USING MOTIVATIONAL INTERVIEWING IN PRACTICE

One of the primary acronyms used in MI is O.A.R.S.

This is a brief method of remembering the basic approached to using Motivational Interviewing in practice.  They are sometimes called Micro-Counseling-Skills.

OARS stands for Open Ended Questions, Affirmations, Reflections, and Summaries.

These are:

Open-ended questions:

These are questions that make it difficult for a client to answer with a “Yes” or a “No”.  They also discourage clients from answering a questions with a short, specific, limited piece of information. These questions invite the client into the conversation and help them think about issues more deeply and with more elaboration.  These questions also move the conversation forward and allow the client to explore reasons for change and the different possibilities for change.  Closed-Ended questions have their place in an interview, but they can also stifle communication.

Affirmations:

These are statements that make communication better.  They are statements that allow you to recognize you client’s strengths.  These statements allow you to build rapport with your client and help them see themselves in a different light.  These statements are only effective when they are genuine.  They must be congruent to be effective.  Using an affirmation that does not match the client will often be perceived as superficial. Often clients have tried to change in the past and have been ineffective.  Affirmations allow clients the chance to start again and to feel change is possible.  These statements often reframe behaviors to show the client’s positive qualities.  These are the key element in facilitating MI’s principle of Self-Efficacy.

 Reflections

Of all the skills in MI, reflective listening is probably the most crucial skill.  Reflective listening has two primary and crucial purposes.

Its first purpose is to activate the basic principle of Expressing Empathy. When the therapist provides careful listening and appropriate reflective responses, the client will begin to accept that the therapist understands the issues from their perspective.

Reflective listening also assists in guiding the client toward their change and supporting the client’s goal-directed change.  Reflections assist the client in perceiving their ambivalence and allow them to focus on the negative aspects of the status quo.  It helps them focus on change.

Summaries:

These are a special form of a reflection in which the therapist reviews and recaps what has been discussed and decided in one or more of the counseling sessions.  These reflections communicate interest, understanding and allow the therapist and client to identify the most important elements of the conversation.  Summaries can be used to help the client re-frame and shift their attention in a new direction, thereby preparing them to change and “move on.”  These statements are able to highlight both sides of a client’s ambivalence about change and promote the development of discrepancies that can be selected by the therapist to strategically determine which information needs to be augmented and which information should be minimized.

Change Talk

These are statements are made by the client. They enable to therapist to watch the client as they reveal the clients consideration and motivation and a commitment to change.  The task of the therapist using MI seeks to guide the client to the expressions of change talk.  The therapist is not the Guru.  They are the trail-guide.  Current research shows a clear correlation between client statements about change and the outcomes the client later reports.  These reports show a greater level of success in changing a behavior.  The more your client talks about change; the more likely they are to change.

Different types of change talk can be described using the mnemonic DARN--‐CAT.

 Preparatory Change Talk

      Desire (I want to change)  

        Ability (I can change)

       Reason (It’s important to change)

       Need (I should change) And most predictive of positive outcome:

Implementing Change Talk

       Commitment (I will make changes)

       Activation (I am ready, prepared, willing to change)

        Taking Steps (I am taking specific actions to change)

10 Strategies for Evoking Change Talk

These are the specific therapeutic strategies that are likely to elicit and support change talk in Motivational Interviewing:

1. Ask Evocative Questions: Ask an open question, the answer to which is likely to be change talk.

2. Explore Decisional Balance: Ask for the pros and cons of both changing and staying the same.

3.  Good Things/Not--‐So--‐Good Things:  Ask about the positives and negatives of the target behavior.

4. Ask for Elaboration/Examples: When a change talk theme emerges, ask for more details.

“In what ways?”

“Tell me more?”

“What does that look like?”

“When was the last time that happened?”


5. Look Back: Ask about a time before the target behavior emerged. How were things better, different?

6. Look Forward: Ask what may happen if things continue as they are (status  quo).  Try the miracle question:

If you were 100% successful  in making the changes you want, what would be different?

How would you like your life to be five years from now?  


7. Query Extremes: What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?

8. Use Change Rulers:

Ask: “On a scale from 1 to 10, how important is it to you to change [the specific target behavior] where 1 is not at all important, and a 10 is extremely important?

Follow up: “And why are you at ___and not _____ [a lower number than stated]?” “What might happen that could move you from ___ to [a higher number]?”

Alternatively, you could also ask: “How confident are that you could make the change if you decided to do it?”

9. Explore Goals and Values: Ask what the person’s guiding values are. What do they want in life? Using a values card sort activity can be helpful here. Ask how the continuation of target behavior fits in with the person’s goals or values. Does it help realize an important goal or value, interfere with it, or is it irrelevant?

10. Come Alongside: Explicitly side with the negative (status quo) side of ambivalence. “Perhaps _______is so important to you that you won’t give it up, no matter what the cost