2/26/2019 1 OARS Skills Lab Chad Connor, LCSW University of Southern Indiana Annual Spring Social Work Conference March 1 st , 2019 YouTube: Soft Questions? Larry King Explains His Interview Style (Source) “The kind of caring that the client-centered therapist desires to achieve is a gullible caring, in which clients are accepted as they say they are, not with a lurking suspicion in the therapist’s mind that they may, in fact, be otherwise. This attitude is not stupidity on the therapist’s part; it is the kind of attitude that is most likely to lead to trust, to further self- exploration, and to the correction of the false statements as trust deepens.” Carl Rogers and Ruth Sanford
Transcript
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OARS Skills LabChad Connor, LCSWUniversity of Southern Indiana Annual Spring Social Work Conference
March 1st, 2019
YouTube: Soft Questions? Larry King Explains His Interview Style (Source)
“The kind of caring that the client-centered therapist desires to achieve is a gullible caring, in which clients are accepted as they say they are, not with a lurking suspicion in the therapist’s mind that they may, in fact, be otherwise. This attitude is not stupidity on the therapist’s part; it is the kind of attitude that is most likely to lead to trust, to further self-exploration, and to the correction of the false statements as trust deepens.”
Carl Rogers and Ruth Sanford
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Today’s Objectives
Participants will understand the link between accurate empathy demonstrated by social workers and client outcomes.
Participants will learn the components of OARS and try out these skills
Participants will know where they can go to further their training / development in the proficiency of using OARS and learning Motivational Interviewing
A Taste of MI
Volunteer needs to be willing to share:Something you want / need to change, but have not yet
(ambivalent about it)
Should be something you’re willing to share with a complete stranger
I need a volunteer to be my client!
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So what is Motivational Interviewing?
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"…a person-centered counseling style for addressing the common problem of ambivalence about change." (Miller & Rollnick, 2012)
Motivational interviewing is…
MI is a COLLABORATIVE
conversation about CHANGE
Spirit of MI
More than technique, MI is person-centered
Derivative of the work of Carl Rogers
Client is in control of making their own decisions
Relationship is collaborative, built on mutual trust
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Spirit of MI
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Accurate Empathy
You never really understand a personuntil you consider things from his point of view…
Until you climb inside of his skin and walk around in it.
Harper Lee
Help someone, you earn a friend.Help someone too much, you make an enemy.
A Continuum of Communication Styles Directing Guiding Following
Traditional Style VS Motivational Interviewing
Traditional
Clinician as expert
"Righting reflex" / Heavy advice giving
Clinician does much of the talking
"I have the answer and I am going to give it to you"
Motivational Interviewing
Client as expert
Eliciting and reinforcing client's change talk / Conversational yet strategic
Client does 50% or more of talking
"You probably know what you want to change, can decide what to change or not change and, together we can help you become "unstuck"
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Common dilemma: "My client isn't motivated"
Translation:
"People are motivated or NOT motivated"
"People have to 'hit rock bottom' in order to change"
"There's not much I can do until they 'come around'"
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…but is this TRUE?
You can arrange the conversation so that people talk themselves into change based on their own values and interests…
Motivation is NOT stable, it is fluid and can be changed!
The way you talk to clients about health, changing beliefs, feelings, attitudes can substantially influence motivation to change and maintain change.
Persuasion (i.e. use of logical arguments) does not work nearly as well as we might think!
Whether change happens is a person's choice. We cannot take this away not matter how hard we try.
* Angela R. Bethea, Ph.D., 2015
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Challenging the Myth of the Unmotivated Client*
(Miller & Rollnick, 2012 ; Miller & Butler, 2008)
Most people know what they need / want to change (why logical arguments fail)
"Decisional balance“ There are reasons for a person to
sustain behavior There are reasons to change
targeted behavior
This is a NORMAL experience
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What prevents our clients from
making the changes they
need to make?
Ambivalence("I want to change AND I don't want to change")
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"Righting Reflex" often isn’t the right reflex for our
clients
As professional helpers, we have the tendency to ‘rescue’ others
"Don't do that, there is a better way!”
" If I can persuade them, they will see that they need to do something different.“
The “Righting Reflex” can lead our clients to following experiences:
Need to explain / defend self
"I am not being understood"
Shame or anger
"What's the point of meeting with you?“
“I know this already!”
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As helpers, what if we had a remote that had a button to get people to talk about change?
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…as it turns out, we do!
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CHANGE
SUSTAIN
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We CAN influence how clients talk about change
There are things WE can do to encourage two types of talk about target behavior
• CHANGE talk
• SUSTAIN talk
Research supports the idea that if we can get our clients talk about their own reasons for change, they are more likely to move toward making that change
Is it Change Talk?
Change
I cut back on how many beers I drink
I need to stop hanging around THOSE people
I guess I could give those meetings a try
I know this stuff is going to kill me
Sustain
I don’t have a drinking problem
It’s impossible to stop when it is so easily available
Nothing will help me stop
Why change? Something’s going to kill me anyway, right?
OARSNuts and Bolts of Practicing Accurate Empathy
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“What people really need is a good listening to.”
Mary Lou Casey
Informing / Advising
OARS
DARN CATS
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Commitment
Activation
Taking Steps
DARN CATS (the way we talk about change)
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DARN CATS (the way we talk about change)
Desire
Ability
Reasons
Need
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Do you remember the
questions asked in the
role play?
They are DARN questions –examples of ways to draw
our change talk from clients
1.“Why would you want to make this change?” (Desire)
2.“How might you go about it in order to succeed?” (Ability)
3.“What are the 3 best reasons to do it, and why?” (Reasons)
4.“On a scale from 0 to 10, how important would you say it is for you to make this change?” (Need)
My last question: “So what do you think you will do?” (CATS question
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MI versus non-MI skills & behaviors (Miller and Rollnick, 1991, 2002)
Open vs Closed Ended Questions Do you want to stop using marijuana?
VS.What are some reasons you might have for not using marijuana?
Be careful not to ask too many in rapid succession – can come across as being interrogated! MI adheres to the strategy of providing at least 2-3 reflections for each question…
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Open Ended Questions
Affirmations
Genuine, verbal recognition and praise of the client’s talk of change
Example: Client: I am thinking about looking into women’s shelters so I have
somewhere to go if I decide to leave Bill. You: That’s great. It takes a lot of courage to take this first step.
Encourage and solidify the client’s talk about change by affirming them when you recognize change talk.
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Reflections
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Conveys active listening and engagement
Allows the client to hear their own talk of change through your reflections
Strategic use of reflection can be used to move a conversation forward or put the client in a position to defend the need to change. (Complex reflection)
Example:
Client: Getting high makes all my problems go away (sustain talk)
You: Smoking makes life easier to deal with, so your life is ok if you continue to smoke.
Client: Nah, well, sort of. My problems feel like they go away when I smoke, but DCS is involved now and I have to do something different I
guess (change talk)
You: On the one hand, smoking is how you have dealt with things, but because DCS is involved now, you have to figure out another way to deal with things. What have you tried before to deal with your problems?
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Summaries• Use these at strategic times to “collect” all the change talk statements
the client has made and feed back to them to hear their own change talk.
• Can be used after a series of reflections and statements from the client to follow up with a new open-ended question (remember, 3-4 reflections for each open ended question is strongly encouraged)
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Example:You: “Let me just make sure I am understanding your thinking at this time. On the one hand, you
and your husband have been together for 10 years, but the fighting has gotten so bad that you are not sure how long you can go on like this. You worry that co-workers have noticed your bruises and you are concerned it is getting worse. You are scared to be alone, but you do have a good friend that said she will help you stay on your feet while you go to a shelter if you decide to do that. On a scale of 0 to 10, how important to you is it that you leave your husband?”
Now that I know a
little about MI, with
whom do I use it?
Anywhere there might be ambivalence to changing a behavior
MI requires a specific target behavior
Addiction
Relationships
Leaving a partner?
Service engagement
Diet / weight loss
Smoking cessation
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Assessments "MI Sandwich“
MI (5-10 mins) ----> Assessment / Data Collection --> MI-style feedback (10-5 mins)
MI to engage client / explore reason for referral MI at end to elicit response to assessment, data collect,
explore ambivalence and readiness for change. Can provide advice (with permission!)
What ideas do you have?
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…And how do I incorporate
it into my practice?
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Where do I learn more?
The MI "bible" Authors & Founders: William Miller &
Steve Rollnick, 2012
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Where do I learn more?
For exercises / practice…
Where do I learn more?
FREE at samhsa.gov
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MINT (Motivational Interviewing International Network of Trainers)
Website (www.motivationinterviewing.org)
Trainings
Formal supervision from MINT trainers
MITI
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Where do I learn more?
Chad Connor, LCSW
Member of Motivational Interviewing Network of Trainers (MINT)
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