Motivational Interview: practicing OARS
The basic components of Motivational interviewing, especially during the early stage of conversation, are the OARS: open ended question, affirmations, reflections and summaries. In motivational interviewing, any talk from the client that involves change is a positive predictor of actual change. So if your client responds by saying ‘I really think I need to make the change’ that’s great. If, on the other hand, we hear sustain talk like ‘I don’t know if the alcohol is really my main issue’ then we know we have smaller chances of seeing real change.
Thus, the immediate goal in your practice is to elicit change talk with the use of your OARS.
Open ended question: these help clarify the reasons for ambivalence and motivations for change. Use them generously, but not more than two in a row. If you are not sure about your skillfulness with open ended questions, visit the specific OEQ trainer here.
Affirmations: these emphasize client strengths and acknowledge behaviours that lead in the direction of positive change. Affirmations build confidence in one's ability to change.
Reflections: Reflecting back the main meaning or emotion spoken by a patient has two main purposes. The first, is making the patient feel heard. This reduces resistance and gets patients more engaged in conversation. The second goal of reflections is deepening specific emotions or insights. To achieve this, therapists need a higher level of skill, because it involves choosing exactly what within the clients words to reflect and in which tone of voice. For practice focused on reflections, visit the specific trainer here.
Summaries: Summaries allow patients to organize their thought, and take a closer look at the benefits and costs of change. This is important throughout the conversation, and without summaries the therapy session can become disjointed without a clear focus allowing for insights and a buildup of positive motivation.
Below the trainer you will find additional tips to improve your MI. If the OARS are new to you, you can practice open ended questions and empathic reflections in the links above. When you are comfortable with them, come back to this trainer.
(first time?? read the ‘how to get the best out of practice’!)
The core processes of Motivational interviewing
Motivational interviewing is a simple and straightforward form of therapy, that can facilitate change when done well. Understanding the basic concepts is vital, but often not enough. once you are familiar with the concepts, its very helpful to practice. The need for practice in this model of therapy is especially impactful because you need to improvise the direction of therapy based on where the client takes you and based on the clients style of talk - change vs. sustain. There is an abundance of materials on MI online, i found Bill Matulich’s work especially useful when learning the method. Below is his introductory explainer on Motivational interviewing.
Change talk: The micro-marker of success
A lovely piece of research on Deliberate Practice was conducted using MI skills. There is a fascinating finding in this study: although all participants thought they had improved, only the Deliberate Practice group (and not the control group) actually showed better results following the training.
This teaches us an important lesson when doing MI (and therapy in general): don’t trust your feelings about client change or your level of performance. look for more objective measures to provide you feedback on performance. These clues that we find in therapy, are called micro-markers. anything from a sigh to a ‘yes-but’ can serve as a marker of where the client is at and if we are on the right track. In the case of MI, change talk is the golden micro marker. If, during conversation with a patient, you hear more and more change talk, you are doing well. If not, try practicing some more, or record yourself and see where you could potentially elicit more of that change talk.
For the research, see: Westra, H. A., Norouzian, N., Poulin, L., Coyne, A., Constantino, M. J., Hara, K., ... & Antony, M. M. (2021). Testing a deliberate practice workshop for developing appropriate responsivity to resistance markers. Psychotherapy, 58(2), 175.
Feel free to make contact with any questions on the training or trainers!
