Tools for motivational interviewing

Use open-ended questions, affirmations, reflection and summaries (OARS)

1. Ask Open-Ended Questions rather than questions that elicit yes/no answers. For example:

"What brings you here today?" "What do you like about smoking?" "How would you go about reducing your drinking?"

2. Provide Affirmations:  comment positively on strengths, effort and potential. For example:

"You've been working really hard to quit drinking." "Those are great ideas on how to reduce your drinking." "I know you're really busy and I really appreciate you coming in today."

3. Reflect what the person says and feels: use active listening.

Reflective listening involves listening carefully to the person and repeating what they say in your own words so the person can clarify their message if there are misunderstandings. For example:

"It sounds like . . ." "So on the one hand I get the sense that . . .  and on the other hand . . ."

4. Summarise what the person has said in each part of the session and at the end of each session.

This can help a person expand on a discussion or move to another topic, ensure clear communication and reinforce important points.

To summarise, be concise and:

• begin by letting the person know you are making the summary, for example: "Let me see if I understand so far" or "What I've heard is . . ."
• give special attention to change talk (see below)
• include both sides of any dilemmas raised (the pros and cons of change)
• end with an invitation, for example: "Did I miss anything?"

Encourage 'Change' Talk

Change talk is statements made by the person that reveals their consideration of, motivation for or commitment to change. The goal is to guide them to expressions of 'change talk' as a pathway to change. The more a person talks about change, the more likely they are to change.

Change talk can either be 'preparatory' or 'implementing'. 'Implementing change talk' is more predictive of a positive outcome.

Prepartory Change Talk (DARN)

• D - Desire (I want to change)
• A - Ability (I can change)
• R - Reason (It's important to change)
• N - Need (I should change)

Implementing Change Talk (CAT)

• C - Commitment (I will make changes)
• A - Activation (I am ready, willing to change)
• T - Taking steps (I am taking actions to change)

Ways to encourage change talk

• Ask evocative open-ended questions that might be answered with change talk.
• Explore decisional balance: ask about the pros and cons of changing and staying the same.

Look back: ask what is was like before the target behaviour began or became problematic.

Look forward: ask what it might be like in five years if things stay the same and if you make the change.

• Query extremes, for example: "What is the worst thing that might happen if you do change, and what is the worst thing that may happen if you don't?"
• When change talk happens, ask for elaboration and examples. For example, "Tell me more".
• Use change rulers: for example "On a scale of one to 10, how important is this change to you, where one is not important and 10 is extremely important. What could make the change more important to you?"
• Explore goals and values. Ask what the person's guiding values are, what they want in life and how continuing the targeted behaviour fits with their goals or values.

1. W Miller & S Rollnick, Motivational Interviewing, Preparing people for change. Guilford Press: New York, 1991.