Motivational Interviewing - Good Example - Alan Lyme

Interview B.
Alan Lyme, LISW, MAC, brings respected and innovative clinical and program management skills as the Director of Training for the Phoenix Center in Greenville, South Carolina. Alan has been an active member of MINT (Motivational Interviewing Network of Trainers) since 2004, is an Internationally Certified Clinical Supervisor, a Master Addictions Counselor, and a Leadership Challenge Workshop Certified Master in Training. He is concurrently the trainer for the University of South Carolina’s SBIRT grant, as he has been for several SBIRT grants since 2009. He can be contacted at [e-mail]

[@thoughtentity]

Thank you so much, as a student it helps greatly to see MI in action. Both this example and the bad example are very helpful.

[@TheIRETAchannel]

We're glad you found this helpful, Josh! FYI, if you're interested in more MI examples, we have a series on Hep C you might like: ireta.org/hepatitis-c/

[@tay873]

Thank you for showing this video, not a lot of people would showcase this. It has helped me with my own struggle ❣

[@gregg.617]

I really liked the inclusion of solution focused scaling questions. It really shows how great MI and SFBT techniques can be together.

[@rachelgreen1575]

i am very happy to have found this MI video (and its counterpart) to share with my trainees. thank you alan!

[@CliffordStarks1]

Nice session, I wish anyone the best of luck going through a time like this.

[@philly111]

Great example, thank you for sharing this video!

[@ryanconnor485]

As someone who is has just signed up to be a trainer, this is very helpful to me

[@muniama1]

Great interview! I like the way the questions are put out by the counselor.

[@Krinkels]

VERY Good OARS!! Amazing session!

[@djago5198]

Great example of MI. Very supportive and non confrontation. It allowed the client to take charge of change in her life.

[@catmomdani21]

I just came back from watching the wrong way to do it and this was a complete 180 flip by her body language and how Alan's behavior and body language was towards the client. Thank you for sharing this, it will help me in my MI journey.😍

[@blutygah]

This is a great MI role play. She obviously displays a lot of concern about her anxiety and believes a prescription will be of help. Asking if she would be open to learning some strategies on managing her anxiety and she continues her consultations with the doctor will be key.

[@iwontlose]

Solid motivational video. Major Salute from iWontLose

[@yeseniarodriguez699]

He did well. Worked on what the doctor sent him to do, and also tried to assist and provide resources with stress management,

[@claytonbailey5119]

Alan Lyme is a master.

[@LittleLadyLifeCulture]

As a second year grad student I really appreciated the MI technique.

[@fista10000]

An excellent video.

[@robbyivy7062]

Great session! Alan Lyme is my mentor....

[@nataliemarie1148]

Thank you for for the video, helpful to see it being done! Seeing lots of similarities between this and solution-focused therapy.

[@TheIRETAchannel]

Thanks Natalie, we're glad you found this helpful!

[@Bluelightcheaphotel]

"I'm a little concerned about the interaction between wine and the benzos I want to prescribe you..."

[@MazDelaCerna]

great watch!!

[@Malexa32001]

Nice input, thanks😊

[@tamarahbernixe]

• Written examples from the videos that demonstrate counselling skills you have learned in this course. • A comparison of the both videos, ensuring the following counselling skills are included: o Reflective listening skills. The counsellor used reflective listening skills when the client came in to discuss her drinking concerns. The counsellor by asking for more information was able to reflect on the information on the form the client had filled by her doctor, he was able to discuss the information correctly back to the client and gained clarification o Summarizing skills o Challenging skills o Assessment and goal identification skills o Change techniques

[@pedroruiz5225]

If you are trying to see how committed she is to change this is good But her showing up is an indication that she wants to change

[@Smsms22]

Go Alan!

[@lucidreflections]

I totally disagree with MI's focus on what I see as the symptom--emphasis on drinking behavior. Her drinking isn't the core issue, it's a symptom of increased stress. And the stress isn't the issue either. The client sees the uncomfortable sensation of stress as the issue, and so she is seeking relief from that. But the stress isn't the core-- I would direct her to look at the causes of her stress. There is a REASON that she feels stressed out. And so yes, by the end, her coming up with the solution to have someone to talk to regularly sounds good, it was good she was guided with the question about easing her stress. But with MI I often feel this approach is accusitory, like she's being put on the spot for drinking, when that behavior is just a symptom of something underlying that needs more attention.

[@2yerMom2]

I agree. She was looking to reduce her stress. He was focused on her reducing or stopping her drinking, to the point that he had a brochure to give her at the ready. To me it felt like he pre-decided she should reduce or stop her drinking, end of story. With kids and being a working parent, fitting in an exercise class when something at work has become (more) stressful sounds like one more thing to stress her time. She may have been hoping for an antidepressant, as they can reduce anxiety and they aren't addictive. A suitable medication and counseling may be ideal.

[@Psylinguist]

The therapist has an agenda of motivating her to stop drinking. Very focused - so he loses a broader approach.

[@Tjs964]

@@Psylinguist True. But unless you explore the "stress" factor and how to reduce it, the triggers for the drinking aren't going to disappear especially when she states that the drinking makes her feel better. She already knows (I'm sure) that exercise is helpful, yet she's not doing it. Why? What is the most likely thing she could do to reduce her stress - what's the most realistic? What have you attempted? Has anything worked in the past?

[@leavesongrass]

I would have felt gently coerced or manipulated if I were her and I would not have liked that. I would much prefer that my therapist had just come out and said, “I can’t prescribe an anti anxiety medication for someone who is drinking as much as you are. I need you to cut back or stop. Let’s talk about it this more.”

[@MuMu-fu7qe]

This is an example of SBIRT - an assessment of substance use and possible need for treatment. It's step one. Focusing on stressors and coping strategies would definitely come later. He's isn't necessarily her therapist - any person in the helping professions can do an SBIRT assessment. People at moderate risk are actually just as likely to get into an accident as someone high risk. This is a crucial time in someone's substance use to intervene before it becomes a serious problem. Besides, if she's looking to get on a benzodiazapine, this drinking issue MUST be addressed or else she could end up in the hospital or even dead from an interaction.

[@erikstark3250]

Idk how to feel about this example, it seemed like he was more interested in convincing her she had a drinking problem than letting her come to that conclusion herself...plenty of examples of MI.....BUUUUUT i didn't catch him amplifying any change talk....

[@Whoemiye1]

I got the same vibe.

[@kylahogan5913]

Pre contemplation is where she is at in the change. She doesn’t see the need to change her drinking problem. He induced her to start thinking of making the change and go into contemplation. I think he hit that on the dot. He got her to start thinking that it is a problem and consequences with a medication known to cause deaths of overdosing esp when combined with alcohol.

[@tay873]

Well done to this lady for admitting her weaknesses on camera 🤕👍👍👍

[@user-yr8qy2no4z]

much better Alan

[@pavelpeev1229]

When he asked - what are the not so good things about drinking alcohol for you . - He assumes that there are some not good things about drinking alcohol. for the client. This could be disengaging a bit. So asking the question like this would be much nicer: what are the not so good things about drinking alcohol for you if any? P.S. I am no expert, just learning about MI at the moment. Btw thank you for the video example :)

[@tay873]

Pavel Peev totally agree

[@truthseeking-]

I like the way you said it better than he did, but there are not so good things about every aspect in this world even being rich!

[@RebeccaEusey]

"What do you make of that?" great check.

[@Alyt14]

get this woman an oscar

[@Godless_Doc]

As a physician, a fan of motivational interviewing, which is evidence based, I must say that after watching this, it seemed to me that the patient here in ten minutes was a bit more than "medication focused" (I didn't count the number of times she independently brought it up, however it seemed to be reasonably blatantly on her agenda, or I'd have thought so if I were the interviewer). I've also noted that only positive comments are noted under these MI You tube videos, so we'll see if this one with some constructive criticism shows up. Thank you.

[@TheIRETAchannel]

Hi, Shell, thank you for sharing your observation. As you suggest, if a similar conversational trend appeared in a real life interaction, that would be a good factor to explore further with your patient.

[@spellbinderorchestra]

Agree with Shell. Nice sample of MI. Hits the keys points and numerous examples of how to use scaling questions. However, the non-invasive approach could quickly become evasive - if there is no education around when medications are appropriate, especially anti anxiety meds, so that the patient isn't fully expecting them. But I suppose it also depends on the culture & workflow of the clinic.

[@keithbonney1989]

I completely agree. She shrugged off the option of exercise and said she would be willing to cut back on alcohol consumption if she were able to get medication. Basically relying on one drug instead of the other. Idk what type of session this was supposed to be but it only lasted nine minutes. He didn't spend much time getting to know her background and figuring out other ways she could try to reduce stress. He could have asked her why she thought medication would be so helpful.

[@Tjs964]

Note: I only watched this one time, so I could have missed something. However, it appears that he implied that she wanted to give up drinking completely and she corrected him and stated that she only wanted to reduce her drinking. Furthermore, he assumed that she had little-to-no information about excessive drinking or mixing pills with alcohol. He could have asked what was her understanding about the effects of consuming that amount of alcohol daily and also mixing it with medication. Maybe she's already been through this process before? Also, he said that he was confident that she would make the necessary changes, without really knowing the client. There was no inclination on her part that could have conveyed that she was ready to make the change other than her saying she was ready. What strengths does she have that demonstrate her ability to make positive changes?

[@lesli3203]

Classic example of med-seeking, obviously. I am an addiction counselor and am frankly surprised that this isn’t blatantly obvious to other professionals on this thread. There are many of other interventions that do not include being prescribed a benzo. Perhaps he could have recommended trying exercising, meditation, deep breathing, yoga, etc. first before jumping to a medication which carries its own set of consequences.

[@cavalvo]

This is a good example of MI. The client is demonstrating textbook drug seeking behavior.

[@commercialcommunication9298]

Very interesting video. I'm wondering if more time could have been spent inviting the client to brainstorm for specific strategies or to have the client set some specific goals.

[@antoinebracy5718]

Great point!

[@grantknott]

He did say..” are there things that you can think of that may lower your stress” and she mentioned exercise but did not have time for, maybe he could have suggested some things. Is that what you meant?

[@ktownsendny1]

Lol bad joke but what I'm hearing is that she wants to be medicated or under the influence of some substance whether it came from her or from her Dr.?

[@MuMu-fu7qe]

I guess since it's just their first visit, you don't want to overwhelm the client. Often times just thinking of their substance use as problematic is a major breakthrough. Notice she thought she was only having "a couple of glasses" to realizing she exceeded the guideline max of 7 drinks per week? Change happens in stages, you don't want to throw everything at your client all at once. Now she has some good food for thought, and maybe will be looking at drinking as a contributor to her stress and not a "harmless" coping strategy :)

[@scarred10]

@@MuMu-fu7qe true,just getting her to agree its a problem that needs changing is enough in the first session.

[@JOSECABRERA-qy9yq]

There are several tips for how to findout about meditation Decide precisely why you wish to learn Decide what method works for you the best. (I discovered about these and more from Reflective folio fixer site )

[@jameswitherspoon1069]

good video..

[@shannonminnick1905]

I'd like to know more about the scale he used during this session. Where would such a scale be available?

[@ImTweetyHD]

i was wondering the same exact thing, he should've referenced the specific scale being utilized during the session

[@veronikjokic9850]

Awesome

[@dominique9898]

This is a bit if MI yes but it also pulls significantly from solution focused therapy

[@81iceprincess]

I'd be concerned with this client's constant mentioning getting a prescription from her doctor.

[@TheIRETAchannel]

Mariposa, you bring up a good point. (Another commenter mentioned the same thing a while back, as seen below.) In a real life situation, this would be something to discuss with the patient.

[@drakke125Channel]

That's the problem about being a social worker. A lot of times nothing is done during these interviews/sessions. You cannot change your client's behavior by force, you have to encourage them and help 'them' make their own decisions to change their lifestyle or behavior. That's what social work is about And I say this because I'm in the Social Work Program, and these are words directly from my program director.

[@lucidreflections]

she percieves the uncomfortable sensation of stress as her problem instead of seeing it as a helpful body guid indicator that something needs to change in her life.

[@leavesongrass]

Well anxiety can get to a crippling state and then it IS the problem.

[@roymorris710]

@@TheIRETAchannel You only have so much time in one session. you have to keep your focus on the issue the client is there for, and take note of new or connecting ones.

[@Vleti9]

this patient is way too self aware and easy to be considered a good example

[@melissageisler3151]

I, too, am concerned about the client wanting prescription meds. Why was this not discussed?

[@samanthahammett9178]

Because it’s a 9 minute video representing a longer encounter.

[@samuelvannoy717]

Sometimes people asking is innocent and not always seeking. Some people just really can't handle those levels of stress or anxiety that they're using alcohol to surpress.

[@wealthtrekkers]

"well I thought red wine.. thats news to me" lol

[@bryanzettler9998]

How rehearsed is this one?!

[@loisnicholson2141]

This client doesn't want to help herself to stop drinking. If she continues to drink her stress level will remain with her. She also wants to try medication to help her. I feel she should take small steps to stop her drinking to reduce her stress level.

[@nicholasmclaughlin9409]

The fact that she sees prescriptions as an alternative to drinking gives me concern,

[@greglippert443]

yeah she just wants to switch seats on the bus

[@gooddayok]

I saw the other one - bad example vs good example (thus get the point)

[@passionformentalhealth1017]

Key question - How important is it to you to ...?

[@11219tt]

I end up trying to relate to the client more and not be so "dry" and clinical as the example here. I'm not a social worker, though, (I help homeless individuals) so maybe i get more room for creativity. I do feel I use this technique but it's mixed in with my casual convo. Thoughts?

[@MsBebabo]

I didn't find him dry at all but very professional/calming/reassuring. It depends on the capacity you're working in.

[@tharris7290]

I agree, but his job is not to live on pure empathy but to think of the situation in big picture mode and investigate solutions.

[@peersupportcounselor1904]

So tell me more about that stress and how it makes you feel

[@peersupportcounselor1904]

And how do you feel about being stressed

[@stevendurrant1724]

Great technique but why not look at the causes of stress rather than the self medication?

[@MagycArwen]

I've just watched this and thought the same. Pretty shocked that he didn't ask her what causes her stress!

[@nurseforyou1]

There are healthier ways to deal with stress rather than using alcohol or medications. Her situation is like most people who have the responsibility of child-rearing and work. If she doesn't find healthier ways of dealing with the stress she may get worse.

[@ferdinandries7232]

This is only an initial consultation with a social worker and not a full counselling session. It seems like the purpose of this session is to elicit change talk from the patient and pave the way for booking an actual counselling appointment .

[@PrimalCoding]

it is not the alcohol!! Why is she stressed? Check her breathing pattern and give her sensations to feel in her body. I bet there is a lot she does not see.

[@gebhardt_53566]

Is there a script that goes with this with a professional coding breakdown?

[@chanigomes3288]

Did you ever find a script for this?

[@shaznbob]

The format is the Decisional Balance formula...

[@filibertoness866]

05:49 03:36 03:19

[@annepiva3236]

so a choice between medication or alcohol???

[@TheIRETAchannel]

Thanks for commenting, Anne! Ideally, this client would be able to continue down the path toward lower-risk drinking choices after this MI session. However, there *are* some medications that cannot be safely combined with alcohol. Mr. Lyme also offers some stress reduction suggestions in the video in place of either medication or alcohol.

[@khemistrykitty9870]

@@alegriart some people actually need medication due to anxiety though, and women aren’t taken seriously in medical offices as often as men due to misogyny, they are more thought to be delusional. So some people quite literally cannot just stop being “afraid of their stress” it could be a disorder.

[@peacefuljourney4858]

This is the first session and all he's doing is engaging with her and trying to build that rapport.

[@grace890]

is that good or bad?

[@anxietyrecoverycom]

So is motivational interviewing only to focus on drugs/aclochol or addictions??

[@generazian713]

Would this patient be in the preparation stage?

[@TheIRETAchannel]

That's correct! The example client begins in precontemplation (she hasn’t yet considered cutting back on her alcohol consumption). She moves through the contemplation phase during the course of the video and by the end she is in preparation.

[@LisaM1]

I am trying to locate a video on motivational interviewing that is used in a feature film. Can anyone help?

[@pe9147]

No I would’ve walked out of this session. Stress management is what she kept on asking..

[@ad.6472]

The guy looks a bit like Simon Lynch :-).

[@nurseswellness6662]

Lots of closed ended questions in the beginning. I didn't hear any affirmations. The importance, confidence scaling system is more appropriate for the 2nd visit. Needed to hear the client speak more, and let the client lead the direction of the session. Still directive style approach vs motivational interviewing, since there was a data chart shown to the patient. The interviewer spoke a lot, sometimes over the client at the end of her sentences. Needed more change talk.

[@TheIRETAchannel]

Tracy, thank you for your feedback. These are all good points to keep in mind when discussing motivational interviewing.

[@oopalonga]

would love to see a video of how you'd approach the first session tracy cuz i thought he did a damn good job

[@nygetrendsetter5104]

I concur, this left me confused after reading about MI.

[@GladiumSpiritus]

For an older woman, this woman is hot!

[@binky8501]

instead of trying to convince her she has a alcohol problem deal with the stress causing it

[@bobjohnson5486]

🤔😊

[@stanleyroberts7726]

Dark chocolate or cold showers.can release endorphines

[@81iceprincess]

Great demonstration, although the therapist may benefit from listening to himself, he often mumbles at the end of his sentences with a low tone, it's hard to understand him.

[@Psylinguist]

and he has an accent (Australian?)

[@MuMu-fu7qe]

I had to turn captions on

[@snarfsnarf3062]

nothing wrong with some wine girlfriend, I have a healthy alternative for stress relief

[@juliecarson3212]

I don’t feel the counsellor has looked into the reasons why she is stressed - isn’t that important to talk about??

[@maxeales4272]

that's exactly what I thought, I would personally want to investigate the stress prior to opening up a conversation surrounding reducing her alcohol intake

[@mindless9342]

It all depends on his goal. If his goal is to steer her away from drinking and then focus on her stress, then I'd say he did a great job (he offers counceling specfic for her stress in the end)

[@wolfiemedia]

This is just a chat, nothing more. Where exactly was the motivation? She's already there, so she wants to change. Where was the focus on the positives of not drinking? Isn't MI about a strength-based focus?Pointing out the thinking distortion (CBT), animated by him making scales with his hands, served no purpose - she knows drinking has pros and cons, she told you that. The "swap" wine for drugs needed to be explored as she was set on it being THE solution - ironically, she WAS clearly motivated by that "solution"!

[@EurekaLiveTV]

My crystal ball says she needs yoga and meditation. No pills, not a chance.

[@michellegordon4211]

Wouldn't it be prudent to ask if her drinking is adversely affecting other areas of her life besides her bank account? Does she wake up hungover? Does she miss work, appointments, etc.? She doesn't seem to have any genuine insight that she's got one foot on a banana peel...she's just saying what she believes he needs to hear.

[@Psylinguist]

she may be an actor with a narrow agenda

[@BabyChingaVC]

The whole point of motivational Interviewing is not asking questions that can make the client act defensive. It is a process, and with the right counselor you can get the client to realize themselves the impact drinking or drugs had on their lives.

[@KendallKitty]

She does say that "on the nights that maybe I have a f-couple more glasses than I should I wake up feeling a little yuck..."

[@kevinl960]

Alan is mumling a lot, not easy to understand what he is actually saying

[@81iceprincess]

I agree, it's somewhat annoying.

[@peachiepoopsie9598]

does anyone else find this technique patronising? And slightly ridiculous? Does anyone know of any better techniques, that may appeal to a more intellectual and self aware patient? Because I would feel uncomfortable adopting this approach, and in my experience as the patient, found this to be a very irritating and frustrating interaction

[@debrathomas4425]

That's part of the goal is to.help determine the level of motivation as well as.explore the problem in depth and guide the client to some insight and provide education. She identified the problem she was concerned with which should be the focus at the onset. That is not to say that a therapist should not or would not also address anxiety but may be in a later session with formal assessment tools.

[@MuMu-fu7qe]

I worry about the same thing.

[@annepiva3236]

I'm surprised she doesn't drink more!

[@caca53444]

why the f are they not talking about why she'sstressed

[@levirapoport1276]

why does he speak so low???

[@tinarusden8904]

Levi Rapoport he is speaking in a low voice like his consumer is. Called mirroring!!

[@JessBeautyJunkie]

This is a very idealistic, scripted version of how this goes. Not reality-based.

[@TheIRETAchannel]

It's true that this is a simple, scripted example, Jess. It's a starting point for folks who are being introduced to the concepts of MI. Then, being able to practice MI helps build those skills.

[@MuMu-fu7qe]

In class when we do MI role play, there is this one classmate of mine who is difficult no matter what lol We wind up not getting to use our skills because he is being so resistant. We end up respecting his choice to not further explore his substance use. EVERY TIME, no matter what the back story or skills we are trying to learn haha

[@RoyBruce007]

I'm surprised she hasn't dated a young man yet. I have asperger.

[@sadguydon8912]

This guy is whiffing.... in fact, he struck out.

[@songsofthecentury3909]

This is not a good example!!!!

[@michael.5447]

Rubbish interview makes no sense I would do better

[@livbennett6388]

Ok so respectfully, I don't think this is motivational interviewing because you can't try to convince the patient they have a drinking problem. That is exactly the opposite of what you are supposed to do. You structure the questions in a way to let them discover the negatives consequences on the own.

[@blissblossum4506]

This is NOT motivational interviewing!

[@SanchoPanable]

so why do you think so?

[@MuMu-fu7qe]

This is more SBIRT, which incorporates MI principles and skills, than just straight Motivational Interviewing.

[@dreams5672]

MI: 1. Made patient feel safe and not judged, thus leading to increased trust and honesty between professional and patient 2. Professional showed concern for patient without making a huge deal out of it and scaring her, and gently spoke to her about her problematic behavior and potential solutions. He gently explains the sheet and what is wrong with her answers, and what she is doing wrong 3. He does not blame her, using words such as ‘stress’ instead of ‘alcoholic’ or ‘junky’ or ‘addict’. 4. He tries to understand her and make her understand herself by asking open ended questions that will create introspection in patient. Not MI: This video was funny. 1. He uses an abrupt, rushed and rude tone, as opposed to his calm, caring, patient demeanor in the MI video. He speaks to her and stares at her in a judgmental, condescending way. 2. He is condescending as a whole, judgmental and unhelpful, looking uninterested and saying “a professional like myself”. 3. He triggers immediate defensiveness in her by immediately pointing out her problems without getting to know her or understand her at all. He sees the worst case scenario, and instead of treating it as an ‘intervention’ as it is, which is a concerned interaction between two people, he treats her in ways professionals are taught not to behave, for example indirectly implying/referring to her as addict, problematic, alcoholic, etc. He is scaring her away from early intervention treatment. He is making assumptions about her. 4. Over and over he reminds her that she is going well over the limit. He says “I cannot promise you a prescription even if you stop.” Which is rude and dehumanizing. His only help is demeaning her and giving her a pamphlet, when in reality he should be doing more and encouraging her more. 5. This client will leave more defensive and in denial rather than seeking help or being honest again.

[@motokiwi4100]

She was not able to get the diazepam this time. Maybe she will come back for another chat.

[@rachelgreen1575]

i am very happy to have found this MI video (and its counterpart) to share with my trainees. thank you alan!