I began this interview with an understanding that I needed to create a safe environment and a therapeutic relationship that would make the client feel heard and understood enough for her to be willing to engage in the process of change. After a brief introduction and explanation of what we were about to engage in, I asked the client to feel free and simply flow with the conversation. I initiated the process by asking an open-ended question “How can I help you today?” This was intended to open the door to a client-driven conversation. To evoke a deeper discussion and clarification about her problem behavior, I asked the client to help me understand what she meant by the statement that her morning schedule was ritualistic. She explained that she follows a strict schedule including a timed shower and dressing, and to her, it is more about the timing rather than the activity itself. Affirmations After the client had explained how timed her schedule is, I commented favorably on her ability to stick to her schedule because that is a trait that has endured over time despite the limitations posed by her busy life. This was a communication of a genuine belief in that strength because I realized this was a trait she could employ in her change journey. I recognized it as a demonstration of self-control, effortful investment in a process, and responsibility. Accurate Empathic Reflection I tried to listen, not only to what she was saying but also to what she meant by her statements, and was aware of the nuance in her tone and her verbal expressions. To this effect, I reflected her thoughts that her rigid schedules have been noticed by other people and they affected how her days ran. I tried to be non-judgmental and avoided criticizing or blaming her by expressing my thoughts that I did not want to use the term ‘rigid’ to describe her. I simply reflected and verified what she had stated by slightly reformulating her statement without adding any meaning to it in an attempt to communicate that I understood her. When the client expressed her concern about missing out on life and not being able to live as freely and as relaxed as her friends and relatives, I found this a good opportunity to employ a complex reflection by amplifying her statement, the value she had stated, and the emotion she expressed. To this effect, I reflected the implied meaning that she would love to be more relaxed, to work outside of a strict schedule and that these are the areas she wished to change. Although I had intended to help her experience the ambivalence in her experiences, I realize that asking her “how” she would like her experience to be different might have pulled her out of her experience and put her on a pedestal to observe herself because it was more of a probing and interrogating question that a gentle show of interest in understanding her aspirations. Clarifying Ambivalence After the client had stated that she wishes to be less bound to her strict schedules and live a free life, I sought to clarify the ambivalence because at this stage, the discrepancy between her present behavior and her goals seemed to be clearer to her and she was beginning to shift her thought processes and perceptions, albeit with some defensiveness. To clarify the ambivalence in the client, I asked her to explain what she considered as good about her present behavior, and what she thought was wrong about her present behavior. I did this intending to help her become conscious of the pros and cons of her behavior, to bring out to the open her incentives for change and the disincentives for continuing with her behavior. This way, I would be able to help her get unstuck by tapping into her motivations and enhancing them so that she would eventually resolve the ambivalence and favor change talk. When the client expressed the thoughts that people might be wrong in thinking that she is too rigid, I identified this as resistance and decided to offer a reflective response to it by giving back a non-resistant, empathic reflection that she wants to find a balance in her life. This was intended to help her get unstuck and start to argue for changes and eventually move towards those changes. I however avoided putting her on defense by acknowledging her feelings and perceptions. I made it clear that that was my understanding of her statement and I achieved that by using the statement “I hear that”. This opened the way for further exploration where she explained that she felt like engaging in things without a plan was wasting time. My reflection and explanation that that was my understanding helped me avoid appearing as if I was taking sides. Initiating the Pregnant Pause Before we transitioned to the planning phase, I asked the client to tell me about a time in her life when she had done things out of schedule. This was intended to provide her with an opportunity to think more deeply about the possibility of achieving the changes she wanted to make in her life. This prompt helped her think of a time when she did what she currently considers impossible. I felt that this would help her see that the changes she was seeking were achievable and therefore trigger a personal perception of capability. The client talked about a time when her mother had called her to go pick her up. When she mentioned her already planned schedule as one of the hindrances she experienced at that time, I inquired how she overcame that and she communicated that she managed to break her regimented routine and it felt good. According to her, that experience made her realize that life is unpredictable and such events might come up. She expressed her worry that she might not be able to come out of her rigid routine to meet such unpredictable events in the future. Taking an Outlook onto the Future To elicit a conversation about what a life with the changes she desires would look like, I asked her to tell me what the change she is seeking looks like to her and she explained that she imagines not waking up at the same time in the morning, not taking the same type of coffee every day, and having spontaneity rather than the boring schedule she currently follows. Responding to Change Talk (EARS) After listening to her change talk, I asked her to elaborate on how she intended to add spontaneity to her routines. She explained that she intends to read books to see how other people deal with their rigidity. I reflected the thought that she intends to gather more information about how other people deal with the same problem. In her explanation, she mentioned that she wonders whether her schedule is more than what it looks like and whether she has obsessive tendencies. She however acknowledged that she knows nothing would go wrong if she changed her schedule a little. I also queried her about her extremes and sought to understand what she believed were the greatest negative consequences of making the changes she was pursuing. I achieved this by asking her what she thought she would lose if she gave up the rigidity of her schedule. To this, she responded that she feels like she might lose control over her time. To understand how her values were inked to the target behavior, I asked her to tell me if she thought the fear of losing control might have been the one holding her back from making the changes, to which she answered in the affirmative. Additionally, I affirmed her change talk through reinforcement, encouragement, and acknowledgment of the fact that she was able to identify both the positive and negative aspects of her target behavior. I further reflected and reinforced her statement that she wants to keep the good aspects of her behavior and change the negative aspects of it. I was able to recognize and appreciate her low-strength commitment language when she mentioned that she is happy in her own way with her life as it was but expressed a desire to make changes. I reinforced this by suggesting that she could try to experiment with a few changes and simply “flow with the flow” to see how it goes for her. Explanation of the Interventions I invested heavily in building a rapport with the client in this interview because I intended to engage her in her own change. The focused use of Open-ended questions, Affirmations, Accurate Empathic Reflections, and Summarizing (OARS) helped me to create a safe and strong therapeutic relationship with the client so that she would feel heard and understood at all times. Furthermore, I engaged with the client using a few, open-ended questions to facilitate a client-driven conversation with the understanding that closed questions were likely to make her feel invalidated and less in control of her life. Open-ended questions, however, make the clients feel that they are the expert on their own lives and they therefore become more active in the engagement and are more open to self-motivation and change talks. Additionally, the use of frequent affirmations and referencing to her positive traits and achievements was intended to move her towards the desired change by helping her recognize her strengths and link them to the changes she was seeking. Moreover, with the understanding that a healthy therapeutic relationship relies heavily on accurate empathic reflections, I employed this intervention to keep my assumptions in check and facilitate a sense of unconditional positive regard for my client so that she would continue feeling heard and believed. I sought to clarify the obvious ambivalence in the client to help her develop consciousness of the discrepancy between her current behavior and her change goals because I understood that such understanding of her situation would elicit the willingness and confidence to make changes. I intended to move her from denial and rationalization to being open to willingly making changes. I attempted to reframe her statements when the need arose to show an acknowledgment of the validity of her perceptions while at the same time offering new meanings so that she could view her situation in a new light. I employed the pregnant pause to provide both the client and myself a chance to collect our thoughts about the next step in the session. This pause was also intended to help the client review her experiences and consider where she was at the moment concerning her target behavior and the future she wants to have. Additionally, asking the client to tell me about how she sees a future with the stated changes allowed me to understand her at a much deeper level concerning her current position with the target behavior and aspirations about the future. My employment of EARS in response to her change talk was intended to strengthen the change and commitment language and assess her agreement, intention, and feelings of obligation toward the future. I feel that I did, to a fair degree, successfully implement the above strategies. I however feel that there was too much to attempt to achieve within a fifteen-minute session that I glazed over some areas. Additionally, I did, on a few occasions, imply that the client did not have a choice like I did when I suggested an action plan for the client at the end of the session. After watching the recording, I feel that there are times when I did not agree with the client's ideas but I managed to raise my concerns in a way that did not communicate that the client’s ideas were flawed and therefore avoided the pitfall of invalidating her. I however do not think I was thorough with my summarizing techniques especially when I was about to transition from one subject to another, and at the end of the session and therefore did not provide sufficient closure on topics. I look forward to refining my summarization and their timing in the future. I also feel that I did not put enough emphasis on the client’s autonomy and personal choice especially when instances of ambivalence came up and this might have contributed to the polarized position the client took towards rationalizing her situation instead of encouraging her to back off and argue for change sooner. Lastly, although I was limited by time, I do not think I took enough time to engage the client in a discussion of her values and how they connected with the target behavior. These are some of the areas I look forward to streamlining to make my use of Motivational Interviewing more effective. Evaluation by Peer My peer evaluator thought I employed the principles of Motivational Interviewing well. According to her, I appropriately sought the client’s permission to broach the topic, built rapport with the client well, and the conversation took a natural path and the collaboration between me and the client was commendable. She also noted that at the end of the interview, the client seemed more motivated to change than she was when the interview began. My attempts to help the client explore her own arguments, according to the peer reviewer, were effective, and I reflected more than I asked questions. Although she cited my suggestion of an action plan, she appreciated that I was able to place the larger responsibility for change with the client and I was neither coercive nor judgmental. The peer reviewer, however, took issue with my failure to employ the readiness ruler to assess the client’s importance/confidence perceptions but appreciated that I suggested a small experimental change for the client before suggesting a move toward a permanent behavior decision. Although the reviewer also cited the time limitation, she noted that there was no discussion about how the client would overcome or eliminate the barriers to the intended behavior change. Overall, I think this was a worthwhile exercise and an approach I would readily use in the future with clients struggling with addiction and behavioral problems. I think I might have gone to the interview with a strategy in my head but I realized soon after the session began that the processes of Motivational Interviewing intermingle and I had to reuse certain strategies throughout the session. I have also realized that a counselor should let the client take charge of their change and attempting to steer a client towards change when they are not ready is highly likely to fail.