Mastering the OARS of Motivational Interviewing
Motivational Interviewing (MI) is a powerful tool in the psychiatric toolkit, especially when working with patients who are ambivalent about change. Whether you’re addressing medication adherence, lifestyle modifications, or other behavioral changes, MI can help patients explore their ambivalence and move toward positive action.
Central to MI are the OARS techniques: Open-ended questions, Affirmations, Reflective listening, and Summarizing. Let’s explore how to use these techniques to develop and navigate ambivalence in your patients. Knowing these skills can help promote change.
Open-Ended Questions and Inviting Exploration
Open-ended questions are the cornerstone of motivational interviewing. They encourage patients to share their thoughts, feelings, and experiences in their own words, providing you with valuable insights into their motivations and concerns.
Example: Instead of asking, “Do you want to start this medication?” try, “What are your thoughts about starting this medication?”
Why It Works: Open-ended questions create a space for patients to express their ambivalence, allowing them to explore both sides of their decision-making process. This exploration is crucial for developing a deeper understanding of their motivations and fears.
Affirmations Build Confidence and Trust
Affirmations are positive statements that recognize and reinforce your patient’s strengths, efforts, and past successes. They help build a supportive environment where the patient feels valued and understood.
Example: “It sounds like you’ve really been putting a lot of thought into how to manage your anxiety. That’s a big step forward.”
Why It Works: Affirmations build the patient’s confidence and self-efficacy, which are essential for overcoming ambivalence. When patients feel supported and acknowledged, they are more likely to engage in the process of change.
Reflective Listening to Demonstrate Understanding
Reflective listening involves carefully listening to your patient and then reflecting back what you’ve heard in a way that shows understanding. This technique helps clarify the patient’s thoughts and feelings while demonstrating that you’re truly listening.
Example: If a patient says, “I’m worried about taking medication, but I know I need to do something about my depression,” you might reflect, “It sounds like you’re feeling torn between your concerns about medication and your desire to feel better.”
Why It Works: Reflective listening helps patients hear their own ambivalence out loud, which can lead to greater self-awareness and insight. It also fosters a collaborative relationship, where the patient feels heard and understood.
Summarizing – Bringing It All Together
Summarizing involves pulling together the key points of what the patient has shared and presenting them back in a concise way. This helps to reinforce the conversation’s progress and ensures that both you and the patient are on the same page.
Example: “So far, we’ve talked about your concerns about medication, your desire to manage your symptoms, and some of the steps you’ve already taken. Where do you think we should go from here?”
Why It Works: Summarizing helps to consolidate the discussion and can highlight any ambivalence the patient is experiencing. It provides an opportunity to move the conversation forward, often leading to the patient identifying their next steps.
Guiding the Patient Toward Change – Developing Ambivalence
Ambivalence is a natural part of the change process, especially in psychiatric care, where decisions often involve complex emotions and significant lifestyle adjustments. The goal of MI is not to push the patient toward a particular decision but to help them explore their ambivalence and arrive at their own conclusion about what is best for them.
How to Develop Ambivalence:
Explore Both Sides: Encourage the patient to discuss both the pros and cons of change. This might involve exploring the benefits of taking medication versus the risks of not addressing their symptoms.
Example: “What do you think might happen if you decide not to start this treatment?”
Emphasize Autonomy: Remind the patient that the decision is ultimately theirs to make. This empowers them to take ownership of their health.
Example: “It’s completely up to you how you want to move forward. Let’s explore all your options.”
Highlight Discrepancies: Gently point out any discrepancies between the patient’s goals and their current behavior.
Example: “You’ve mentioned wanting to feel better, but you’re also unsure about starting treatment. How do those feelings fit together?”
Why It Works: Developing ambivalence helps patients see the gap between their current behavior and their goals. By exploring this ambivalence in a non-judgmental way, patients are more likely to engage in a thoughtful decision-making process and commit to the changes that are right for them.
Using OARS to Navigate Ambivalence
Using the OARS techniques of Motivational Interviewing can significantly enhance your ability to support patients through the complexities of change. By asking open-ended questions, providing affirmations, practicing reflective listening, and summarizing effectively, you create a collaborative environment where ambivalence can be explored and resolved. Remember, the goal isn’t to push patients toward a specific outcome but to guide them through their ambivalence, helping them to make decisions that align with their values and goals.
