Whether we are working with someone as they explore the reasons they do not want to escape (and go back to using substances) during the COVID-19 crisis or someone who is thinking about changing careers, some basic MI skills are important to consider. One of the most important skills we can learn as a clinician is to be able to recognize change talk from the client. And once we have a good ear for hearing from the client that they want to make a change or do things differently than from the past, we want to make sure we respond because it can make a huge difference in the amount and quality of change talk they share.
Again, once we hear change talk from the client, we want to make sure to respond in order to strengthen it and to encourage more. The basic skills we have all heard, read, and practiced involve asking Open questions, and providing Affirmations, Reflections, and Summaries. The acronym is OARS and when we respond by using one of these MI techniques, we will often receive more change talk with more specifics.
The first important technique we will discuss is Open Questions, where the clinician is attempting to receive more information or to have an example provided by the client. When you hear change talk from the client, this is an opportunity to not only build rapport by expressing your genuine interest and curiosity, but it can also increase their motivation for change as they hear themselves speak about what is most important to them. And for us clinicians, it is important that we stay open to the “option of surprise” where the client might share something that is not at all what we thought they might say. Again, the goal is to learn more from the client, both details and examples of the negatives of the status quo and the positives of changing behavior.
Below, please find interactions from Miller and Rollnick between the clinician and client where the clinician is asking questions to have the client share more information and provide examples:
Client: Well, sometimes when I wake up in the morning after drinking I don’t feel so good.
Elaboration: In what ways do you feel bad?
Example: Tell me about the last time that happened to you.
And…
Client: I think my family would be happier if I spent less time at work.
Elaboration: How do you think it would be better?
Example: Tell me about a time when you really enjoyed being with your family.
In these interactions, the client is asked to provide more information and examples from their experience. And in both cases, the client is sharing more change talk with the clinician.
Again, when we hear change talk, we want to make sure we respond in order to strengthen it and encourage more. In addition, how we respond can also determine the amount of change talk and the quality of change talk we hear from the client. The two examples shared in this blog explored how asking Open Questions elicit both information and examples of the negatives of the status quo and the positives of changing behavior. Next month, we will continue looking at the how we respond to change talk. I hope everyone is doing as well as possible and you have opportunities to use and practice Motivational Interviewing. Take good care!
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.