MRI+Case+Examples


 * Michael presents to therapy because he is concerned and "anxious" about following through with his marriage to his fiancé, Stacy. Michael reports he thinks about this all of the time, and it is interfering with his work. While at work, he continuously forgets deadlines and appointments because his thoughts are consumed with worry and anxiety. When he is not at work, he becomes too anxious to talk about it with her so he completely avoids the conversations regarding this topic. Stacy, though, wants to talk about the wedding details and get Michael's input on everything but he walks away when she approaches him with this topic. He feels like he is making a mistake if he marries her because he thinks he likes her more as a friend. He would like to talk to her about it but he just cannot bring himself to opening the conversation about this.**

A therapist using the MRI therapy model will ask detailed questions about Michael's behaviors. Have client define what the main problem is by asking for behaviors and actions from any person who is dealing with the problem. - ask details about how often it occurs, when (what time of day), who is there, how the person acts, etc. "So, Michael, tell me about the days when you are at work and you are thinking more about your relationship with Stacy and, thus, forgetting work deadlines?" "Tell me about the times when you are at home with Stacy and she approaches you with the dreaded topic. How does she approach you? What do you do when she approaches you? Does she usually approach you at the same time of day? How do you know when she is going to talk about this certain topic?" etc. - also find out what other person does in reaction to others dealing with the problem "So, when you avoid Stacy, what do you do to avoid her and discussing this topic? What does she do when you try to avoid her? How many times do you have to avoid her in a day?" "Michael, tell me about a time when the problem does not affect you as much. What are you doing? When?" "Are there times when you and Stacy have discussed the wedding plans and you did not have to avoid her? What was different about that time? How did you talk with her about it then?" etc. - "What would be a small sign that you were not as anxious about talking to Stacy about the wedding? What would be doing? When? How would she know? How would she react to your behaviors?" etc.
 * Session 1:**
 * "What is the problem that brings you here today?"
 * The therapist will use //implicit optimism//, which makes the assumption that there are times when the problem is affecting Michael less or when it is not occurring.
 * Assign homework: Ask Michael to //**think**// about a small and concrete significant sign that he is moving in the direction of being less anxious.
 * Remind him to go slow and the preference is to change little by little (baby steps).

- ask Michael what thoughts and ideas he came up with regarding a small sign that things had improved. - It appears that Michael has been telling himself not to think about the wedding and avoiding discussions about it with his fiancé. He has been telling himself to stop thinking about it or trying to do something else. These attempted solutions are what is maintaining the problem. Therefore, it would be helpful to ask Michael to take note of the thoughts that make him "anxious" and keep a diary of them. The therapist can frame it as an investigation to see if these thoughts have the power to make him "anxious".
 * Session 2:**
 * Discuss what was done about the homework.
 * Encourage Michael to take his time and show concern if he is moving too fast towards improvement.


 * Subsequent Sessions:**
 * Reviewing homework is always the focus point of subsequent sessions.

- Telling Michael to slow down and not change too fast shows him that there is change being made. It also keeps the therapist from pushing him in the direction where he is already going (not working harder than the client). Then, Michael is able to take credit for the progress and change. - Taking a more cautious and pessimistic approach allows Michael to present a more optimistic view of the situation as well. So, you can also start sessions with Michael by asking him, "How bad has your anxiety been the past week?"
 * Continue to remind Michael to go slow and it is better not to change much at this point. This intervention is used as a counter balance to the client's decision that "it is now time to make a change".