3 Motivational interviewing Core Skills in Action
Summary
TLDRThe video script showcases a health psychologist, Dr. Turner, engaging with a patient referred by her GP due to concerning drinking habits. Through attentive listening and motivational interviewing techniques, Dr. Turner encourages the patient to reflect on the pros and cons of her alcohol consumption. The discussion highlights the patient's awareness of the risks, especially in relation to her future family plans, and her readiness to consider cutting back. The session aims to motivate change by examining the patient's social drinking habits and their impact on her health and future goals.
Takeaways
- 😀 Building a collaborative relationship from the start is crucial, showing interest and attentive listening to the patient.
- 🗣️ Utilizing motivational interviewing strategies such as open-ended questions, reflecting, affirming, and summarizing is effective.
- 📊 The readiness ruler and pros and cons technique are helpful tools to assess and reflect on behaviors and current situations.
- 👩⚕️ The patient was referred by her GP due to concerning drinking habits revealed by a secondary screening tool.
- 🎓 The patient is a grad student in Environmental Policy with plans to possibly travel abroad and start a family.
- 🥂 Alcohol consumption is a social activity for the patient, often involving friends and weekend gatherings.
- 🚫 The patient acknowledges the risks associated with alcohol, especially with future family plans and personal health.
- 🤔 The patient is surprised to be referred for counseling, as they perceive their drinking habits as normal among peers.
- 🔢 The patient's drinking pattern includes three to four nights a week with occasional heavy drinking on weekends.
- 🤰 The patient is aware of the health risks of alcohol during pregnancy and plans to abstain when starting a family.
- 🔄 The patient is willing to consider cutting back on drinking, motivated by future family plans and health concerns.
Q & A
What is the main purpose of the interview between Marcia and Dr. Turner?
-The main purpose of the interview is to address concerns about Marcia's drinking habits, which were flagged by her GP during a secondary screening tool, and to discuss how these habits might affect her future plans, including starting a family.
What motivational interviewing strategies does Dr. Turner use during the session?
-Dr. Turner uses open-ended questions, reflecting, affirming, summarizing, and readiness rulers as motivational interviewing strategies to help Marcia examine her drinking behaviors.
Why was Marcia referred to Dr. Turner by her GP?
-Marcia was referred to Dr. Turner because her scores on a secondary screening tool for drinking indicated a level of risk that concerned her GP.
What degree is Marcia pursuing in grad school, and how does it relate to her future plans?
-Marcia is pursuing a degree in Environmental Policy, and she sees herself possibly going abroad with her fiancé Ben, who is interested in international politics, after they get married.
What are some of the social activities Marcia enjoys in her free time?
-In her free time, Marcia enjoys outdoor activities like whitewater rafting and rock climbing, hosting parties at her house, and cooking for friends.
What does Marcia consider the pros of her drinking habits?
-Marcia considers the social aspect and the ability to feel less inhibited as the pros of her drinking habits, especially when she is with her group of friends.
What are some of the cons or negative effects Marcia has experienced due to her drinking?
-Some negative effects Marcia has experienced include hangovers, blackouts, and embarrassing situations, such as being involved in an incident in college that required her mother's involvement.
How does Dr. Turner bring up the topic of alcohol and its relation to Marcia's future family plans?
-Dr. Turner brings up the topic by asking Marcia if she has considered the health risks of drinking during pregnancy and by connecting her current drinking habits with her future family plans.
What is the safe limit for women's alcohol consumption according to the script?
-The safe limit for women's alcohol consumption mentioned in the script is seven drinks per week.
What is Marcia's readiness level on a scale of one to ten to address her drinking habits seriously?
-Marcia's readiness level to address her drinking habits is 8.5 on a scale of one to ten.
What steps does Marcia plan to take in the following week to change her drinking habits?
-Marcia plans to talk to her fiancé and her mother about her intentions to cut back on drinking, and she considers limiting her alcohol consumption to only weekends as a manageable change.
Outlines
🤝 Building Rapport and Understanding Patient's Lifestyle
This paragraph introduces the video script's setting, where a health psychologist, Dr. Turner, is having a conversation with a patient referred by her GP due to concerns about her drinking habits. The psychologist uses motivational interviewing techniques, such as open-ended questions, reflection, affirmation, and summarization, to establish a collaborative relationship and understand the patient's life, including her academic pursuits, social activities, and future plans involving marriage and family. The patient acknowledges her drinking habits and expresses a desire to reduce alcohol consumption, especially considering her future family plans.
🍻 Discussing Alcohol Consumption and Its Impact
The second paragraph delves into the specifics of the patient's alcohol consumption, noting the frequency and quantity of her drinking. The psychologist explains the health risks associated with exceeding the recommended weekly limit for women and the potential complications it may cause, both medically and psychologically. The conversation explores the pros and cons of the patient's drinking, highlighting the social benefits and the negative aspects such as hangovers and blackouts. The patient expresses concern about the impact of alcohol on her future family and acknowledges the need to address her drinking habits.
🚀 Planning for Change and Accountability
In this paragraph, the patient and the psychologist discuss the patient's readiness to address her drinking habits and the steps she can take to reduce alcohol consumption. The psychologist uses a readiness ruler to gauge the patient's motivation, which the patient rates as 8.5 out of 10. They talk about the patient's social circle and the influence it has on her drinking. The patient considers discussing her intentions with her fiancé and her mother to ensure accountability. The psychologist suggests setting a weekly alcohol limit and encourages the patient to make an appointment for a follow-up session to track her progress.
Mindmap
Keywords
💡Collaboration
💡Motivational Interviewing
💡Open-Ended Questions
💡Reflecting
💡Affirming
💡Summarizing
💡Readiness Ruler
💡Pros and Cons
💡Alcohol Risk
💡Blackouts
💡Family Planning
Highlights
Importance of building collaboration and showing interest in the patient from the beginning of the interview.
Use of motivational interviewing strategies such as open-ended questions, reflecting, affirming, and summarizing.
Introduction of readiness ruler and pros and cons techniques to assess patient's behaviors and readiness for change.
Patient's initial reaction to being referred by GP due to concerns about drinking habits.
Patient's personal background, including education in Environmental Policy and future plans.
Discussion of patient's social life and activities, including outdoor adventures and hosting parties.
Relevance of alcohol in the patient's social circle and its perceived normalization.
Patient's awareness of the risks associated with drinking and the desire to reduce consumption in the future.
Clarification of the patient's typical drinking pattern and the associated risks.
Patient's acknowledgment of the negative impacts of drinking, such as hangovers and blackouts.
The patient's consideration of the health risks of drinking during pregnancy.
Patient's readiness to address drinking habits and the use of a scale to measure motivation.
Identification of social drinking as the main reason for the patient's alcohol consumption.
Patient's commitment to discussing drinking habits with close ones and seeking support.
Setting a weekly alcohol limit as a goal for the patient to manage drinking.
Patient's plan to limit drinking to weekends as a first step towards change.
The role of follow-up appointments in reinforcing the patient's commitment to change.
Demonstration videos aim to replicate real-life scenarios for educational purposes in primary care settings.
Transcripts
by
could you sort of summarize what you see
is the essential elements and the
essential some skills and strategies
that you've used in these interviews I
think the first is really done building
a collaboration from the get-go showing
you're interested and and really
listening attentively to the patient
giving a hundred percent of your focus
and then using some well-known
motivational interviewing strategies the
basic ones are the open-ended questions
reflecting affirming then summarizing I
try to do that
quite frequently and then maybe bringing
in one of the techniques like a
readiness ruler the pros and cons some
of these techniques that are so helpful
to get people to take a look at their
behaviors and where they are right now
hi I'm Marcia Cox hi my GP sent me in
nice to meet you nice to meet you I'm
dr. Turner I'm the health psychologist
here at the practice like to get to know
you before we get started but I know
you're probably wondering why your GP
did send you in ok your GP sent you in
because when she had you take that
secondary screening tool I don't know if
you remember the one specifically for
your drinking oh yeah mm-hmm
the scores on that tool and some of the
ways you were drinking concerned her and
so she thought it would be good for you
to come in and talk to me for a bit hope
that's okay okay sure and that's not
unusual in this practice a lot of
patients will come in and see me after
those after taking those screening tools
okay okay yeah no sounds good all right
so before we get started with that it's
always good for me to just spend a
minute or two and just get to know you
sure um I just finished my second year
of grad school and getting a degree in
Environmental Policy Wow sounds
interesting it is I really enjoy it
where can you see yourself ending up
with a degree like that um well my
fiancee Ben is interested in
international politics
so we're thinking about um going abroad
after we get married
um so yeah in grad school it's going
well yeah thinking about maybe traveling
abroad mm hmm hmm thinking about
marriage especially sometime soon and
having a family mm-hmm
what are you doing your free time what
um when we have it which right now is is
pretty often um we get outside as much
as possible I have a big group of
friends um we just went whitewater
rafting last week um some rock climbing
not nothing crazy um I like to host
parties at my house I like to cook so
sometimes we have people over so your
social yeah get outdoors yeah we have a
good group all right so let's get back
to why your GP sent you in to see me all
right
um you showed by by answering the scores
as honestly as you did that your
drinking level is putting you at risk
and now that you're also thinking about
having a family that also might be even
more add to the concern more and I'm
gonna sort of look at this around the
alcohol where does the alcohol fit in
there
I guess my worry as to why this is a
concern is because I feel like um so
many of my friends drink as much more
than me yeah almost everyone my age that
I know um and they're all very busy
active people um it's just something
that we definitely do on the weekends
definitely my fiancee probably has a
drink every day um yeah so it sounds
like you know and almost like a surprise
well I can't believe that I'm even being
asked to come see me yeah when my
friends drink my fiance drinks right if
anything they drink sometimes more than
I do
it's something I'm aware of I don't and
I've haven't always said this but I
definitely feel like you know I don't
want to be drinking this much when I'm
thirty I've definitely had that thought
um and especially if I'm starting a
family I don't see that as part of you
know my future okay so you even have
noticed that maybe as you get older it
might be good to sort of bring it down a
little bit uh yeah I mean I'm aware of
it yeah for the most part yeah all right
and and so let's talk about
to what I read in your answers let your
drinking about three or four the nights
that you drink does that seem accurate
and then maybe once a week you might go
out and really have a good time and let
loose and have more than five thousand
eighty six yes and and one thing I want
to say is it also said that you're not
doing any drugs and and you're shaking
your head like of course not right is
that right but that's really nice you
know we deal with a lot of patients here
and some have both but in this case you
know that's really to your benefit that
it's really strictly we're talking about
alcohol is that right and so it's really
seven seven drinks a week is really that
the safe limit for women and that what
happens as doctors get concerned and the
research shows that when you drink more
than that you could be at risk for
medical complications with your drinking
right and also psychological ones
relationship lines and how's that sound
and you know that your drinking is
putting it at risk um yeah I mean I'd
prefer to be healthier I guess yeah it's
definitely been it's not something I've
never thought of as I said my parents
and my brother have had some issues with
it so yeah so if we were to write down
some of the pros and cons of your
drinking just to understand them um it's
always good for me to know why people
when they drink light to drink and even
maybe for you to figure out and then
figure out what might not be so good
about it okay get into that so so what
are some of the pros well definitely the
social aspect um
it's fun it's fun you know what is it
about it that makes it fun for you think
when we're all together and we can all
feel a little less inhibited um my group
of friends that's definitely the primary
place where I'm drinking the most with
my groups of friends for sure so it sort
of loosened you up it gets you less
inhibited and yeah definitely um it's a
way to let go on the weekends when I'm
not doing around those papers
it has fun loose in general so it's
definitely a social yeah yeah part of
your group mhm
what are some of the negatives that have
come up for you
in drinkin well um well no one likes a
hangover so that's no fun
hangovers and how often does that happen
to you I mean I probably have I would
say I wake up with a headache on the
weekends one day of the weekend and and
again just so I'm real clear how much I
say you drink in most of the week so
when when you know during the week what
would you say a drink and then on the
weekend um probably two or three times
two or three days of the week days of
the week and how many during those days
would you say me three or four three or
four drinks and then during the weekend
yeah sometimes it's more orders yeah um
maybe five five a night 500 night yeah
how about what other effects have you
noticed or others I'm sorry
sure uh this doesn't happen very often
but definitely I would prefer to never
get to this place where I've had a few
blackouts probably Harley damn in
college in college degree idea yeah
what's head and undergrad especially an
undergrad and um what was concerning
about those for you well I'm not
remembering what exactly happened never
feels great um I got into a one bad
situation in college that my mother was
involved in which was not pleasant um
really risky to you to your health and
to your safety bad like embarrassing um
I would say not usually risky to my
health I feel safe around the people
that I drink with for the most part okay
um but there have been a few
embarrassing moments there for sure it's
an embarrassing photos alright so yeah
so you know one thing you said and I
just want to bring that back up as you
talked about wanting to have a family
mm-hmm and um so I'm wondering if you
know you're pretty aware probably that
it's really unhealthy for the fetus to
drink during stage of pain so if you
thought about that at all is you've been
thinking yeah absolutely
yeah and
yeah um you know my my mom stopped
smoking and drinking right away when she
um had my brother so I definitely plan
on doing that and I think I have more
friends from home who are already
starting to have kids um so I think
there's some definitely support there um
it seems like you do it socially it's
really helped you feel less inhibited
mmm sounds like and then there's you do
it frequently on the weekends really you
let loose that way and have a good time
you have some blackouts that are of
concern right um you haven't seen a lot
of effect up till now although your mom
and now your doctor mm-hmm this time you
is concerned and you said you're also
interested in starting a family yeah and
so that's something that might have you
change your mind I'm wondering what
would have to happen to you you know
when you think about it like what would
be an indication free for you that this
is more like your brother and your dad
that this is something that really is a
concern um I think that I just have been
ignoring it maybe um not putting it all
putting all these pros and cons out
makes it sort of more an apparent issue
it's dink the most difficult part is
that everyone I'm around is sort of
doing the same thing yeah and I get that
and that's funny that's very common for
people your age and I hear you saying
that I guess what I'm wondering is you
know just personally would there be
something that would tell you okay I
really do need to cut back is there
something that would have to happen in
your life right now that would say hey
it's time in your doctor's concern and
your you know the tools that we use I
examine this say you're at risk but what
has to happen I mean given where I want
to be I think in the future and with
having a family I think I'd like to
start cutting back right away so I'm
wondering on a scale of one to ten how
ready you are right now to take a look
at this seriously like you've done today
and then have that have you bring it
down one being you know not at all ten
being very motivated honestly making
eight point five wow you are very
decisive I can see why you so it's eight
point five and you know what I'm
wondering is I wonder
like that there's so many reasons
socially for you to but it's really only
cute I feel like it's really only social
and I feel like if I can't overcome that
that's kind of so you feel like those
reasons that you're drinking aren't
enough to you personally to have you
continue with these harmful rubbers are
risky let's call them yeah I mean I'm
not gonna lose friends okay I don't
think so given that what do you think
you could do in this next week and I'd
like to see you next week but what what
can you do in this next week is that
that's good with you to actually change
you were drinking rest well I definitely
would want to talk to my fiance oh
you're not it um not even necessarily
get him to cut back but just tell him
where I'm at and what you guys have said
um and then um with my mom as well I
think my mom would be a great person to
hold me accountable although I would
hate to admit that she might be right
about my habits but sighs those sound
like some great steps is there anything
that I can do to remind you to do those
and to follow through on that um I think
uh you know seeing you next week will be
good motivation for it and if I think if
seven is a weekly limit to work for then
I think probably drinking only on the
weekends is something manageable so
knowing the safe limit and then yeah
limited to a set period during a week
yeah why is that something you can try
this week yeah all right great so what
I'd like to is great to talk to you you
have any questions for me not right now
okay all right so like you to go out and
make an appointment to see me next week
okay
all right nice to meet you nice to meet
you take it yep bye
so in this in in this first couple of
videos what's the setting what's what's
the scene that that's going to get
played out to demonstrate the well in in
all of the demonstration videos our
intent here is to try and replicate as
much as possible just like normal people
so that the cases in the
studies that were selected are the kinds
of clients or the kinds of patients that
you might see in a primary care practice
and we look through a number of
different case profiles and made these
selections and that we try to really
have just the kind of normal s pert
brief and
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