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

Download Motivational Interviewing: OARS and Change Statements and more Schemes and Mind Maps Communication in PDF only on Docsity! 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 of communicating with clients, colleagues and family alike. OARS, an acquired MI skill, will eventually become a natural interpersonal communication 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 share information, in their own words, without input from their ISO. ISOs must listen to what the client is saying which will assist the ISO in asking 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? How does being on probation affect your home/work life? Who are the 5 most important people in your life? How can I help you with ___? Help me understand ___? What was the best 5 minutes of your day? What was the worst 5 minutes of your day? How would you like things to be different? What are the good things about ___ and what are the less good things about it? When would you be most likely to___? What do you think you will lose if you give up ___? What have you tried before to make a change? Who in your life support you changing this behavior? What do you want to do next? How does your (behavior) affect your family? “What do you know about the risks of (drinking/drugs)?” How will getting off probation affect your home/work life? 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 overlap significantly: 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 professional knowledge, treatment, research, courts, or family). 3) Be clear & concise. 4) End with an invitation. For example: Did I miss anything? If that’s accurate, what other points are there to consider? 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. DEARS – Used For Ambivalence Develop Discrepancy • Compare positives and negatives of behavior • Use the pros and cons form to develop discrepancies • Acknowledge self-motivational statements Empathize • Ambivalence is normal • Be understanding of the fact that behavior change is difficult. Avoid Arguments • Don’t push for change, avoid labeling • Change directions Roll with resistance • Change strategies in response to resistance • Acknowledge reluctance and ambivalence as understandable • Reframe statements to create new momentum • Engage client in problem-solving Support Self-efficacy • Reinforce responsibility and ability to succeed • Cultivate hope with menus of options 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: Asking For A Decision • Repeat/Rephrase client’s ambivalence • You were saying that you were trying to decide whether you should continue or cut down… • After this discussion, on a scale of 1 to 10, how sure are you of your decision? • 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 a decision? • Ask what do they need to feel comfortable with making the decision? Appropriate Motivational Strategies for the ISO Client's Stage of Change Establish rapport, ask permission, and build trust. Raise doubts or concerns in the client about current unwanted behavior patterns Express concern and keep the door open. Precontemplation The client is not yet considering change or is unwilling or unable to change. Appropriate Motivational Strategies for Each Stage of Change Affirm the client's determination for the accomplishments and continued positive lifestyle. Review and document with clients the coping strategies that are being used to avoid a return to the unwanted behavior Maintain a supervision plan that supports the lifestyle change: proactive friends, prosocial leisure activities, stabl employment and positive support system, which includes the ISO. Review long-term goals with the client Maintenance The client is maintaining the accomplishment of completing their goal. They are in a daily routine of normalcy and appears to be stabilizing, sustaining the behavior change. Appropriate Motivational Strategies for the ISO Clients Stage of Change Stages of Change Assist client in reentering and understanding the change cycle reconsider positive change. Discuss the meaning of a lapse and relapse as a learning opportunity. Agree on a plan if a lapse occurs in the future. Develop or update supervision plan with new goals and plan of action, depending on behavior 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 a lapse (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