OARS: MI Core Conversational Skills

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Brenda Lloyd
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1 OARS: MI Core Conversational Skills Open Questions Gather information (vs. facts) Create open, non-judgmental tone Demonstrate genuine interest, respect Invite reflection and elaboration Affirm autonomy, self-direction Closed Questions Invite brief, limited responses Useful to get basic facts Keep conversation superficial Focus on what interviewer wants to know Feel interrogative when used repeatedly Closed questions sound like... Do/did you? Could/can we? Have/has there? Will/would you? Are/is there? Were you? How many? When did? How often? Open questions sound like... Tell me What... How... Why... Open or Closed? What would help you feel more comfortable living here? Don t you think it would help if you took your meds every day? What is your understanding of your responsibilities as a tenant? What kind of work interests you most? What concerns, if any, do you have about living in this neighborhood? How s it going? Did you pay your rent in time? Open or closed: What difference does it make? Exploratory open questions sound like What would you like me to know about yourself? What are some of the most important things to you in your life? What are you most interested in focusing on today? What concerns, if any, do you have about finding steady work? How do you know when your diabetes is and is not well controlled? What does meth do for you? What are the downsides? Exploratory open questions sound like What will you lose if you give up drinking? What s at stake if you don t change? If you were to do more cooking for yourself, what would be your reasons to do that? Your best reason? What ideas do you have to succeed in meeting your goal? What skills and strengths do you bring? What do you think you ll do next? How can I, or others, be of help? 1

2 Converting Closed Questions I d like to get a part-time job to contribute to the rent, but who s gonna hire somebody like me? Respond with a helpful question. I don t really think I have a drinking problem. It s just that my girlfriend is overly sensitive because her dad was an alcoholic. Respond with a helpful question. Do you realize how much money you could save by quitting smoking? How many drinks do you have on a given day? Don t you think you d feel better if you stopped eating so much fast food? Forming Evocative Questions So, instead of arguing like I usually do, I went for a walk. Now that I have my own place, I m having a hard time saying no to all my friends who want to stay with me. So, I gamble a little. What s the big deal? Guidelines: Open Questions Ask open questions to deepen the conversation. Use open questions to guide the conversation. Ask more open questions than closed ones. Keep questions clear and brief? Avoid negating open questions with closed ones e.g., "What are your thoughts about that? For example, do you think that? Affirmations Video Demo What are affirmations good for? Strengthen engagement Reduce defensiveness Increase confidence in a person s ability to change Build hope 2

Affirmations Shine a light on what s good about a person Must be genuine Different from praise Affirmations focus on Intentions and actions Reframing actions or situations in a positive light

Examples of Strengths Organized Goal-oriented Persistent Keep commitments Courageous Confident Planner Persistent Know yourself well Know what works Value professional advice Care about your health

3 Affirmations Shine a light on what s good about a person Must be genuine Different from praise Affirmations focus on Intentions and actions Reframing actions or situations in a positive light Positive traits or skills Prizing of the person in general What are examples of strengths? Examples of Strengths Organized Goal-oriented Persistent Keep commitments Courageous Confident Planner Persistent Know yourself well Know what works Value professional advice Care about your health Have a support system Focused Integrity Optimistic Resilient Positive attitude Hopeful Don t give up Can see possibilities Creative Sound like... You are very skillful at I noticed that you You showed a lot of patience You are a courageous person You really value You are very knowledgable about... That took a lot of persistence to Thank you for Activity Trudy smokes two packs of cigarettes a day. She knows it isn t good for her but is fed up with people reminding her of it. At some point, she will stop, but just not yet. With everything else going on in her life, this is one area she feels is her own. Trudy s strengths include Trudy smokes two packs of cigarettes a day. She knows it isn t good for her but is fed up with people reminding her of it. At some point, she will stop, but just not yet. With everything else going on in her life, this is one area she feels is her own. Examples You re clear about what you want/need. You have clear boundaries. You know your mind. You know what your priorities are. You don t let others easily influence you. You re aware of the benefits and negatives of smoking. You have a plan to stop smoking. Reflective Listening 3

What people really need is a good listening to. Mary Lou Casey https://www.youtube.com/watch?v=4voubvb4ctu reflection (n.) late 14c.

4 What people really need is a good listening to. Mary Lou Casey reflection (n.) late 14c., in reference to surfaces, from Late Latin reflexionem (nominative reflexio) "a reflection," literally "a bending back," noun of action from past participle stem of Latin reflectere, from re- "back" (see re-) + flectere "to bend" (see flexible). Meaning "remark made after turning back one's thought on some subject" is from 1650s. Reflective statements Make a reasonable guess about person s meaning, thoughts, feelings, values, hopes Guess what might come next - continue the paragraph Sometimes overstate or understate what person says Skillful reflections move past what the person has already said, but not too far ahead. Why a statement? Consider the difference You don t see your drinking as a concern? You don t see your drinking as a concern. You re not sure you can trust me? You re not sure you can trust me. You re still upset? You re still upset. Responding with a well-formed statement rather than a question is less likely to evoke defensiveness and more likely to encourage continued exploration. MI, 3rd edition Forming reflective statements 1. Hear what the person is saying 2. Make an educated guess about the underlying meaning 3. Choose a direction for the reflection 4. Share your guess as a concise statement (not a question) Common sentence stems It sounds like... As I listen to you, it seems... For you... You re wondering You re concerned You re feeling like It s really important to you You re hoping You... Activity 4

Using reflections for strategic emphasis Example I love smoking weed. I ve been doing it since I was about 14. It mellows me out and helps me relax.

Drinking alcohol is much more dangerous than smoking pot. Examples: /understanding: Smoking weed gives you a lot of pleasure. You d be pretty high-strung and anxious without it.

Example I love smoking weed. I ve been doing it since I was about 14. It mellows me out and helps me relax. Drinking alcohol is much more dangerous than smoking pot.

5 Using reflections for strategic emphasis Example I love smoking weed. I ve been doing it since I was about 14. It mellows me out and helps me relax. I don t see any point in giving it up, at least not at this point in my life. As long as I m not hurting anybody, I don t see why it should matter to anyone else. Drinking alcohol is much more dangerous than smoking pot. Examples: /understanding: Smoking weed gives you a lot of pleasure. You d be pretty high-strung and anxious without it. Cannabis is an important part of your life. You wish people would get off your back about it. You don t feel like it s harming you or anyone else. There are a lot worse things you could be doing. Example I love smoking weed. I ve been doing it since I was about 14. It mellows me out and helps me relax. I don t see any point in giving it up, at least not at this point in my life. As long as I m not hurting anybody, I don t see why it should matter to anyone else. Drinking alcohol is much more dangerous than smoking pot. Examples: Highlight/explore ambivalence: You love smoking weed and also have some slight reservations. Drinking s a lot worse and ye there are some risks with smoking weed. For now, you feel fine about your use of cannabis, although when you get older you might consider giving it up. Example I love smoking weed. I ve been doing it since I was about 14. It mellows me out and helps me relax. I don t see any point in giving it up, at least not at this point in my life. As long as I m not hurting anybody, I don t see why it should matter to anyone else. Drinking alcohol is much more dangerous than smoking pot. Examples: Complex Reflections : There s a tiny bit of you that wonders about your pot use. You ve considered what it would be like to give it up. Someday you ll likely reconsider how pot fits in your life. Form reflections to convey empathy I know all the reasons I m supposed to take these meds. But I hate the way they make me feel. Sometimes I think I d be better off without them. Form reflections to explore ambivalence I know all the reasons I m supposed to take these meds. But I hate the way they make me feel. Sometimes I think I d be better off without them. 5

Form a reflection to highlight change talk I know all the reasons I m supposed to take these meds. But I hate the way they make me feel. Sometimes I think I d be better off without them.

6 Form a reflection to highlight change talk I know all the reasons I m supposed to take these meds. But I hate the way they make me feel. Sometimes I think I d be better off without them. Using reflections for strategic emphasis In talking with a client about risky behaviors, you bring up the possibility of being tested for HIV. The person replies I suppose I ought to be tested, but I don t really want to. I usually play things pretty safe. I have way too many other issues in my life right now to worry about one more thing. I guess it would be good to know. But what if it came back positive? I m not sure I could handle that! No way! I have no interest in that. Period. End of conversation. What difference does it make? We all have to die of something. What would you do if you were in my shoes? 6

Summaries Summaries Let me see if I understand thus far Useful anytime in conversation Help to ensure clear communication Are basically reflective paragraphs Three common types: collecting, linking,

7 Summaries Summaries Let me see if I understand thus far Useful anytime in conversation Help to ensure clear communication Are basically reflective paragraphs Three common types: collecting, linking, transitioning Common Elements Begin with statement indicating you are making a summary Often focus on: - Expressing empathy - Reflecting both sides of ambivalence - Accentuating change talk End with an invitation Collecting Summary The gist of what I m hearing is that your life feels pretty overwhelming. Money is tight and you can barely afford to meet your kids basic needs. You want to work more shifts than your boss is giving you. That s a frustration. You d also like to be able to get your own place to live, which would make it easier to manage your life, including your depression and diabetes. While you ve begun using meth again to help cope with everything, you re wondering whether it might be hurting more than helping. How does that fit with how you see things? Linking Summary Let me see if I understand. You mentioned last week when we met that you were feeling frustrated that your boss wasn t giving you more shifts and you had no idea why. After talking with him yesterday, you realize that he s been concerned about your showing up late for work and being less friendly and more impatient with customers. And this is causing you to wonder if your increased meth use has anything to do with these concerns he has. Does that about sum it up? Transitioning Summary As our time draws to a close today, here are a few things you ve said that seem to stand out. Even though things are really hard right now, you re not giving up. You re doing what you can to take care of your health and to provide for your kids. You have a goal of getting an apartment as soon as possible for your family. Also, you really want to work more shifts to ensure there s enough money for your family s needs. And you re beginning to wonder if your increased meth use as of late might have something to do with your boss giving you fewer shifts. What would you add to that? 7

Attitude. Founding Sponsor. upskillsforwork.ca

Attitude. Founding Sponsor. upskillsforwork.ca Founding Sponsor Welcome to UP Skills for Work! The program helps you build your soft skills which include: motivation attitude accountability presentation teamwork time management adaptability stress