Updated: Sep 9, 2019
You can give people all the right information, facts, figures, solutions, advantages, and disadvantages, however, these are all useless unless they are internally motivated to change. One way to assist clients in becoming more inspired to change is through a technique called motivational interviewing.
People usually believe what they hear themselves. Motivational interviewing was developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D in order to help clients with just that. Hear what they need themselves. It was created to give clients choice and control and help elicit change.
Bottom line, your client needs to come up with their own solutions, rather than you telling them what they need.
We need to respect our client's choices. Their responsibility to make choices. Their resources to make those choices. Even respecting that the client may not be ready for change.
Take these two examples:
Example 1: Forced control
Case manager As I said many times, I really think that you need to see a psychologist. You’ve been through a lot of trauma and have lost so much.
Client I don’t think I need to see anyone. I will be fine and plus I don’t want a stranger knowing about my personal issues.
Case manager Trust me this psychologist will help you. They are an expert and have helped many people in your position before.
Client Yes but I’m not sure about this. I feel okay now and will manage.
Case manager Yes but the last time you expressed that you have depression and suicidal thoughts. Trust me, it’s important.
Client Look! I’m fine. Why do you need to bring this up. I’m getting better.
(These pushy statements by the case manager in this example, will only create more resistance and resentment.)
Example 2: Autonomy Support
Case manager How do you feel about going to see a psychologist?
Client I’m not too sure about it. I don’t want my privacy invaded.
Case manager That’s totally understandable. Tell me a little about what is going on with you at the moment?
Client I’m not sure. I just have no energy to wake up in the morning. I also feel tired all the time. It's hard to sleep at night. I keep having flashbacks from my time spent in Iraq.
Case Manager It must be really hard for you. What can you do right now to help you feel better about your situation?
Client I haven’t really made any friends. I would like to maybe join a social group to help keep my mind occupied. I also haven’t painted in a long time. Painting used to be really therapeutic.
(The questions by the case manager in this example, followed up with more questions can help someone open up and lead to them coming up with their own conclusion that they need to see a psychologist.)
“We know what we believe, when we hear what we say”
Let me give you a basic introduction to motivational interviewing.
OARS: Four Basic Skills of Motivational Interviewing
“OARS ” Can be used to help clients and case manager establish focused and interactive communication. The aim of this technique is to help lead clients into resolving their problems and behaviours themselves.Develops discrepancy between where they are now and where they want to be. Helping them acknowledge and resolve their ambivalence (conflict) in making the necessary changes to reach their goals.
Four basic skills in motivational interviewing (OARS)
Open-Ended Questions Affirmations Reflective listening Summary statement
Now let's go through how OARS can be used in a conversation with a client.
1. Open-ended Questions: Questions that cannot be answered with a limited response. Open-ended questions help clients explore their own thinking and moves the case manager away from offering advice.
Eg: What are some of your goals? What’s important to you as a father, worker etc..
2. Affirmations: Statements from the case manager that affirm the client’s strengths, resources, intentions, attempts, and their achievements. They need to be done genuinely.
Eg: You are clearly a very resourceful person.
3. Reflective Listening: Paraphrase (mirror) the individuals’ comments by repeating back what they said. This lets them know that you’re listening, at the same time allows the individual to hear (again) what they said, which will help them understand their own thoughts better.
Eg: It sounds like you…
4. Summary statements: Summary statements pull together everything stated, allowing you to transition to the next topic.
Eg: Let me see if I understand this so far…
Remember that motivational interviewing is about: Evocation vs Education Autonomy vs Authority Exploration vs Explanation
No matter which skills or method used, empathise personal choice and control. If you tell someone what to do, it is usually taken as being confrontational and will often foster resistance.
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