Motivational Interviewing Techniques
The fundamental approach to motivational interviewing interactions?contains the following four elements:
- Open-ended questions
- Reflective listening
Motivational interviewing creates an acronym OARS from this and the goal in using OARS is to assist the person to move forward, creating change talk and motivation from within. This change talk contains statements that the client may be considering change. There are four categories that these statements can be organised into:
- Problem recognition
- Concern about the problem
- Commitment to change
- Belief that change is possible
Any statement therefore regarding the present or future, either cognitive or emotional may represent a motivational statement. For example a statement such as “I think that using may be causing me problems” (present cognitive), “You know I’m starting to feel that this just might work out” (future emotional).
Open ended questions
These cannot be answered with a ‘yes’ ‘no’ or ‘five times in the past month’. Commonly most sessions commence with an open-ended question, ‘What’s been going on since we last got together?’ This type of question allows the client an opportunity to move forward and whilst closed questions undoubtedly have their place, they do not create the same opportunity.
Example: “I assume, from the fact that you are here that you have something you would like to talk over. What would you like to discuss?”
There are really no better ways of building rapport with a client than offering affirmation. This is particularly relevant to clients suffering from addictions as affirmation for this group has been a historically rare occurrence. Remember that affirmation has to be commensurate with the step achieved as the client may feel that the counsellor is being insincere if they are over praising them. This can lead to rapport being seriously damaged rather than built.
Examples: “Thanks for coming in on time.” / “I must say, if I were in your position, I might have a hard time dealing with that amount of stress.”
This is really the key. The best motivational advice a counsellor can give to himself is to listen attentively to the client. All the information a counsellor requires will come from the client, what works, what has failed them etc. However this is a directive approach. The counsellor will actively guide the client by this technique; focusing more on change talk and less on non-change talk. For example “You are unsure about your readiness to change but you are aware that your drinking has damaged your relationships and your health”.
The level of reflection should be varied. Keeping it at one level could lead to a feeling of moving in circles. Reflections regarding affect, particularly if the effect is unstated can be excellent motivators for example; “Your wife has left you. That appears to be giving you a lot of pain”.
If that is correct the intensity of the session deepens, if wrong the client will correct you (or the client may not be ready to deal with this) and the session moves on regardless. Reflective listening maintains the movement of the interview and forward movement is what motivational interviewing is all about.
Summaries are a specialized form of reflective listening and are an effective way to communicate that you have been listening by calling attention to central points and moving attention and concentration. There is no hard and fast rule as to how often you do summarise but the frequency should be quite high as there is a risk that the amount of information given may be too large to give adequate feedback. When you are about to summarise let the client know that that is what is going to occur and invite the client to correct you where he/she feels necessary.
If you feel that there were points that were not clear during this period, inform the client of that when you announce your intention to summarise.
Example: “So, this heart attack has left you feeling really vulnerable. It’s not dying that scares you, really. What worries you is being only half alive, living disabled or being a burden to your family.”