Derek Joyce MID-TERM EXAM, FALL 2012 Directions: Use one of the case studies provided below and

apply Motivational Interviewing as your theoretical approach, incorporating the Transtheoretical Model. Identify where you believe your client may be in his/her readiness to make changes. Then, you must explain how you would apply the theory to work with the client. You may use your notes to complete the assignment, so be thorough and specific in your explanation. See the Rubric at the end for an explanation of how your case studies will be evaluated. Your highest possible score is 50 points. Please submit your completed exam by GeorgiaView email by Thursday, October 18th at midnight.

Case Study #1: Jim Hernandez

Jim is a 68-year-old Hispanic male who was diagnosed with type 2 diabetes two years ago and is a retired electrician. He enjoys golfing, fishing, walking, and spending time with his children and grandchildren. Jim divorced his wife five years ago and also has two adult children, Mary and Tom, that live in the same town as he does. Jims children visit him often and Tom helps him with the shopping for healthy meals every week. Jim has four siblings, two sisters and two brothers. All of his siblings live near his house and also visit almost weekly. When Jim doesnt have any energy, he watches television or calls one of his family members to catch up on whats going on in the family. Jims family knows about his diabetes and is supportive of his plan to exercise, eat healthier, and take his medications. Lately, Jim has had difficulty monitoring his diabetes. Although, he takes his medication as prescribed, he hasnt had the energy to exercise or prepare fresh, healthy foods. He also has noticed he is more thirsty than normal and is going to the bathroom more frequently. Jim recently went to see his primary care physician for his regular sixth month check-up. After a physical examination, his doctor informed him that his blood sugar levels were higher than normal. Jims doctor urged him to check his blood pressure more often, eat more low-fat foods, and get plenty of exercise. Jim was worried that he might not be able to follow the doctors recommendations and asked his doctor if there he knew a counselor that could possibly help him. Jims doctor agreed that counseling or possibly a support group could help motivate Jim to better maintain his diabetes and an appointment with a counselor was set up for a week later.
During the initial meeting with the counselor, Jim expressed some doubt about his ability to changing his behaviors even though he knew he needed to change to manage his diabetes. Jim stated, I know I need to change and I want to change, but its so difficult to take that first step. He made other statements like, I am already so old, why do I need to change? (Insert your response to the case study here if you choose case study #1.)

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Jims case is characterized by necessity and confusion. He has the knowledge, tools, and the support group needed to support change. He even states that he has the occasional desire to change. What Jim is lacking is the guidance to make accommodations for and to adhere to his new lifestyle and a way to settle his ambivalence. Based on his statements and actions, I believe that Jim is in the Contemplation Stage of the Transtheoretical model. This stage is categorized by the client jumping back and forth on the concept of change. This is evidenced by Jims alternating statements of I know I need to change and I want to change, but its so difficult to take that first step and I am already so old, why do I need to change? To begin the session, I would ask the client to describe himself to me before addressing his diabetes. Having a degree of knowledge of Latin American society, one of the largest cultural differences would be the concept of masculino, which dictates the character traits and behaviors that are considered appropriate for Latin American men. For instance, it is considered taboo to show signs of weakness and to complain about lifes hardships. It is likely that this is one of the sources of ambivalence for Jim, since checking his blood sugar and other behavioral changes would only confirm and actualize his affliction. Using Motivational Interviewing, it is my role as the counselor to not object to the Jims resistance, but to empathize with it and to redirect that into a motivational force. Because I know going in that the client is a diabetic, I must be wary not to fall for the Labeling and Premature Focus traps. That means I must be careful not to address the diabetes and Jims actions regarding it before the client is ready to discuss it. When Jim is ready to discuss his diabetes, I will use a combination of empathic statements and open questioning in order to build rapport with the client and to draw out the clients story. When it comes time to discuss his recent behaviors, I would use two-sided questioning to assess the pros and cons of Jims current path of action. If the client still maintains resistance to behavior change, I will ask how he was able to work with the diabetes and blood monitoring before. I would then use reframing and emphasize personal control to suggest that by checking his blood sugar, exercising, and maintaining the program given to him by his doctor, that he will have more energy with which he could be with his family

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and to resume some of his favorite activities, such as golf and fishing. Hopefully, this would help him resolve his ambivalence towards change. Once we have entered the Determination Stage, where the client is seriously considering change, Jim and I would work together to develop a change strategy that is of his origination with goals that he has set. My role would be to help Jim refine his goals and plan of action. The important thing, though, is that the client is in charge of this program, using his reasons and motivations. My affirmations will strengthen his resolve and evoke change and collaboration will lead to specific and realistic behavioral goals. After that, the client would be asked to engage in homework assignments to act towards his goals. Once the goals are met, our focus would be shifted to relapse prevention and the difficulties of maintaining the change. This would be done by focusing on Jims ability to act on his own, through his own strength and will, being empathic towards his struggles, and reassessing what it would take to maintain the change.

Derek Joyce EXAM GRADING RUBRIC

15 points Student demonstrates superior knowledge of the theory.

12 points Student demonstrates above average knowledge of the theory

CRITERION 9 points Student 7 points Student demonstrates demonstrates average knowledge below average of the theory. knowledge of the theory.

Score
4 points Student demonstrates very little knowledge of the theory. 0 points demonstrates no knowledge of the theory chosen

15 points Student is very thorough and specific in describing the process of applying the theory to this case study.

12 points Student is thorough in describing the process of applying the theory to this case study, and lacks no more than one element. 12 points Students paper has no more than two or three errors.

15 points Students paper is free of grammatical, spelling, and punctuation errors.

9 points Student is fairly thorough in describing the process of applying the theory to this case study, and lacks no more than two or three elements. 9 points Students paper has no more than four or five errors.

7 points Student is sketchy in describing the process of applying the theory to this case study, but lacks no more than 4 or 5 elements 7 points Students paper has more than 5 errors.

4 points Students application of the theory to this case study is inadequate, and lacks many elements

0 points student does not apply the theory to the case study.

4 point Students paper has more than 10 errors.

0 points Students paper has many errors and demonstrates no effort to follow rules of grammar, spelling, or punctuation.

Total Score out of 50 Points

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