Primary Care of the Psychiatric Mental Health Client II

Motivational Interviewing - Good Example Video Transcript

Ms. Clark: Hi, Ms. Clark. My name is Alan Lyme. I'm a social worker here, at the Family Health Center. Dr. Seel asked me if I would spend some time with you today. I'm really glad that you're here. I'm just curious as to why he would send you to me.

Alan: I came to see Dr. Seel last week because of increasing stress and anxiety that's getting the best of me. In the course of my appointment with him, he was asking how I was dealing with that stress. I mentioned that my one or two glasses of wine a few nights a week is turning into more frequent and maybe three or four on some nights. He had some concerns about that and felt like maybe you could help me with stress, or something.

Ms. Clark: He asked you to see me because you went to him for increased stress. He's concerned that your alcohol consumption may be a part of that increase. Prior to prescribing you anything, he wanted to make sure that you at least had someone to talk to about that.

Alan: I suppose.

Ms. Clark: I saw that you filled in one of the pink sheets. May I take a look at that?

Alan: He told me to fill that out and bring it with me.

Ms. Clark: Thank you. You say here that you have four or more drinks in one week. You mentioned that you may be increasing that a little bit, as well, and that you have one or two drinks in one sitting.

Alan: Typically.

Ms. Clark: Maybe monthly you had more than that. What kind of drinks do you have? What do you drink when you typically drink?

Alan: Wine with my meals. Again, one or two typically, and more frequently three or four since my stress has increased.

Ms. Clark: It's starting to increase. You're starting to drink a little more. Based on what you put here, it gives you six points on this scale. The scale ranges from zero to forty. Six points would put you in what we consider an at-risk zone. If it's okay with you, I'd like just to talk a little bit about that. The at-risk zone, as I said, it runs zero to forty. It's not a super high risk, but it certainly could be a risk for maybe increasing stress. Maybe some physical [inaudible 00:02:08] related to alcohol, as well, could start to show up if you were to increase your drinking from there or even stay there. This is a typical standard drink size over here. I'm not sure whether that fits your description of a glass of wine or not.

Alan: I fill the glass up, so maybe a little more than that.

Ms. Clark: Maybe that little space at the top. Perhaps a drink and a half, each one. That would also increase a little bit more. Perhaps you're maybe drinking more than you indicated on here. For a healthy woman your age, no more than three drinks in one sitting is considered to be low or no risk, and no more than seven in one week.

Alan: Seven total in one week?

Ms. Clark: Seven total in one week. What you say here is that even on this sheet you're perhaps already drinking more than that. What do you make of all that?

Alan: That's news to me. I thought red wine with your meals is supposed to be healthy. No more than seven in a week, that seems kind of prohibitive.

Ms. Clark: It seems a little less than perhaps you've been drinking or what you consider to be healthy drinking. Certainly there's this conflicting information out there about what's healthy and what's not healthy. I imagine the increased stress is what concerned Dr. Seel as your stress increases. If he were to prescribe you anything, maybe some interaction between the two would also be a concern for him, I would think. If you would, what is it that you like about alcohol?

Alan: It does, at least in the moment, temporarily reduce my stress. I like a good glass of wine. I don't drink the cheap stuff. I like the expensive.

Ms. Clark: You like the taste of it and it does help to lower the stress, even if it's just for that time you're drinking. What are the not so good things about alcohol for you?

Alan: The nights that maybe I have a couple more glasses than I should I wake up feeling kind of yuck. Of course, part of my stress is finances. I mentioned I like the good stuff. If I'm drinking more, then I'm increasing my financial burden.

Ms. Clark: Your financial stress may be increased by the fact that you're drinking.

Alan: Yeah. Defeating the purpose there.

Ms. Clark: A catch-22. You're drinking to reduce stress and increasing stress at the same time. On the one hand, it lowers it. On the other hand, it's increasing. A see-saw, teeter-totter effect there. What do you make of that, given that on one hand it lowers and the other hand it increases, and now it's increasing even more?

Alan: Maybe I need to find some other way to deal with my stress.

Ms. Clark: I imagine you've had some thoughts of that. What have you thought of trying, if anything?

Alan: I've exercised in the past. That helps. Right now my schedule is out of whack. I just really don't know what to do. That's why I came to see Dr. Seel. I thought maybe he could prescribe me something that would help me when I'm feeling overwhelmed.

Ms. Clark: He may be able to. I'm not saying that he cannot. I'd just imagine that he's concerned that if you continue to drink on the level that you are drinking that whatever he prescribes you there may be an interaction with it too. I imagine that's his concern. I'm not completely sure. You've had some success in the past with changing behaviors. If you were to decide to make any changes here, it sounds like you could draw upon that to make those changes. How important would it be for you, on a scale of zero through ten, I have a little visual here of that, if zero is it's not important, ten is it's very important, to do something about your drinking right now?

Alan: If it means that it's increasing my stress and/or he's not going to prescribe me anything because of my drinking, then it's fairly important. Maybe about a seven.

Ms. Clark: That's pretty up there. Why did you choose a seven, not a five or a four?

Alan: Again, I've got to get things under control. My kids are depending on me. I've got to go to work to help ease this financial stress. All those responsibilities make it ...

Ms. Clark: There's a lot riding on your decision here on what to do with this. What, if anything, would bring it up to an eight or a nine on that scale?

Alan: The risk that you mentioned about the drug interaction. I certainly can't afford to have any more stress.

Ms. Clark: You'd choose to lower your stress, rather than increase it. If lowering your drinking would have that effect, that's something you'd be willing to do right now. How confident are you that you could do something about your drinking?

Alan: Pretty confident. Probably about a seven or an eight.

Ms. Clark: It's pretty high up there again. What, if anything, would you choose to do? Would it be to cut down? Would it be to quit? I'm just curious about where you're at.

Alan: Like I said, I like a good glass of wine. I don't want to quit altogether. I'd be willing to try cutting back. If Dr. Seel would agree to prescribe me something for the anxiety and it meant that I had to not drink at all, I'd be willing to do that at least for a period of time.

Ms. Clark: You'd be willing to stop altogether if that's what was indicated by the physician. Based on that, how ready are you to do anything right now, whether it's to cut back, whether it's to quit?

Alan: Again, if I can get something to help me manage, if maybe I can find some other way to deal with the stress, then I'd be pretty ready. Again, maybe about an, on that scale, maybe an eight.

Ms. Clark: That's pretty high up there, as well. It sounds as though you're pretty motivated to do something about this right now, given your responsibilities, given your children relying on you at this point, and just on lowering your anxiety in general. It sounds that that's one of your goals, as well. I'm pretty confident that once you decide to do whatever it is you decide to do you'll be able to follow through with that based on your experience in the past of making behavior changes. I imagine there are some things that you can draw upon. What's one thing that you could do? I imagine that you've thought of some things that might help to lower your stress.

Alan: The exercise, but, again, that's difficult to fit in right now. I'm hoping that Dr. Seel will prescribe something for me to take when I'm feeling particularly overwhelmed. Maybe just having somebody to talk to, to bounce some things off of.

Ms. Clark: One of the things we can offer here is for you to come in and talk to one of our behavioral health specialists who may be able to help you talk through this, this area of your life, this area of increased stress and it sounded like responsibility there. We can make an appointment for you, if you like, before you leave today to talk to somebody.

Alan: That'd be nice.

Ms. Clark: Great. I also have some information here, if you're interested, a pamphlet on alcohol and what healthy limits are and how it may be affected by medications that you take, as well. I wish you lots of luck. It sounds as though you're really committed to making this shift and this change. I imagine Dr. Seel will want to follow up with you and see how you do with your change within a few weeks. Again, I look forward to speaking to you in future.

Alan: Thank you very much.

Ms. Clark: You're very welcome.