Motivational Interviewing: An Effective Tool for Positive Change
Introduction
In my experience with the MI role play, I learned that having a person-centered approach can have a significant impact on the client's willingness to change. Using the OARS technique, I was able to effectively listen to the client and help guide the conversation towards change talk. The DARN CAT technique was also instrumental in helping me evoke change talk and commitment from the client. These techniques, along with my strengths-based approach, were successful in helping the client identify her ambivalence towards change and empowering her to take the necessary steps towards her desired outcome. To explore the effectiveness of motivational interviewing, in this essay I'll reflect on my experience.
Analysis
MI revolves around taking a client’s ambivalent feelings towards something and exploring those feelings to assess whether there is any room for change to occur. The techniques I utilized in my effort to evoke change talk and motivate the client to take steps towards change were: OARS, DARN CAT, Scaling, and Psychoeducation. OARS was the basis of my approach to the session. Applying OARS to the work I did with the client helped by providing me a template for how to effectively guide the session. I applied the OARS technique by asking open-ended questions to try and get as many details as possible surrounding the client’s personal life and sexual activity. Asking open-ended questions and reflections have both been found to be effective methods of producing higher levels of change talk. Moreover, these techniques are also effective at minimizing client resistance. Reflections are a crucial skill to implement when conduction MI.
The importance of reflections is two-fold. First, reflections are an effective way of showing empathy to the client. If a client does not feel like the clinician understands their story, they will display higher resistance to change OARS is so effective because it’s client-centered nature. What is more, reflections can be strategically used to guide a client towards resolving their ambivalence. In other words, clinicians can use reflections to address negative aspects of client behavior, as well as highlighting positive aspects of change. In addition to open-ended questions and reflections, OARS also suggests that the clinician should effectively use affirmations and summarizations to bring life and strength-identification to the session. During the session, affirmations were used to identify client strengths and bring some positivity into a discussion that might have been causing her to feel some shame or embarrassment. By effectively implementing affirmations, the clinician is able to show support and compassion for the client at a time when they are feeling vulnerable.
Approaching the client wish compassion and offering affirmations has been found to be a significant strategy when attempting to evoke change talk. This is evidenced by the study conducted by Watson (2011) which stated that MI techniques are most effective when they are used to galvanize a client’s intrinsic motivation. More specifically, Watson (2011) came to the conclusion that clients will have greater change potential when they feel they are seen as “partners in the change process, rather than passive recipients. ” In other words, it is important that clinicians approach an MI session with a spirit of collaboration and partnership. In addition to OARS, DARN CAT is another very useful technique that was utilized during the session. The DARN CAT technique proved to help significantly helpful in evoking change talk from the client. Successful execution of DARN CAT occurs when the clinician is able to guide the client towards the desire, ability, reasoning, and need for change. This is in addition to guiding the client towards commitment, activation, and taking steps towards change. I made sure to have a clear understanding of the DARN CAT technique before conducting the session.
During the session I guided the client towards change using the DARN acronym and looked for language the indicated the client was ready for change which would allow me to use the CAT acronym. The DARN CAT technique was a great reminder that this session was about the client addressing their ambivalence. As clinicians, we are the ones who ultimately guide the conversation, but it is the client that makes all of the decisions. I really appreciate the DARN CAT technique due to its person-centered nature. There is no room in DARN CAT for advice giving, lecturing, or shaming. In other words, DARN CAT tells us to let the client take the lead. That being said, clinicians are still encouraged to provide advice and expertise, when appropriate. Psychoeducation is just as important as OARS or DARN CAT. For example, if we are meeting with a client, who has been diagnosed with HIV and is still having unprotected sex, it is within the scope of our practice to warn them about the risk of spreading the virus. There is a fine line we must walk, as clinicians, between advice giving and providing factual information. It is appropriate to make sure the client is aware of information associated with their behavior.
On the other hand, it is not appropriate for the clinician to make goals for the client or tell the client how they should be living their lives. As clinicians, we might feel like we know exactly what changes this client should make to better their life. Not only is this not respecting the client’s right to self-determination, dignity, and self-worth – this type of practice can lead to the client not being able or willing to follow the change plan.
Considerations for Future MI Sessions
While I feel I did a decent job at conducting this MI session, there are certainly some things I would have done differently. Now that I have had the opportunity to go back and take a good look at the session, I have a much clearer idea about how I would conduct further MI sessions. The client and I have an exchange at 20:50. During this exchange we discuss what potential role her sister might play in providing the client a support system while deciding who else to disclose her diagnosis to. At that point in the conversation I was feeling a lot more comfortable speaking to the client and I fear this might have affected my practice. I expressed to her that I felt she should talk to her sister, when she is ready. If I had the chance to do this session over I might have left that statement out, as I feel it comes across as advice giving. AS mentioned throughout this paper, advice giving is not beneficial in MI or general social work practice. Advice giving can make the client feel disempowered, or just a passive recipient, in their change process. If I were to do this session over, I would make more of an effort to guide the client towards c coming up with the idea to talk to her sister on her own. Something else I regret not addressing was a safety plan. Although it felt like the client was on board for changing her sexual activity, I wish I would have discussed a safety plan with her. This would have allowed me to make sure the client knew I cared about her well-being, as well as making sure she is aware of the access she has to services that might be able to help her, even if she is not ready to follow through with changing her sexual behaviors.
Internal Dialogue
An issue that arose for me during the session was the client’s general disregard for safe sex practices. I felt I maintained a non-judgmental stance throughout the entire session, but a part of wanted to tell the client that the lifestyle she had been living was extremely dangerous to herself and others. I worried about the well-being of others who would engage in sexual activity with her, not knowing about her diagnosis. Ethically, I was concerned about whether or not I should tell supervision about her sexual activity. Some states legally require individuals to disclose their HIV status to people they are engaging in sexual activity with. I felt the pressure to maintain the client’s confidentiality, but I also felt the need to consult with a supervisor about additional steps that might need to be taken. HIV can be a life altering diagnosis and if were to send this client back out into the general population, without guiding her towards commitment to change, I would feel responsible if she transmitted the disease to someone else. I managed this internal conflict by tapping into the empathy I was feeling for the client. I realized that she truly wanted to disclose her diagnosis, but her fear of facing the stigma surrounding HIV was holding her back.
I also drew upon the NASW Code of Ethics to manage the internal conflict I was experiencing. More specifically, I drew upon the values of service, dignity and worth of the person, importance of human relationships, and competence. These values helped keep the session client-centered. It would have been easy for me to just tell the client what steps she needed to take in order to live a healthier and safer lifestyle but that is not what social work is about. My job is simply to guide the client on her change process, while presenting factual information. It is not within out practice, principles, or ethical standards to be life coaches or advice givers.
Conclusion
Out of all of the assignments I have completed, as a Simmons graduate student, I undoubtedly feel that this assignment has pushed me and challenged my practice knowledge more than any other assignment. Before this assignment I was terrified of MI. I had a general understanding of it but thanks to this assignment, I now know what it takes to conduct an effective MI session. I am nowhere near considering myself a master at MI, but I now feel that I have a solid foundation to move forward and start perfecting my practice. Through this assignment I have learned that change takes time and trying force change will do nothing but elicit higher resistance. I have also learned the importance of person-centered practice. When you approach a session with a collaborative spirit, you are much more likely to have favorable outcomes.
I will integrate the teachings of MI into my practice by realizing that my sessions will be more effective if I let the client move through the session at their own pace, rather than the pace I feel they should be moving at. By becoming more intimately familiar with MI practice, I now know that MI is more about exploring and resolving ambivalence, rather than focusing on the client’s problem and how to fix it. Moving forward, my MI practice will be solely focused on supporting change, rather than trying to impose it. My practice will forever be increased thanks to the lessons I have learned through the completion of this assignment.
