Prompt 2: “I’d cook more if I wasn’t so tired when I get home.”
“It’s hard to cook when you’re so tired.”
Feedback if chosen: This reflects the patient’s reluctance to change. Instead, use a statement like “You’d like to cook more often.” to emphasize their interest in change.
“You’d like to cook more often if you could find some easy recipes.”
Feedback if chosen: Right! This reflection emphasizes the patient’s implied interest in cooking. They’re likely to respond with more change talk on that subject.
“You haven’t been successful in cooking more.”
Feedback if chosen: This reflects the patient’s failure to change. Instead, use a statement like “You’d like to cook more often.” to emphasize their interest in change.
Prompt 3: “I don’t smoke much when I’m by myself, but when I’m with friends, I smoke more than I mean to.”
“You don’t like how much you smoke when you’re out with friends?”
Feedback if chosen: This question will stop the patient’s train of thought and prompt them to verify what they just said. Instead, phrase your reflection as a statement like “You smoke more than you’d like when you’re with friends.” to encourage them to continue their narrative.
“You’d rather be by yourself than feel like you have to smoke.”
Feedback if chosen: This is more of a guess than a reflection. A simple reflection like “You smoke more than you’d like when you’re with friends” would do more to show you’re listening.
“You smoke more than you’d like when you’re with friends.”
Feedback if chosen: Correct! This emphasizes the patient’s awareness and interest in change and encourages them to continue with this train of thought.
Prompt 4: “My family thinks I smoke too much, but I’m just doing it to relax.”
“Smoking helps you relax.”
Feedback if chosen: This reflects a reason to continue tobacco use, which is sustain talk. A simple reflection like “They’d be happier if you smoked less.” would emphasize change talk and likely elicit more of it.
“They’d be happier if you smoked less.”
Feedback if chosen: Right! This reflects a possible reason for change, which is change talk.
“Your life is stressful.”
Feedback if chosen: This could be an accurate reflection, but it doesn’t connect to changing tobacco use. A simple reflection like “They’d be happier if you smoked less.” would emphasize change talk and likely elicit more of it.
“Do you think they’re right?”
Feedback if chosen: It’s best to offer a reflection, not ask a question. This question could also make the patient feel pressured. A simple reflection like “They’d be happier if you smoked less.” would emphasize their change talk without sounding confrontational.
Pic 47: The questionnaire screen updates with the title “Identify Complex Reflections” on the top. Each prompt has a few response selections.
Prompt 1: “I want to take care of my health, but I feel like I’m on so many medications already.”
“You are considering how a cholesterol medication would fit into your plan for your health.”
Feedback if chosen: Nice! You identified the change talk in the patient’s statement (their desire to take care of their health) and reflected it. You reframed their objection into a desire to consider change.
“You don’t want to have to take another medication.”
Feedback if chosen: The patient did imply that, but reflecting that sentiment won’t help build motivation for change. Instead, identify the change talk in their statement (their desire to take care of their health) and try to reflect that.
“If you want to take care of your health, then you’ll want to start taking something for your high cholesterol, too.”
Feedback if chosen: This isn’t a reflection of what the patient said; it’s your recommendation. This could provoke a defensive response or derail the patient’s consideration of change. Instead, identify the change talk in their statement (their desire to take care of their health) and try to reflect that.
Prompt 2: “I eat a lot of snacks during the day. Then, I’m already pretty full when it’s time for dinner.”
“Snacks have become part of your routine.”
Feedback if chosen: This is a good guess about what the patient means, but it reflects an argument against change, when you should be trying to amplify the patient’s arguments for change with a statement like “You’re worried these snacks may not be good for your weight.”
“When you snack, you don’t eat dinner.”
Feedback if chosen: This is a simple reflection, restating what the patient just said. A complex reflection adds meaning or emotion like “You’re worried these snacks may not be good for your weight.”
“You’re worried that snacking might make it harder to lose weight.”
Feedback if chosen: Right! This is a reasonable guess about what the patient might be thinking or feeling, and it emphasizes a reason for change.
Prompt 3: “I started smoking back when I was in high school. I didn’t think I’d still be smoking all these years later.”
“You never imagined that smoking would develop into such an unhealthy habit.”
Feedback if chosen: Good job! You made an educated guess about the unspoken desires for change this patient might have, based on what they said. This reflection highlights those desires and encourages the patient to continue with this train of thought.
“Are you worried you might have health problems in the future?”
Feedback if chosen: This is a question instead of a statement, which interrupts the patient’s train of thought and can make them feel interrogated. It would be better to use a statement like “You never imagined that smoking would develop into a habit.”
“What I’m hearing is that you want to quit smoking.”
Feedback if chosen: This is quite a leap from the patient’s comment about smoking, and they might feel like you’re pressuring them to quit. It would be better to reflect the patient’s feelings like “You never imagined that smoking would develop into a habit.” and let them say if they’re ready to quit.
Prompt 4: “It’s tough because I tried being more active with my friends, but they didn’t stick with it either.”
“You wish your friends were more active.”
Feedback if chosen: This is an educated guess about what the patient meant, but it focuses on something that is probably beyond their control, their friends’ behavior. It would be better to focus on something the patient does control like “You wish you could get more exercise.”
“It’s hard to find time to be active.”
Feedback if chosen: This is an educated guess about what the patient meant, but it reflects an argument against change, when you should be trying to amplify the patient’s arguments for change with a statement like “You wish you could get more exercise.”
“You wish you could get more exercise throughout the week.”
Feedback if chosen: Correct! This is a reasonable guess about this patient’s unspoken desire for change. It’s no big deal if it isn’t accurate. The patient will correct you, and you’ll learn more in the process.
Pic 48: The iconography and titles disappear, leaving Danielle centered on screen.
DANIELLE: You’ll have the opportunity to practice Motivational Interviewing with several virtual patients. Each virtual patient possesses a unique persona and history that you must address to achieve your objectives for the visit. But first, we’ll learn a little more about the social and cultural factors that can affect a patient’s health, and how these techniques can help.