The point of MI is to get someone towards the stage where they are preparing to make changes. What's happening here in the first half of the video is that the interviewer leads the conversation entirely towards why he doesn't want to change and what reasons he has to sustain his behavior. The fact that a person's own reflections and voicing of their thoughts can boost their confidence works as a two-headed coin. If you let someone reflect on all the benefits of their own unhealthy behavior, you are letting them reinforce their own thoughts and reassure themselves. The obvious follow-up of the benefits should immediately be the negative impact on one's life, and particularly the personal risk involved (such as the wife leaving, the most glaringly obvious example of personal risk there is). In this situation, showing empathy and understanding definitely helped get the client to reflect and eventually say they don't want to lose their relationships, but the interviewer doesn't push for more concrete change talk, let alone talk of a commitment. Let's say the client indicates he wants to do as he pleases and doesn't like being told what to do. You can affirm that and rightfully so. He does have autonomy. So, given that he can do what he wants, what does he want to do? Will he leave his wife because he likes to drink? Well, no, he'd probably seek some kind of middle ground there. Bam, you're evoking change talk by engaging the client with an extreme question, and you can use his response to that in order to navigate further change talk. If someone's relations with all their family are on the line, it's extremely obvious this man really wants to un-dig the hole he dug for himself. The only thing keeping him is his sense of autonomy and his habitual behavior (presumably, judging by the title and context, reaching the level of an addiction). This is almost picture-perfect of a set-up because giving a sense of autonomy is exactly what MI is designed for. This guy has excessive personal risk and a need for autonomy, both of which are the hallmarks of what MI plays into. But here, it didn't really happen. There was no active effort to eke out change talk and to then start turning it into commitments. Still, an impactful interview because the interviewer did marvelously succeed at making a genuine connection which is far more effective than coming in with guns blazing, as I've seen a lot of interviewers do in more widespread approaches.
In consideration of relapse prevention were this mock client to become sober, what would be at least one high-risk situation for this mock client (from "Motivational Interview with “Resistant” Heavy Drinker")?
In MI you need to gain an empathic understanding of the person and communicate that, and this was achieved successfully by exploring the resistance/discord. Please learn more about MI before commenting.
Thank you for posting! Much appreciated by this MSW student in early-internship, looking for technique on MI. From a content standpoint, you may consider snipping the first minute. Great work - thanks :)
I only realised towards the end of the video that this was MI for a resistant client! I thought the therapist was talking way too much at first but now it makes the MI techniques used by the therapist look a lot more effective considering he was playing the role of a resistant client :)
Around 7 minutes and 47 seconds into the video - "are you gonna tell my wife?" No, because of confidentiality. - And then the world gets to see the entire session online. If this man is not an actor this is a huge HIPAA violation.
I understand this is role playing, but I did not hear, clear paraphrasing, or summarizing....reflective listening. I heard the the interviewer/ counselor jump to assumptions and opinions a few time ....where client was not saying that,..and even the client corrected him.
i know this is a training video and they were joking prior to filming it, but i really don't see the empathy coming across in this video. I think the therapist comes off as immature in his tone of voice, e.g., at 03:02 the tone he uses when he says "alright alright" suggests subtle condescension towards the client, and then the follow up tone at ~03:05 "you know, you work, ur responsible. . "etc., comes off as overly placating. In other words. . .im picking up from the therapist the subtle mentality he knows best for the client. Im sure it wasn't his intention, but = P
Good training video on MI. I would possibly take a little more of a client centered approach and as the therapist let the client lead the session more and do more talking. The paraphrasing and encouragement were good early in the session. Thank You
Yes, way too much talking from the interviewer, and little reflecting and summarizing. He just doesn't sound like he is a trained counselor or licensed therapist. Under ethical guidelines, he was leading rather walking along-side his client.
The interviewer is putting his own words into the interviewie. That's not MI. The interviewie is the one who should be doing 70% of the talking and interviewer should talk 30%
But this is a video of "what not to do, not what to follow". Motivational interviewing requires paraphrasing, summarizing and most of all reflective listening...reflect, reflect reflect,... that was bot done here.
Talk only about the person in room. You talk about his wife, kids, dad, and doctor. They don't matter. You didn't watch for key the key words. I did like that you built a roper with the client and you were on his side.
What the wife doesn't realize (and what most wives don't realize) is that when he stops drinking, will he still be interested in her as a wife? Plus, ... I'll bet drinking is not the only thing in this guys life she wants to change. Men marry women hoping they don't change; women marry men hoping they do.
As an Addictions Specialist myself, I have some issue with the negligence being exhibited by the therapist... This is a deadly disease and "pussy footing" around the issues will just perpetuate and keep this patient sick. MI is not for addiction treatment... Gestalt therapy & REBT is a much better avenue to treat addiction.
MI was actually originally intended for ambivalent clients such as those with addictions. Not sure why you would say it would not be used for substance use...
it sounds like you are from the old school camp where you have to scare the client straight in order for them to change. this statement is troubling for sure
The point of MI is to get someone towards the stage where they are preparing to make changes. What's happening here in the first half of the video is that the interviewer leads the conversation entirely towards why he doesn't want to change and what reasons he has to sustain his behavior. The fact that a person's own reflections and voicing of their thoughts can boost their confidence works as a two-headed coin. If you let someone reflect on all the benefits of their own unhealthy behavior, you are letting them reinforce their own thoughts and reassure themselves. The obvious follow-up of the benefits should immediately be the negative impact on one's life, and particularly the personal risk involved (such as the wife leaving, the most glaringly obvious example of personal risk there is).
In this situation, showing empathy and understanding definitely helped get the client to reflect and eventually say they don't want to lose their relationships, but the interviewer doesn't push for more concrete change talk, let alone talk of a commitment.
Let's say the client indicates he wants to do as he pleases and doesn't like being told what to do. You can affirm that and rightfully so. He does have autonomy. So, given that he can do what he wants, what does he want to do? Will he leave his wife because he likes to drink? Well, no, he'd probably seek some kind of middle ground there. Bam, you're evoking change talk by engaging the client with an extreme question, and you can use his response to that in order to navigate further change talk.
If someone's relations with all their family are on the line, it's extremely obvious this man really wants to un-dig the hole he dug for himself. The only thing keeping him is his sense of autonomy and his habitual behavior (presumably, judging by the title and context, reaching the level of an addiction).
This is almost picture-perfect of a set-up because giving a sense of autonomy is exactly what MI is designed for. This guy has excessive personal risk and a need for autonomy, both of which are the hallmarks of what MI plays into. But here, it didn't really happen. There was no active effort to eke out change talk and to then start turning it into commitments. Still, an impactful interview because the interviewer did marvelously succeed at making a genuine connection which is far more effective than coming in with guns blazing, as I've seen a lot of interviewers do in more widespread approaches.
In consideration of relapse prevention were this mock client to become sober, what would be at least one high-risk situation for this mock client (from "Motivational Interview with “Resistant” Heavy Drinker")?
In MI you need to gain an empathic understanding of the person and communicate that, and this was achieved successfully by exploring the resistance/discord. Please learn more about MI before commenting.
Thank you for posting! Much appreciated by this MSW student in early-internship, looking for technique on MI. From a content standpoint, you may consider snipping the first minute. Great work - thanks :)
I think the counselor might have talked more than he needed to, silence is okay.
amazing video! thanks for posting it!
I only realised towards the end of the video that this was MI for a resistant client! I thought the therapist was talking way too much at first but now it makes the MI techniques used by the therapist look a lot more effective considering he was playing the role of a resistant client :)
this man doesn't want to quit and the decision has Got to come from him.
Can we see an MI video with a gibbon as the client please? Thanks
Around 7 minutes and 47 seconds into the video - "are you gonna tell my wife?" No, because of confidentiality. - And then the world gets to see the entire session online. If this man is not an actor this is a huge HIPAA violation.
A release would have been signed prior to release.
Great video! Very helpful
I understand this is role playing, but I did not hear, clear paraphrasing, or summarizing....reflective listening. I heard the the interviewer/ counselor jump to assumptions and opinions a few time ....where client was not saying that,..and even the client corrected him.
i know this is a training video and they were joking prior to filming it, but i really don't see the empathy coming across in this video. I think the therapist comes off as immature in his tone of voice, e.g., at 03:02 the tone he uses when he says "alright alright" suggests subtle condescension towards the client, and then the follow up tone at ~03:05 "you know, you work, ur responsible. . "etc., comes off as overly placating. In other words. . .im picking up from the therapist the subtle mentality he knows best for the client. Im sure it wasn't his intention, but = P
I do not know what is best for the client. What I felt like I understood was something about his experience of being forced into treatment.
I felt the same way, no empathy and no deep reflective listening ... He needs to listen more instead of listening to react, and reply.
Good training video on MI. I would possibly take a little more of a client centered approach and as the therapist let the client lead the session more and do more talking. The paraphrasing and encouragement were good early in the session.
Thank You
Yes, way too much talking from the interviewer, and little reflecting and summarizing. He just doesn't sound like he is a trained counselor or licensed therapist. Under ethical guidelines, he was leading rather walking along-side his client.
The interviewer is putting his own words into the interviewie. That's not MI. The interviewie is the one who should be doing 70% of the talking and interviewer should talk 30%
He’s paraphrasing
How can I get get in contact with the owner of this video about using it for a training?
Shoot me an email at bengle@fiu.edu or tex or call: (954) 328-2241
But this is a video of "what not to do, not what to follow". Motivational interviewing requires paraphrasing, summarizing and most of all reflective listening...reflect, reflect reflect,... that was bot done here.
This client had no sustain talk
Talk only about the person in room. You talk about his wife, kids, dad, and doctor. They don't matter. You didn't watch for key the key words. I did like that you built a roper with the client and you were on his side.
What is a roper if you don't mind me asking.
What the wife doesn't realize (and what most wives don't realize) is that when he stops drinking, will he still be interested in her as a wife?
Plus, ... I'll bet drinking is not the only thing in this guys life she wants to change.
Men marry women hoping they don't change; women marry men hoping they do.
I just sent you an e-mail. Thank you!
As an Addictions Specialist myself, I have some issue with the negligence being exhibited by the therapist... This is a deadly disease and "pussy footing" around the issues will just perpetuate and keep this patient sick. MI is not for addiction treatment... Gestalt therapy & REBT is a much better avenue to treat addiction.
Julian Rodriguez ... false...
MI was actually originally intended for ambivalent clients such as those with addictions. Not sure why you would say it would not be used for substance use...
As a professional working in addiction for over 40 years, I find your statement troubling.
it sounds like you are from the old school camp where you have to scare the client straight in order for them to change. this statement is troubling for sure
This was a training in North Carolina with about 70 people.
Thanks for the feedback.