powerpoint presentation on directing the change itself when we need to focus on: engaging/listening...

11/1/2018

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Motivational Interviewing

A client centered, goal-oriented way to enhance motivation and

to help clients move from “maybe I should” to “I did.”

Debbie Granick, MPH, LCSW, PMHNP

www.debbiegranick.com

Debbie Granick, MPH, LCSW, PMHNP • www.debbiegranick.com

We like to think if we…2

TELL THEM

ENCOURAGE THEM

TEACH THEM

BEG THEM

SCARE THEM

CONFRONT THEM

THEY WILL CHANGE. BUT THEY WON’T.

PERHAPS, THERE IS ANOTHER WAY.


Goals for Today3

INTRODUCING THE CONCEPT

Introduce the concept of motivational interviewing

as it relates to behavior change.

UNDERSTANDING THE ”SPIRIT OF “MI”

Understand the “spirit of MI” and practice concepts

of MI that move people towards sustained

behavior change:

• Engaging with the client

• Evoking ambivalence

• Rolling with resistance

• Empowering success

PRACTICING THE CORE CONCEPTS OF MI

Learn and practice the core interviewing skills of MI:

• Asking

• Affirming

• Reflecting

• Summarizing

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What is Motivational Interviewing?4

Motivational Interviewing is built on

the concepts that:

We believe what we hear ourselves say.

Motivation is intrinsic and based on our

individual priorities, goals, values.

Humans, when they feel deeply and

genuinely accepted for who they are, find

the freedom and courage to change and

move forward instead of to entrench and

defend.

Four clinician values are important to

support client change: compassion,

collaboration, acceptance, and evocation.

Bob Newhart – Stop It (Mad TV) https://www.youtube.com/watch?v=aAhA7KfbJgg


“People are generally better persuaded by

the reasons they have themselves

discovered than by those that enter the

minds of others.”

Blaise Pascal, Mathematician and Theologian, 1623-1662


MI Recognizes Key Elements of

Behavior Impact Behavior Change6

There are pros and cons to every

behavior.

We choose behavior based on

assessing these pros and cons

consciously or unconsciously.

Ambivalence is the unresolved conflict

between the pros and cons and leads

to continuing a certain behavior.

Ongoing ambivalence is the most

significant road block to change.

Ambivalence is resolved when re-

evaluation of the values that inform

and propel our actions pushes us in a

new direction.

https://www.youtube.com/watch?v=aAhA7KfbJgg

https://www.youtube.com/watch?v=aAhA7KfbJgg

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The Process of Change7

Good MI guides towards change. A

common mistake is to focus

prematurely on directing the change

itself when we need to focus on:

Engaging/listening to understand

client values and readiness for

change.

Evoking and empathizing with

ambivalence that only the client can

resolve.

Empowering the client to

autonomously initiate change.

Precontemplation

Contemplation

PreparationAction

Maintenance


Four Concepts to the ”Spirit” of MI8

Motivational Interviewing is a spirit, an essence, a

perspective on partnering with people to help them identify

their path, resolve the roadblocks on that path, and find their

way forward towards the life they desire. How? We….

Engage Evoke Roll Empower


Motivational Interviewing

Addresses Barriers to Change9

• Fear

• Ambivalence

• Resistance

• Lack of confidence

• Empathy and engagement

• Evoking and valuing ambivalence

• Rolling with vs arguing against resistance

• Guiding and empowering clients to see their strengths and skills

Barriers

What differentiates MI from other therapies is the focus,

the “spirit” of MI which continually comes back to

EVOCATION of client values, goals, priorities, fears, belief,

strengths, and commitments which guide their

life decisions.

This is the HOOK of MI.

Strategy

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“An MI approach honors people’s autonomy, trusting

in their own natural wisdom and desire to grow in a

positive direction.” Miller and Rollnick, 2013

MI Spirit | Engagement

“If you treat an individual

as he is, he will stay as

he is, but if you treat him

as if he were what he

ought to be and could be,

he will become what he

ought to be and could be.”Johann Wolfgang Von Goeth

Build rapportEnsure comfort and a sense of collaboration

Listen to client priorities and

motivation

Set a mutual agenda

Give hope

Tools for Engagement


Engagement Done Well11

YOU

Hi Mr. Jones. Can I call you Mr. Jones?

CLIENT

Sure.

YOU

Thank you for coming today and dealing with

this required paperwork. We appreciate that.

CLIENT

No problem.

YOU

I have your referral from the Judge, but before

we go into that, would it be okay if we started

fresh by you helping me understand what

brings you here and how you hope I can help

you?

CLIENT

I don’t know why I’m here. The judge made me

come. I guess I hope you can help me get off

probation.

YOU

I see. You would like to get off probation but

are unclear why you were sent to us.

CLIENT

Yeah.

YOU

Would it be okay if I explained what our

agency does and how we have helped other

people with that goal of getting off probation in

the past?

CLIENT

Sure.

YOU

We are a job skills organization and work with

people who have ideas of what kind of job they

might want but have had a hard time finding

that in the past. Job hunting is a frustrating

process and many people really struggle with

having to expose a felony. Has that been

something you’ve had to deal with?

CLIENT

Yes. Every time I talk to someone, they shut

me out as soon as they see that checked box.

YOU

Yep. It’s really hard to make a new start.



CLIENT

I’m just trying to do right by my lady and my

kids.

YOU

You sound really committed to success and

like someone who really values his family.

CLIENT

I am. I cannot get locked up again. I miss my

kids too much.

YOU

I’d like to help you stay with your family. If I

understood more about the kinds of jobs that

interest you, perhaps we could make a plan

that you think could work to set up some

interviews. And I can talk with you about how

we help find employers willing to hire people

with criminal records.

CLIENT

That sounds good.

YOU

Great. Sometimes people have a lot of other

things on their mind right when they get out of

jail. Are there other things on your mind that

you might want to talk about or see if we can

help with?

CLIENT

Yes. My lady and I are pregnant again already

and I’m worried about her getting good food for

the baby.

YOU

Congratulations! Sounds like you could use

some help getting food assistance for her to

have a healthy diet for her now and for the

baby when it’s born?

CLIENT

Yeah.

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YOU

If it’s okay with you, after we talk about jobs, I

can refer you to my colleague who can talk

with you about food assistance. Or if you

prefer, you could talk to her first and you and I

can meet next week to talk about jobs.

CLIENT

Nah, we can talk about jobs today. I’ll wait to

talk about the food til my lady is here, too.

YOU

Great. I’m so glad you came here today and

hope we can help you and your family. We can

start with this interest inventory you filled out

while you waited…..


The best way to give advice to your children is to

find out what they want and then advise them to do it.Harry S Truman

MI Spirit | Evoking

Motivational Interviewing requires the clinician to understand the clients

motivation and reasons to change, reasons to not change, fears of change,

skills, failures, goals. These must be evoked through compassionate guiding.

Our training is partly based on a deficit model--identifying what is wrong or

missing what this person needs from us. There can be value in this

approach. However, when it’s time to help the client make changes, this

paradigm decreases our effectiveness.

In MI, we assume that this person knows herself much better than we do and

has the internal resources to make changes. Our job is to help clients find

the motivations and resources within themselves (Molly Kellogg, RD, LCSW)


MI Spirit | Evoking15

To see if you are operating in this

spirit, ask yourself:

• Am I focused on client motivation for

change rather than my own sense of

what matters?

• Am I spending the majority of our

session exploring client knowledge,

opinions or ideas or on offering

information and suggestions?

• Is my advice, when given, within the

context of what the client needs to

move forward?

• Is this plan one that the client has

developed and embraces?

Sketch Show UK Pros & Conshttps://www.youtube.com/watch?v=POycYoNDu7g

https://www.youtube.com/watch?v=POycYoNDu7g

https://www.youtube.com/watch?v=POycYoNDu7g

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Evoking, validating and

helping clients resolve

ambivalence

16

• I want to look better in a swimsuit

• I want to experience successful weight loss

• I want to be healthy

• I want the body I had 10 years ago

• I want to eat with my family

• I want to deny I have a weight problem

• I want to indulge

• I want to accept who I am without the

pressure of change

I want..

I also want


Evoking ambivalence leads to

motivation to change17

YOU

So you like desserts, but

hate insulin shots. Is that

correct?

CLIENT

Ugh. I need to find a way to

get over that fear.

YOU

You love eating out. But you

don’t want to end up back

here at the hospital. Would

you sum it up that way?

CLIENT

Yes. And I’m not getting a

slimmer waist line either.


The Spirit of Evocation18

NURSE

Tell me about your other tries at cutting down

the drinking.

PATIENT

I tried. I’ve thought about it. But the guys drink

every weekend so I don’t get too far,

NURSE

So you think about it, but doing something like

that would separate you from your friends.

PATIENT

I’ve thought about this for a long time. I want

better grades. I just like hanging out with

everyone all weekend and it’s part of the

scene.

NURSE

Makes sense. You’re a social guy and want to

hang out. But you have reasons to want to

avoid the alcohol that comes with it as well.

PATIENT

These have been my guys for years,

NURSE

They’ve been your buddies. But now you have

other goals, too. How do you try to make those

happen?

PATIENT

Not easily. And I hate to be the one who says

“sorry, gotta study.”

NURSE

You like to fit in with everyone. Does anyone

else, anyone at all, ever have to take time out

of the weekend to study?

PATIENT

There are some guys who study on the

weekends. But they miss out.

NURSE

So you wouldn’t be studying alone. There’d be

a few of you. But you wouldn’t be part of

everything, either.

PATIENT

Yeah. Which could have some

advantages….but would kinda suck, too.

NURSE

Sounds like there’s an up side and a down

side here. How have you resolved these

choices before?

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Ambivalance19

Ambivalence is safe, normal,

healthy, and expected.

Your role is to support and guide your

client through this and help them identify

factors involved in behavior choices.

The Effective Physician:

Motivational Interviewing Demonstrationhttps://www.youtube.com/watch?v=URiKA7CKtfc

Finding housing Staying in the shelter

Pros

Can live alone

Can smoke

Won’t get sick as much

Used to it

No pressure to work

Always heat on

Cons

Have to go to the program lectures

Miss my friends

Have to work

Sick of it

Worse on anxiety

Don’t sleep as well


20

• Desire

• Ability

• Reasons

• Need

• Steps

• OARS

• Pros and Cons

• Evocation

• Importance ruler

• Using extremes

• Looking forward

• Using

goals/values

• Typical day

questions

Change Talk (D.A.R.N.S.)

Tools

Evoking Change Talk


21 Identify the Change Talk

“I wish I could stop

smoking because my teeth

would look better.”

“I lost 10 pounds once for a

wedding and felt great.”

“I’ve got to use condoms. I

don’t want to get another

infection.”

“My boyfriend would be so

happy if I quit drinking.”

“I’d love to walk steps

without panting.”

“I could probably cut out

one coke per day.”

https://www.youtube.com/watch?v=URiKA7CKtfc

https://www.youtube.com/watch?v=URiKA7CKtfc

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Resistance is what happens when we push for change

before a client is ready. When we see these signs,

clients are less likely to change:

MI Spirit | Rolling with Resistance

Disputing

Interrupting

Denying

Diverting

Resistance is normal.

Reasons for resistance may not be clearly known even

by the client.


Signs of Resistance23

YOU

I can imagine you want to quit drinking so

you’ll do better in school.

CLIENT

I can’t quit drinking. I’m in a fraternity!

YOU

Is your fraternity more important than your

health?

CLIENT

In some ways, yeah. I’m with them all the time.

They’re my brothers.

YOU

But your liver test results indicate a growing

problem here.

CLIENT

A big problem or a little problem?

YOU

Liver issues are never a small problem.

CLIENT

That’s gotta be due to something else. I

traveled to Tunisia last year….

YOU

Well drinking can make that worse.

CLIENT

I don’t think I’m drinking too much. I think there

are too many cops in this town with not enough

to do.


24 Rolling with Resitance

The body craves homeostasis. You push; I pull.

You lean in; I lean out.

Don’t fall into the direct/resist trap.

If there is nothing to push against, the pushing can cease.

If we feel accepted, empowered, and understood, we are less

likely to push.

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Tools for Rolling with Resistance25

Show empathy: “You seem to feel very disheartened about this.”

Acknowledge ambivalence: “You clearly have good reason to stay angry. It

seems you also want to feel calm enough to go out with your wife tonight.”

Reflect negative emotion: “It sounds like you feel hopeless about finishing

this outpatient program.”

Reaffirm autonomy: “You don’t have to do any of these things. The choice to

join this program or not is totally voluntary.”

Acknowledge resistance and don’t fear it: “It feels like we are arguing and

getting off track. I’m pushing for something that doesn’t feel right to you. You

know yourself better than anyone else. Let’s go back to talking about your

goals and what’s important to you.”


Mi revolves around the concept of self efficacy and

relies on the clinician to help the client believe in their

capacity to change and gain more confidence to make

that change reality.

MI Spirit | Empowerment

Identify success with changes,

even small ones, in the past

Give positive feedback for work

already done

Recognize all signs that change

is possible

Techniques:


MI Spirit | Empower, Empower, Empower27

• Why hasn’t this changed?

• What gets in the way?

• You really need to do this….

• It doesn’t seem important to you because_____

• What do you think will happen if you keep doing this?

• What makes this achievable for

you?

• How will life look different when

this happens?

• What steps have you already

taken in this direction?

• What have you succeeded at in

the past that might help you do

this as well?

Diminish Build Up

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Techniques to Empower Change | Scale Questions28

YOU

“On a scale of 1-10 with 10

being ready and 1 being not

ready at all, how ready do you

feel to return to college?

CLIENT

“I would say a 3. I’m pretty

scared of the whole process.”

YOU

“What makes you say 3. Perhaps

there is something making you

feel even a little ready?”

CLIENT

“Well, my mom has agreed to

help babysit my daughter. So

that makes me feel a bit better.”

YOU

“So your mom will babysit and

you get to come home and have

your daughter see you going

after your goal and returning to

school. What an awesome role

model for her.”


Techniques to Empower Change | Scale Questions29

NURSE

So how important, on a scale of 1-10, is cutting

down drinking?

PATIENT

About a 4.

NURSE

What keeps it from being a 0?

PATIENT

I’m on probation and truthfully, I’m getting too fat.

NURSE

How do you see things being different when you cut

down?

PATIENT

I see my parents off my back; school off my back;

my friends giving me a hard time; but me feeling

better.

NURSE

And where do you see yourself starting this

process?

PATIENT

Maybe going home more on weekends. And maybe

cutting out Thursday happy hour and just doing

Fridays and Saturdays.

NURSE

You said it’s hard to not hang out. What’s going to

help you make this happen?

PATIENT

I can tell my girlfriend to make me. And I can put

some reminders in my phone….I sometimes work

out instead of hanging out every Thursday.

NURSE

Oh –so you were holding back on me! You’ve

already met your fitness goals by making the tough

choice to work out instead of relax with the guys on

a Thursday night. That’s not easy to do.

PATIENT

No. And they give me a hard time for it.

NURSE

And you came here – that’s a big step in the

direction you want to go. It’s no easy task to get

here on a Saturday. And you even had time to stop

for a bagel first! I’m impressed.

PATIENT

Just call me superman.

NURSE

I think I will.


Techniques to Empower Change | Take a Step Questions30

YOU

It sounds like eating three meals a day like the

Nutritionist recommended would be overwhelming

to you. If you were taking one step towards your

goal this week; one step you feel confident you

could take, what might that step be?

CLIENT

I dunno. Nothing too drastic. I could probably eat

100 extra calories this week.

YOU

Sound like a great place to start. How would that

look for you? What food do you have in mind and

what time of day works for you to eat more?

CLIENT

I like guacamole. Maybe I could add some to my

toast in the mornings.

YOU

Yum. But change is hard and I know it’s not easy for

you to add calories. What else might help you reach

your goal?

CLIENT

I think if I post those pictures of myself when I was

healthier, it would help.

YOU

Visual inspiration helps a lot of people. That’s a

great idea. Are those photos in your phone?

CLIENT

Yeah. I can stop at the drug store and print a couple

on my way home

YOU

Great idea. I look forward to hearing how the

experience is for you when you come back in two

weeks. Thanks for coming in today.

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Techniques to Empower Change

What Advice Would You Give Someone Questions31

YOU

I know you’re working hard to stop smoking and are

disappointed that it’s not happening yet. I hear lots

of reasons why it is not working for you. What

advice would you give someone in your shoes?

CLIENT

I’d tell them not to start smoking.

YOU

I bet. It’s such an addicting habit and our society

does a great job of promoting it. But if they did start,

based on your past success even stopping for a few

hours, what would you say?

CLIENT

I think when I’ve stopped, even for a day, it’s

because I got the cigarettes out of the house,

cleaned the house, and washed all my clothes. That

made me less likely to make things smelly

again…but obviously that didn’t work for too long.

YOU

So you would tell them to make it less tempting by

cleaning and getting cigarettes out of the house.

And if you think they needed a bit more inspiration

or something that could last a bit longer, what else

would you suggests?

CLIENT

Maybe if I had done something else instead, like

start eating popcorn or chewing Nicorette, or even

forcing myself to walk the dog when I felt like

smoking. I just tried to white knuckle through the

cravings and crashed every time.

YOU

So telling folks to have more distractions available

would be helpful.

CLIENT

Yes, very. And maybe going away for a few days to

change up the routine.


Techniques to Empower Change

What Advice Would You Give Someone Questions32

YOU

You have a lot of great ideas here….remove the

temptation of tobacco by getting rid of the cigarettes

themselves and the smell in the house, distract

yourself with other activities, and even get away for

a few days to change up the routine. You sound like

you could write a book about this to help others.

How might I support you trying these again for

yourself?

CLIENT

I do think I could help others. Maybe I should go to

that stop smoking support group. It might be good

for me, too.

YOU

Awesome. It’s always great to give and get

inspiration. And you certainly have lots of

experience to share. I can give you the contact

information on your way out. Anything else you think

would be helpful today?

CLIENT

No. Baby steps. I’ll go to a meeting and see you

next week.

YOU

Yep, one thing at a time. Good luck. The people

there will be lucky to have your advice!


The Interview33

An MI interview, through questions,

affirmations, reflections, and summaries

offered through the spirit of MI, guides the

client through the woods of fear and

ambivalence to find the flowers of strength

and commitment.

MI asks: “Help me understand how smoking

works in your life.”

MI affirms: “I get it. You smoke for comfort.

This makes sense. You make sense.”

MI reflects: “You also see it makes sense to

cut down. You’ve expressed strong reasons

to change. “

MI summarizes: “You’ve talked about how

your past success can help this time too and

you sound ready to take a big step forward

towards success.”

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Core Interviewing Skills of MI34

Asking Open ended questions

Affirmations

Reflective listening

Summarizing

O.A.R.S.

The focus should always be on the client

values, perspective, experience.


Motivational Interviewing | Asking Skills35

• Ask open ended questions

• Ask permission

• Ask questions focusing on the impact

of the behavior on the client

• Ask questions that look for the hook

What examples do you see in the

video?

Dr. Marilyn Herie - MI Skills

Tobacco Cessation -- Angry Clienthttps://www.youtube.com/watch?v=hB-zchaxlNc


OARS | Open Ended Questions36

Have you been keeping the

diet we discussed?

He keeps hurting you.

Are you going back to him again?

Your last pregnancies were

unplanned. It seems you really

should start using birth control.

You’ve been working on weight

loss. How is it going?

This relationship seems to be

causing stress. What are you

thinking about for next steps?

What concerns do you or your

boyfriend have about different

methods of birth control?

Questions Better Questions

https://www.youtube.com/watch?v=hB-zchaxlNc

https://www.youtube.com/watch?v=hB-zchaxlNc

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Open Ended Questions Invite

the Client Story37

How can I help?

What might be a next step?

What has worked in the past?

How would your life be different if

you made this change?

How is this behavior impacting

the people you love?

What makes this a good time to

change?

What are you most afraid of in

making this change?


The Client Story Leads

to the Hook38

How many pounds have you lost?

How are you feeling about yourself

two weeks into your diet?

Are you still living with your husband?

How is your living situation

impacting your children?

How many job interviews did you have

this week?

What has job hunting taught you

about what you want to do?

Are you still feeling depressed today?

What were a few significant things

that impacted your mood this week?

What were you able to do this week

with your friends?

How much did you smoke this week?

How did smoking impact your

activities this week?

How are you doing?

What would be most helpful for us

to focus on today?


Open Ended Questions | Let the Client Have the Best Lines39

YOU

What thoughts do you have about the role alcohol

plays in your life?

CLIENT

In general, it works. Everyone in my family drinks

when they hang out. Mine has gotten a bit out of

control I guess.

YOU

In what ways?

CLIENT

Like I ended up here because I spit at a cop when I

was drunk. I can’t be doing that stuff.

YOU

How did that situation resolve?

CLIENT

This class. A fine. A ticket. And a big fight with my

girlfriend.

YOU

What is your girlfriends perspective?

CLIENT

My girlfriend wants me to quit. She’s pretty pissed.

YOU

And you?

CLIENT

I think I need to do something. At least in the short

term….if I want to keep my girlfriend and not end up

with a record.

YOU

Sounds like you have some good reasons to quit.

This class might be a step to help you reach your

goal and your girlfriend sounds like she would like to

help as well.

CLIENT

Yeah. Maybe I’ll bring her for moral support. See

you next week.

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Open Ended Questions | Gone Bad40

YOU

So it looks like you got a citation for alcohol

recently?

CLIENT

Yes

YOU

When did that happen?

CLIENT

Last weekend.

YOU

So is that why you are here today?

CLIENT

Yes

YOU

I’d like to help you quit drinking so that doesn’t

happen again. You could derail your college

education and your future if you ended up with a

record.

CLIENT

I know. I need to stop.

YOU

I agree. Drinking can cost you everything and you’re

so lucky to be here at this school and have all these

opportunities. You have to stay for the whole class

and then come back next week.

CLIENT

Ok. Thanks.


OARS | Affirmations41

Try responding to these:

• I’m sorry I’m late. I totally forgot my

appt today.

• I know we talked about being

positive, but I’m still spiraling thinking

about how awful this divorce is for

me.

• I didn’t manage my anger well

yesterday. Totally lost it at the store

manager and had to go apologize

and beg for mercy today.

• I know I need to totally stop drinking.

I drank this weekend but never

blacked out.

Affirmationshttps://www.youtube.com/watch?v=VaUQ7dvwWfk


OARS | Reflective Listening42

What it is:

Rephrasing, paraphrasing,

reflecting emotion behind the

words

What it does:

• Reflects their perspective without

judgment

• Builds trust and reduces

defensiveness

• Reduces defensiveness

• Increases client motivation

“There is something about being heard and

understood, about being the focus of full

compassionate attention, that is in itself healing.”

https://www.youtube.com/watch?v=VaUQ7dvwWfk

https://www.youtube.com/watch?v=VaUQ7dvwWfk

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When listening…43

Beware the righting reflex: The

often insuppressible need and

impulse to correct, to “accurately”

inform our clients of what they

“should” do.

What this does is put them in a

corner to respond with the

opposite or to superficially accept

our rationale in place of creating

their own.


Reflective Listening Guides Towards the Issue44

NURSE

We’ve talked about your friends and your family.

Let’s talk about what brings you to this class today.

Would it be okay if we talked about your drinking?

(ask permission)

PATIENT

I don’t drink too much.

NURSE

You would say you’re a light drinker? (overcorrect)

PATIENT

Maybe not light. Maybe that I can hold my liquor

pretty well.

NURSE

So you can drink and it doesn’t affect you?

(rephrase)

PATIENT

True. I can drink quite a bit. It doesn’t affect me too

much.

NURSE

And you drink a few drinks….most nights?

PATIENT

Yeah. I guess I drink most weekends for sure.

NURSE

Most weekends you drink, but it doesn’t affect you

too much?

PATIENT

I don’t think it’s too big of a deal.

NURSE

Drinking is some degree of a deal. But not a big

one. (Guide)

PATIENT

Well, sometimes I think I need to cut back.

Especially during exams.

NURSE

You’ve thought about cutting back during exams.

Tell me how you’ve thought that would

help…(Reflect and guide)

PATIENT

I’m sometimes less sharp in morning classes.

NURSE

So drinking can affect your school work? (Reflect

and guide)

PATIENT

Yeah…I would say it hasn’t helped too much.


Reflective Listening Guides the Client to

His/Her Own Motivation45

YOU

Help me understand how drinking affects your

school work.

CLIENT

Well it did last semester, that’s why I am here. I had

to come or they’d kick me out of school.

YOU

I’m glad you picked my alcohol class over leaving

school.

CLIENT

Yes, if I left school my parents would kill me.

YOU

For your parents, it’s important that you finish

school.

CLIENT

It’s important to me, too. I want to get an MBA.

YOU

An MBA. Wow. Tell me about your career goals.

CLIENT

I’m hoping to do some CIA kinda thing. I guess I

need a clean record, too.

YOU

I’m getting a picture of a very motivated person. You

want good enough grades to stay on the CIA path.

Cutting down the drinking is part of your bigger plan

to improve grades, keep your parents off your back

and make them happy, go on to grad school, have a

clean record, and get your MBA.

CLIENT

It’d probably be a good thing for this gut I’m getting,

too.

(Both laugh…..)

11/1/2018

16


OARS |Reflective Listening46

YOU

What do these other guys do to get

weekend time to study?

CLIENT

My roommate sets his alarm on

Sunday and can get through his

calculus problems before the rest of us

wake up.

YOU

Does any part of that seem doable to

you at all?

CLIENT

Starbucks does. And maybe getting

time to work out. Maybe I could just try

waking early to go eat and work out

first.

YOU

So am I understanding that you could

practice waking early by using that

time to go out for breakfast and work

out – which are much more appealing

to you than studying.

CLIENT

Yeah. I guess I could try that. Who

knows, maybe I could study at some

point..

YOU

Baby steps! Sounds like coffee first is

a good plan.


OARS

Great Sessions End with Great Summaries47

Perfect for use in transitions or

after significant statements

Begin by saying you are going

to summarize

Focus on their hooks and their

change-promoting statements

Include the positive and

negatives they expressed

Feel free to include a little (!)

additional information

End with an invitation


OARS | Summary48

YOU

Let me see if I can capture some of the highlights of what

we talked about today. It sounds like you enjoy drinking

and it’s a great bonding activity for you and your friends.

But recently it’s caused you academic problems and

trouble with your family…and your weight. Right?

PATIENT

Yup.

YOU

Today you came up with some good reasons to cut down

and a couple ways to start the process. You said you could

study with a friend perhaps at the library, hang out more

with your girlfriend when she’s studying, and maybe even

post the emblem of the CIA on your mirror.

PATIENT

Yeah. Those could work.

YOU

You also told me you’ve thought about this before and

have good reason to make it work this time. Am I still

getting this?

PATIENT

Yeah, all true

YOU

It sounds like you have some support – for sure your

girlfriend and your parents and a few other guys who study

on the weekends.

.

PATIENT

Yeah – there’s a few. And my parents would probably buy

me a beer on a Saturday if that was the only day I went

out!

YOU

Even more reason to go for your goal! Sometimes people

can cut down on their own. And some people have seen

our doctors here for some medications that can reduce

cravings for alcohol. I have some information on ways to

reduce alcohol use, with and without medication, and

some more information on how it can improve your health.

Are you interested in learning more?

PATIENT

Sure. Especially if you information on buying a

breathalyzer. One thing I can’t have is a DUI.

YOU

I can get that for our next meeting. You’ve made it very

clear you have your eyes on that CIA career and that even

a misdemeanor on your record could end that dream. Did I

miss anything else we focused on today?

PATIENT

Nope, sounds good. See you next week.

YOU

I look forward to talking again.

11/1/2018

17


49 Bringing It All Together

Group Practice:

Case Studies & Role Play


Thank

You

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