Relapses are almost inevitable and become part of the process of working toward lifelong change.

Motivational Interviewing: The Basics, OARS Open questions, affirmation, reflective listening, and summary reflections (OARS) are the basic interaction techniques and skills that are used “early and often” in the motivational interviewing approach.

The 4 Processes include Engaging, Focusing, Evoking, and Planning. These processes are not linear or a step by step guide to MI.

• PRECONTEMPLATION STAGE. During the precontemplation stage, patients do not even consider changing.
• CONTEMPLATION STAGE.
• PREPARATION STAGE.
• ACTION STAGE.
• MAINTENANCE AND RELAPSE PREVENTION.

The four core motivational interviewing skills or OARS are Open questioning, Affirming, Reflecting and Summarising (Miller, W. R., & Rollnick, S. 2013).

The spirit of MI is based on four key elements:

• Collaboration between the practitioner and the client;
• Evoking or drawing out the client’s ideas about change;
• Emphasizing the autonomy of the client.
• Practicing compassion in the process.

Five Principles of Motivational Interviewing

• Express empathy through reflective listening.
• Develop discrepancy between clients’ goals or values and their current behavior.
• Avoid argument and direct confrontation.
• Adjust to client resistance rather than opposing it directly.
• Support self-efficacy and optimism.

Motivational interviewing is a counselling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and Empower the patient.

Motivational Interviewing breaks acceptance down into 4 components: absolute worth, accurate empathy, affirmation and autonomy support. Absolute worth in the form of unconditional positive regard is the basis of acceptance, this is the notion that all humans deserve our respect and compassion.

Motivational interviewing seeks to evoke motivation for change by making salient the inconsistency of a problem behaviour and that which is more deeply valued. Its aim is not explicitly to create or alter value systems and could be, in this sense, considered a less manipulative intervention than education.

helps us recognize change talk

Research shows that change talk is associated with enhanced motivation for change, and motivation is associated with increased likelihood of actual change. This supports the emphasis that MI places on listening for–and eliciting–change talk as key counselling skills (Miller & Rollnick, 2013; Moyers et al., 2009).

“Change talk” is the mentioning of a person’s desire, ability, reason, and need to change their behavior. The belief is that a person is more likely to change and stick with it if they personally invest in their recovery plan. Desire: Why would you want to make this change?

Ex. I guarantee, I am prepared to, I swear, I am going to do it, I intend to change. I am going to quit smoking. Action: Current movement toward change.

Bethea, Ph.D.

1. 10 Ways to Evoke Change Talk.
2. Evocative questions.
3. Ask for elaboration.
4. Ask for examples.
5. Looking back.
6. Looking forward.
7. Query extremes.
8. Use change rulers.

1. Recognize and affirm that it is the individual’s decision to make. “Of course, it really doesn’t matter what I think, because this is your decision to make.”
2. Inquire about the client’s thoughts. “I wonder what you think.”
3. Emphasize change statements, provide affirmations and statements of hope.

One of the easiest and most straightforward ways to evoke change talk is to simply ask for what you want to hear. For example, asking open ended questions where the response is related to change talk.

Preparatory Change Talk—A subtype of client change talk that expresses motivations for change without stating or implying specific intent or commitment to do it; examples are desire, ability, reason, and need.

Statements about the willingness of change. “I am going to “ “I promise …” “I intend to “ Statements about their willingness to change. “I am ready to “ “I will start tomorrow…” Statements about action taken.

Amplified Reflection. Amplified Reflection. Reflect back what your client has said in an exaggerated or extreme way. Do it with empathy in a matter of fact tone. Any hint of sarcasm, irony, impatience, or incredulity can elicit a hostile or resistant reaction.

Amplified: Reflect what the client has said in an exaggerated way (over or under). This encourages the client to argue less, and can elicit the other side of the client’s ambivalence. Client: “I’m here because my girlfriend made me come here.” Helper: “That’s the only reason why you’re here.”