Motivational Interviewing – Good Example – Alan Lyme
why miss Clark my name is Alan Lyme I’m
a social worker at the Family Health
Center dr. Sheila asked me if I would
spend some time with you today
I’m really glad that you here I’m just
curious as to why he would send you to
me well I came to see dr. Steele last
week because of increasing stress and
anxiety that’s kind of getting the best
of me and in the course of my
appointment with him he was asking how I
was dealing with that stress and I
mentioned that my one or two glasses of
wine a few nights a week is turning into
more frequent in maybe three or four on
some nights and he had some concerns
about that and and felt like maybe you
could help me with stress or something
yeah so he he actually see me because he
went to him for increased stress and
he’s concerned that your alcohol
consumption may be a part of that
increase and prior to prescribing you
anything you want to make sure that you
had someone to talk to about that I
suppose okay I saw you filled in one of
the pink sheets might take a little bit
he told me to fill that out and bring it
with me okay thank you so 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 um
and that you have one or two drinks in
one setting typically yeah and maybe
monthly you have more than that what
what’s what kind of drinks do you have
what do you drink we need to drive wine
with my meals
um you know again one or two typically
and more frequently three or four so my
stress is increased so starting to
increase this times drink a little more
okay well based on what you put here you
give it gives you six points on this
scale scale ranges from zero to forty so
six points will put you in what we
consider an at-risk zone so if it’s okay
with you lots to talk a bit about that
okay
okay so that was sunset run zero to
forty it’s not it’s not a super high
risk but it certainly could be a risk
for maybe increasing stress maybe some
physical Emmas related to alcohol
well could start to show up if you were
to increase your drinking from there or
you can 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 a lot I fill the
glass up so maybe a little more than
yeah maybe the little space that it’s
upside to drink drink and a half each
one so that also increased a little bit
more so perhaps maybe drinking more than
you indicated on here and for women you
healthy woman your age no more than
three drinks in one setting is
considered to be lower or no-risk and
1/7 in one week so in total how much
total in the week and what you say here
is that even on this sheet you’re
perhaps already drinking more than that
mmm
so what do you make of all that well
that news to me you know I thought red
wine with your meals is supposed to be
healthy and you know no more than seven
in a week that seems kind of prohibitive
yeah it seems it seems a little less
than perhaps you’ve been drinking with
what you consider to be healthy drinking
and certainly there’s this conflicting
information out there about what’s
healthy what’s not healthy imagine the
increased stresses what because we’re
concerned or to seal as your stresses
increases and if you were to prescribe
you anything maybe some interaction
between the two but also build and serve
them I would think so if you would what
is it that you like about alcohol well
you know it does at least in the moment
temporarily reduce my stress and I you
know like a good glass of wine I don’t
don’t drink the cheap stuff I like the
expensive what so you like the taste of
it mm-hmm and it does help to lower the
stress signal which is for that time
you’re drinking one of those so good
things about alcohol for you um well you
know the nights that maybe I have a
couple more glasses than I should I wake
up feeling kind of yuck and of course
part of my stress is finances and I
mentioned I like the good stuff and so
if I’m drinking more than I’m increasing
my financial burden yeah so your
financial stress may be increased by the
fact that you’re drinking yeah kind of
defeating the purpose there 22 the
drinking to do stress and increasing
stresses
so the one hand it lowers it on the
other hand it’s increasing kind of a
seesaw teeter-totter effect then what do
you make of that give them that on one
hand it lowers and the other had it
increases and now it’s increasing even
more maybe I need to find some other way
to deal with my stress yeah imagine
you’ve had some thoughts of that what
have you thought of trying well I’ve
exercised in the past and that helps
right now my schedule is kind of out of
whack and I just really don’t know what
to do that’s why I came to see dr.
Steele I thought maybe he can prescribe
me something that would help me you know
when I’m feeling overwhelmed and he may
be able to I’m not saying that he cannot
I’m 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 the to imagine that
she’s concerned I’m not completely sure
so you’ve had some success in the past
with changing behaviors and if you were
to decide to make any changes here it
sounds like you could drop all that to
make those changes how important would
it be for you on a scale of 0 through 10
i below the visual here with that if
zero is not important tennis is very
important to do something about your
drinking way mm-hmm well I mean if 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 7
mm-hmm let’s put it up there why do you
choose a 7 or a 504 well again I’ve got
to get things under control you know my
kids are depending on me and I’ve got to
go to work to help ease this financial
stress and so you know all those
responsibilities there’s a lot riding on
your decision in what to do this what if
anything will bring up too late online
on that scale
um well the you know the risk that you
mentioned about the drug interaction I
certainly can’t afford to you know have
any more stress
yeah so so you choose to lower your
stress rather than increase it and if lo
and your drinking would have that effect
that something be willing to do right
now how confident are you that you could
do something about your drinking I’m
pretty confident and you know probably
about a seven or eight okay so it’s
pretty hot up there again and what if
what if anything would you choose to do
would be to cut down with a bit to quit
just in case but you know I like I said
like a good glass of wine I don’t want
to quit altogether
I’d be willing to try cutting that but
you know if it’s going to if doctor seal
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 so
you’d be willing to stop altogether
that’s what was indicated by the
physician okay so so based on that how
ready are you to do anything right now
whether it’s to cut back whether it is
to quit well again you know if I can get
something to help me manage if maybe I
can find some other way to deal with the
stress then then you know I be pretty
ready I again maybe about in on that
scale maybe an eighth okay so that’s
that’s pretty hot there as well it
sounds is that you’ll be pretty
motivated to do something about this
right now given your responsibilities
given your children relying at this
point and just on on lowering anxiety in
general it sounds and that’s one of your
goals as well 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 that based on your
experience in the past of of making
behavior changes imagine some things
that you can draw upon what’s one thing
that you could do imagine you thought of
some things might help to lower your
stress well I you know the the exercise
but again that’s that’s kind of
difficult to fit in right now hoping
that dr. seal will prescribe something
for me to take when I’m feeling
particularly overwhelmed and maybe just
having somebody to talk to to bounce
some things off of one of the things we
can’t offer here is for you to come in
and talk to one of our behavioral health
specialists may be able to help you talk
talk through this there’s a terrible
stress and sound like responsibility
there and we can make a point for you if
you like before you leave today dad talk
to someone that’d be nice right it also
has some information here if you’re
interested some a pamphlet on alcohol
and and how what healthy limits are and
how it may be affected by medications
that you took as well and I wish you
lots of luck it sounds as though you
really committed to making this shift in
this change and imagined doctors still
wanna fight with you and see how you do
with your with your change within a few
weeks again I look forward to speaking
to in the future all right thank you
very much you’re welcome
