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Motivational interviewing skills & techniques: Examples, tips and tools

Originated by: Anne Jani

Submitted: 12 Mar 2013

Last updated on: 12 Mar 2013

Related Health Topics:

Overview

Motivational interviewing (MI) is a counseling approach used to help a patient (or client) make or get ready for positive behavior change. MI is defined as “…a collaborative, person-centered form of guiding to elicit and strengthen motivation for change1.”

Official MI requires all four techniques; however the MI strategies would enhance any one-on-one coaching or counseling session (together or in isolation). The four strategies of motivational interviewing are called the ‘OARS’2:

  • Open-ended questions
  • Affirmation
  • Reflections (Reflective Listening)
  • Summaries

Check out this example of OARS skills used by a nurse with a patient. http://www.youtube.com/watch?v=_KNIPGV7Xyg

Open-ended questions: Encourage a dialog

Asking open-ended questions can help you start (or maintain) a more in-depth conversation. What are open-ended questions? Open-ended questions are not easily answered by yes or no and encourage elaboration3.

By asking open-ended questions you can encourage a patient to tell their story. Your goals are to gather information, learn what’s important to the patient, allow the patient to listen to themselves, and to provoke thought and consideration1.

How do you ask open-ended questions?

  • Begin the question with “What, Who or How” 4:
    • “What is your dream…”
    • “What are your ideas…”
    • “What steps can you take…”
    • “Who has helped you…”
  • Probe for more information:
    • Please elaborate
    • Tell me more about…
  • Ask general open-ended questions:
    • “How does this make you feel?”
    • “How do you feel about that?”
  • But, avoid asking “why”((4 –everydayleaners.org))
    • “Why” can sound judgmental or threatening

A few more examples of Open-Ended Questions5:

  • “What’s happened since we last met?”
  • “What makes you think it might be time for a change?”
  • “What brought you here today?”
  • “What happens when you behave that way?”
  • “Tell me more about when this first began.”
  • “What’s different for you this time?”
  • “What was that like for you?”

Note: It’s also important to avoid ‘leading questions’ which would direct the conversation ((1-SAMSA)). For example: “You have been struggling with eating healthy foods, right?”

Practice! Try to re-frame a few close-ended questions into open-ended questions:

Close Ended- Questions Open-Ended Questions
Has it been difficult to change your eating habits?  
Have you tried to make any changes this week?  
Do you think you need to make a change in your life?  


Affirmations: Support the patient by giving and accurate description of his or her strengths

You can empower a patient by helping them recognize their strengths and see themselves more positively. By offering positive affirmations, you build a patients’ confidence (or self-efficacy).

How do you give ‘affirmations’?

  • You can use affirmative and positive language such as1:
    • "I'm really glad you brought that up."
    • "I think what you are doing is really difficult. I'm really proud to be working with you on this."
    • “I appreciate that you are willing to talk about this.”
    • “That’s a good idea.”
    • “I’ve enjoyed talking with you today.”
  • Emphasizing past successes may help you demonstrate the patient’s strengths2
    • “You have struggled, but you have had some real successes”
    • “You are clearly a very resourceful person”
    • “You handled yourself well in that situation”
    • “If I were in your shoes, I don’t know if I could have managed nearly so well.”
  • Reframe behaviors or concerns as evidence of strengths, for example3:
    • "So many people avoid seeking help. It says a lot about you that you are willing to take this step."
    • “You’ve had a setback, but you are really trying. Look at the progress you are making”
  • Ask questions to prompt the patient to give themselves affirmations, for example1:
    • "What have you noticed about yourself in the past few months since you started coming here?"
  • But, be realistic and sincere3
    • Your relationship with the patient should be based on mutual respect and trust

Reflections: Help the patient listen to themselves

You can demonstrate that you understand a patient’s issues or feelings by reflective listening. Reflective listening can also help the patient listen to themselves provoke thought and consideration of inconsistencies. Reflective listening also helps a patient clarify misinterpretations or add depth to the thoughts and feelings they express3.

How do you listen reflectively?

There are three levels of reflective listening6:

  • Repeat or rephrase
    • By repeating the same words the patient says (or similar) patients may be able to hear themselves and clarify, or dive deeper into a subject. For example:
      • Patient A: “I feel like it’s so difficult to avoid eating snacks at work”
        Your Response: “It sounds like it’s difficult for you to avoid snacks at work”
        Patient A: “Yes, I think it’s because…”
    • How do you start the reflective-phrase and not sound like a robot?
      • So you feel…
      • It sounds like you…
      • You’re wondering if…
      • What I hear you saying is…
  • Paraphrase
    • Make a statement that reflects what the patient is staying. For example:
      • Patient B: “I know I should exercise, it’s just that I can’t seem to start”
        Your Response: “You are aware of all the reasons you should be exercising, it sounds like it has been hard to find the motivation to start”
  • Reflect the feelings
    • You may be able to tell what a patient is feeling (from verbal or non-verbal cues) and give him or her words for those feelings
      • Patient C: Appears despondent
        Your Response: “How have you been feeling, do you feel like you have lost hope?”
    • You can express empathy for the patients feelings and emotions

Summaries: Looking at the bigger picture –
let the patient see his or her whole story

Summarizing a patient’s storyline can help him or her get motivated to make a change by helping them see the bigger picture. This process can help you call the patients attention to the most important elements of your conversation3

A summary may:

  • Help you encourage an cue to action or an “Aha moment”
  • Encourage a patient to look their strengths
  • Give the patient an alternative view his or her options
  • Prepare the patient to move on2
  • Help the patient see both sides of his or her ambivalence for change3

How do you summarize your conversation?

  • Pull together the information you gathered in your interview/counseling session
  • Create the storyline – what are the:
    • Problems/concerns/challenges
    • Potential solutions,
    • Patient’s strengths
    • Feelings and emotions expressed
  • How do you start the summary?
    • “If we add up the puzzle pieces and put them together…”
    • “The picture that I see is…”
  • How do you encourage the patient with a summary?
    • Demonstrate misalignment in the patient’s thoughts, feelings, and actions – can you help the patient see the reasons for his or her ambivalence?3
    • Don’t include everything you’ve learned in the summary – be strategic and use the information that will encourage the patient3

References

1 SAMHSA Training, Motivational Interviewing http://www.samhsa.gov/co-occurring/topics/training/motivational.aspx

2 O.A.R.S.: 4 Strategies of motivational interviewing in the early stages of treatment, Adult Mental Health Division http://www.amhd.org/About/ClinicalOperations/MISA/Training/MI%20H2%20Strategies%20and%20Principles.pdf

3 Principles of Motivational Interviewing, motivational interviewing.org http://www.motivationalinterview.org/Documents/1%20A%20MI%20Definition%20Principles%20&%20Approach%20V4%20012911.pdf

4 Tips for Mentors: Open-Ended Questions, EverydayLearners.org http://www.everydaylearners.org/sites/uwucdev.org/files/attachments/Open%20Ended%20Questions.pdf

5 Motivational Interviewing Strategies and Techniques: Rationales and Examples , NOVA Southeastern University http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf

6 Reflective Listening, Michigan Tech, http://www.mtu.edu/dean/conduct/officer/docs/Reflective-Listening.pdf


Learn more about positive behavior change:

The Teach Back Method

Interested in learning more about Motivational Interviewing?

Join us for our upcoming webinar which will focus on the Ask-Educate-Ask approach (combination of teach back and motivational interviewing). 

Or, check out Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing)

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