Motivational Interviewing: OARS and Change Statements, Schemes and Mind Maps of Communication

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Motivational Interviewing

Desk Reference

Foundation of Motivational Interviewing (MI):

OARS

- The Basics

Motivational Interviewing is an

“A directive, client-centered counseling style for helping clients explore and resolve ambivalence

about behavior change.”

William R. Miller, 1991

Open-ended Questions, Affirmations, Reflective Listening, and summarizing (OARS) OARS are the foundation of the MI skills and techniques that are used regularly and consistently, and will become a comfortable way ofcommunicating with clients, colleagues and family alike. OARS, an acquired MI skill, will eventually become a natural interpersonalcommunication skill observable in all interactions. Open-ended Questions Open-ended questions allows the client to speak more than the Intensive Supervision Officer (ISO), they allows the client to shareinformation, in their own words, without input from their ISO. ISOs must listen to what the client is saying which will assist the ISO inasking any follow up questions. Open-ended questions while used often in an exchange in dialogue are not exclusive, closed questions(yes or no responses) and will be used as follow up tools to expand on the subject or provide clarification.Here are some samples of open questions:

Who is the most important person in your life? And why are important to you? ¾ How does being on probation affect your home/work life? ¾ Who are the 5 most important people in your life? ¾ How can I help you with ___? ¾ Help me understand ? ¾ What was the best 5 minutes of your day? ¾ What was the worst 5 minutes of your day? ¾ How would you like things to be different? ¾ What are the good things about ___ and what are the less good things about it? ¾ When would you be most likely to? ¾ What do you think you will lose if you give up ___? ¾ What have you tried before to make a change? ¾ Who in your life support you changing this behavior? ¾ What do you want to do next? ¾ How does your (behavior) affect your family? ¾ “What do you know about the risks of (drinking/drugs)?” ¾ How will getting off probation affect your home/work life?

There are three types or degrees of reflective listening that can effect and impact the rapport building process. In general, the depthshould match the situation.Examples of the three levels include:

Repeating or rephrasing : Listener repeats or substitutes synonyms or phrases, and stays close to what the speaker has said ™ Paraphrasing : Listener makes a restatement in which the speaker’s meaning is inferred ™ Reflection of feeling : Listener emphasizes emotional aspects of communication through feeling statements. This is the sincere and genuine form of listening. Varying the degree of reflection is effective in listening. Also, at times there arebenefits to over-stating or under-stating a reflection. An overstated reflection may cause a person to back away from their position orbelief. An understated reflection may help a person to explore a deeper commitment to the position or belief. OARS: Summarizing Summaries can be used throughout a conversation but are particularly helpful at transition points, for example, If you are in a lengthyconversation with a client, you may summarize at some point to ensure you are on track with where the client is going, then continuewith the conversation. Summarizing is also done at the ending of the conversations as well. Example of Summaries: Begin with a statement indicating you are making a summary ¾ Let me see if I understand so far… ¾ Here is what I’ve heard. Tell me if I’ve missed anything. ¾ “What you’ve said is important.” ¾ “I value what you say.” ¾ “Here are the salient points.” ¾ “Did I hear you correctly?” ¾ “We covered that well. Now let's talk about ...” ¾ In summarizing…

Change Statements During all conversations with a client pay special attention to

Change Statements

. These are statements made by the client that point

towards a willingness to change. Miller and Rollnick (2002) have identified four types of change statements, all of which overlapsignificantly:

Problem recognition : “My use has gotten a little out of hand at times.” ™ Concern : “If I don’t stop, something bad is going to happen.” ™ Intent to change : “I’m going to do something; I’m just not sure what it is yet.” ™ Optimism : “I know I can get a handle on this problem.”

1) If the person expresses ambivalence, it is useful to include both sides in the summary statement. For example:

“On the one hand you

feel… on the other hand you want to…” 2) It can be useful to include information in summary statements from other sources to offer a full picture (e.g., your own professionalknowledge, treatment, research, courts, or family).3) Be clear & concise.4) End with an invitation. For example:

Did I miss anything? ¾ If that’s accurate, what other points are there to consider? ¾ Anything you want to add or correct?

5) Depending on the client’s response to your summary statement, it may lead naturally to change talk and/or show client’s ambivalence.

Motivational Strategies: Develop Discrepancies

How does your (lack of a GED/using drugs/alcohol/peers) fit in with your goals? - On one hand you say your (Health/Children) are important to you, however, you continue to (Drink/Use Drugs/get arrested) , help me to understand…. - What do you feel you need to change to obtain your goals? - How is being unemployed working for you? And/or your family? - How will things be for you a year from now if you continue to _____? - Hypothetically speaking, if you were to make a change in any area of your life, what would it be?

Motivational Strategies: Owning Problems

How has owning this affected your relationships/family?

But, how is this a problem for YOU?

Do you agree with what they say?

How has taking responsibility benefitted you?

Do you think that these things will ever happen to you?

Give praise and support self-efficacy:

You’ve done well to have survived all of that…

I can tell this has really bothered you…

Motivational Strategies: Asking For A Decision

Repeat/Rephrase client’s ambivalence - You were saying that you were trying to decide whether you shouldcontinue or cut down… - After this discussion, on a scale of 1 to 10, how sure are you of yourdecision? - Tell me about your decision? - What is it you would like to do?

Motivational Strategies: If No Decision • Accept no decision Empathize with difficulty of ambivalence

Ask if they have a plan to manage not making a decision - Ask what is the barrier (information, time) standing in their way of making adecision? - Ask what do they need to feel comfortable with making the decision?

™™ Discuss steps client feels are needed toDiscuss steps client feels are needed to make the change.make the change. ™ ™ Have client to repeat goals thenHave client to repeat goals then rephrase what client stated.rephrase what client stated. ™ ™ Using statements client has previouslyUsing statements client has previously mentioned (goals, steps, importantmentioned (goals, steps, importantpeople, need for change, etc.), negotiatepeople, need for change, etc.), negotiatea changea change-- --or treatment or treatment-- --plan and/or plan and/or behavior contract.behavior contract. ™™ Consider and lower barriers toConsider and lower barriers to change.change. ™™ Assist the client enlist social support.Assist the client enlist social support. Preparation The client is has decided to take stepsThe client is has decided to take steps necessary to make a change and is in thenecessary to make a change and is in theplanning process. This requiresplanning process. This requiresdetermining what is needed, visualizingdetermining what is needed, visualizingwhat the action will look like andwhat the action will look like andensuring everything needed is in placeensuring everything needed is in placeprior to beginning the change process.prior to beginning the change process. Appropriate MotivationalStrategies for the ISO Clients Stage of Change Stages of Change

™™ Have client make the contact, provideHave client make the contact, provide information needed, (treatmentinformation needed, (treatmentprogram/school, etc.) and reinforce theprogram/school, etc.) and reinforce theimportance of their commitment for theimportance of their commitment for thechanged behavior.changed behavior. ™^ ™ Acknowledge difficulties for the clientAcknowledge difficulties for the client in early stages of change.in early stages of change. ™ ™ Assist the client identify high-Assist the client identify high -risk risk situations and develop appropriatesituations and develop appropriatecoping strategies to overcome these.coping strategies to overcome these. ™™ Be Supportive throughout the processBe Supportive throughout the process Action The client is taking steps toThe client is taking steps to change, (maybe inchange, (maybe in treatment/school) but hastreatment/school) but has not yet reached anot yet reached a stabilization.stabilization. Appropriate Motivational Strategies for the ISO Clients Stage of Change Stages of Change

™ Assist client in reentering and understanding the change cycle reconsiderpositive change. ™ Discuss the meaning of a lapse and relapse as a learning opportunity. Agree on a plan ifa lapse occurs in the future. ™ Develop or update supervision plan with new goals and plan of action, depending onbehavior may want to develop an agreement. ™ Support positive decision to get back on track. Offer encouragement. Relapse The client has started the unwanted behavior again. Treatment clients experiencing relapse often occurs, generally alapse (thinking about relapsing prior to actually relapsing) Client must address with consequences and decide what to do next. Appropriate Motivational Strategies for the ISO Clients Stage of Change Stages of Change