Table 3.

Example of MET-EA Phase 3: Providing Feedback and Education

Dialogue	MI Strategy
THERAPIST (T): You filled out questionnaires that can help us see in what ways you may be anxious and whether you seem to be depressed. I’d like to review how you answered so we can talk about it together and see what your thoughts are. Would that be okay?	Brief structure and introduction; asking permission
CLIENT (C): I guess that would be all right.
T: Okay, and as we go through it please let me know if it sounds right for you. I want to make sure that I am understanding what you think is going on. The first questionnaire you answered helps us see if you are depressed or not. You scored in the range that we often consider someone to be depressed. For example, you said you often feel tired, have some difficulty sleeping, and don’t enjoy things as much. Tell me a bit more about how some of these things are affecting you.	Inviting active participation, providing feedback, and asking for elaboration; note last sentence is considered an open-ended question
C: Well, I feel so stressed out all the time, that I really can’t enjoy anything. Work is probably the thing I enjoy the most because I can get my mind off my own problems. But since I don’t sleep well, I feel tired all of the time. I worry about things all night, so I get on my computer and I start e-mailing or texting my friends. That helps.
T: So you’re tired a lot, at least partly because you can’t sleep well at night. It also sounds like your stress is pretty bad at night and getting in the way of your rest.	Clarifying symptoms
C: I am basically a vampire, up all night. An anxious vampire. I don’t know why I can’t sleep. It’s such a problem.
T: Sleep difficulties are often seen in depression, but we also see that people with anxiety can worry a lot at night, which may lead to problems sleeping. It’s also common to see depression and anxiety happening at the same time. Both depression and anxiety can affect feelings and thoughts and make things seem less interesting. Tell me a bit more about not enjoying things as much.	Offering information
C: Well, things are so stressful and at times I just feel like being alone and not dealing with anyone. It seems weird because I also still want to go to work, but I guess I just want to avoid all the problems that are always running through my head. In the end it makes things less fun.
T: Sitting alone with all of your anxious thoughts is pretty tiring. It’s better to try to keep busy.	Collecting summary and reflection
C: Yes, it’s much harder, the anxiety part. It’s much tougher this year. There’s so much for me to get done.
T: You’re overwhelmed.	Reflection of feeling
C: Yes! Isn’t that horrible? I am such a loser sometimes. I can’t deal.
T: You’re really doing your best to manage your anxiety and depression, and you’re really making an effort. But when people are depressed and anxious, we often feel and act in ways that make us unhappy and frustrated. When people have the types of problems you describe like sleep problems, worries, and low energy, we usually think they have depression or anxiety, or both, and that they might need some help to stay on track. That may be what’s going on now, and the added stress of transitioning out of school and into work can make things feel worse, even if you are looking forward to the change. What are your thoughts on that?	Supportive statement and reframing her mood in terms of medical model, then eliciting her reaction; note open-ended questions; note framing in medical model without seeming too “pathologizing,” which might seem negative to EAs
C: Well it is pretty stressful, that’s for sure! I just can’t deal with it I guess.
T: This is a challenging time and it can feel like you’ll never dig your way out.	Rolling with resistance via reflection
C: Yes! I could really use some help from my parents, but I’m not holding my breath. Maybe if I had support from them—or someone—I would feel better.
T: That makes sense. When things are stressful, it is a good thing to feel helped or supported. Stress can make both depression and anxiety worse, and getting support—especially from our family—can be helpful. I think that’s consistent on how we see things. What do you think?	Supportive and reframing to medical model; note open-ended question
C: So can the depression and anxiety get better? Because I don’t think the stress is going to go away.
T: Well, I believe your situation feels pretty bad for you. When you’re depressed or feeling really anxious, everything can start to look overwhelming very quickly. It feels like things are just too much to handle. It’s also harder to find solutions to problems, and it’s likely that you will feel frustrated with yourself and others. As you become less depressed, you may feel stronger or more able to deal with difficult situations, even if the problems or stressful situations don’t change right away. We do find that depression and anxiety can get better.	Reframing without minimizing difficulty of situation; reframing to medical model to respond to question
C: Well, I can use some help to feel better. It’s pretty stressful, and I need some help to get through it better.	Adherence talk
T: The good news is that we can provide help for your depression and anxiety, we can look at what has and hasn’t helped in the past, and we can offer some options that might help. You can then start to feel a little less overwhelmed and more able to do the things you find important, while feeling less stressed.	Offering hope
C. That would be great if it worked.