OpenQuestionsPracticeSheetConverttheclosedquestionsbelowtoopenones.Remembertherearemanypossibleresponses.Becreative.Comeupwithatleastthreeopenquestionsforeachexample.Youwantyourquestionstoelicitwhatthepatientknows,wants,believes,thinks,andfeels.Itisusuallywisetoavoidaskingwhyquestions,astheytendtohaveanaccusatoryordemandingtone,andthusputpeopleonthedefensive.Howmanytimeshaveyouusedmethinthepastsixmonths?Istheresomereasonyoucan’tcheckyourbloodsugartwiceaday?Youknowyoursmokingputsyourkidsatriskforgettingasthma?Right?Writeatleastthreeopenquestionsforeachofthefourprocessesthatonewouldlikelyaskwhenhavingaconversationaboutchange.ENGAGINGFOCUSINGEVOKINGPLANNING

FormingAffirmations1.Thinkofafriend,relative,client,orpatientthatyouknow.Writedownthevariousstrengths,virtues,andpositivequalitiesyouseeinthisperson.2.Nowprovideseveralaffirmationsthatyoumightoffertothispersonrelatedtoparticularstrengthsorqualitiesthatyouidentified.Affirmationsarestatementsthatcommonlybeginwithyou.Forexample: -Thattookalotofcourageto... -You’reaveryresourcefulperson. -Youshowedalotofpatiencewhen... -Youputinmanyhoursofhardworktoachieve...Affirmationsaremoreeffectivewhentheyarespecific.Statetheminapositivemannerandensurethatyouarebeinggenuine. 3.Repeattheprevioustwostepswithdifferentpeopleinmind.Considerchoosingsomeoneyoufindparticularlychallengingtobearound.Example:Trudysmokestwopacksofcigarettesaday.Sheknowsitisn’tgoodforherandisfedupwithpeopleremindingherofit.Overtime,shehascometorealizethathersmokinghasmovedfromasocialhabittoaharmfuladdiction.Shefeelsguiltyabouthersmokingandtriestohideitfromherfamily.Atsomepoint,shewillstop,butjustnotyet.Witheverythingelsegoingoninherlife,thisisoneareashefeelsisherown.Strengths:

• Independent,doesn’tletothersundulyinfluenceher.• Awareofchangesinherbehaviorandisbotheredbyit.• Wantstobemorehealthy

Affirmation:Youaresomebodywhomakesupherownmind.You’reawareofthenegativeeffectsofsmokingandwhenyou’rereadytomakeachangeyou’lldowhat’sneededtobesuccessful.AdaptedfromRosengren,DB.(2009).BuildingMotivationalInterviewingSkills:APractitionerWorkbook

FormingReflections

Overview:Ingroupsof3-6,practiceformingandrespondingwithreflectivestatementstowhataSpeakersays.Choosefromtheactivitiesbelow,ormakeupyourown.1.AdesignatedSpeakerbeginstalkingaboutatopic(favoriteactivity,personwhoinspiresthem,decisionthey’refacing,challengingsituation,dilemma,other)for30-45seconds.Inturns,eachpersoninthecirclerespondswithareflectivestatementchoosingdifferentreflectionstemslistedbelow.Afterseveralrounds,repeattheactivitywithanotherSpeaker.2.Asin#1,adesignatedSpeakerbeginstalkingaboutatopic.ThistimethepersontotheleftoftheSpeakerrespondswithareflectivestatementusingoneofthestemsbelow.TheSpeakerrespondsbrieflytothatstatementandthenthenextpersoninthecircleformsareflectionbasedonwhattheSpeakerjustsaid.Afterseveralrounds,repeattheactivitywithanotherSpeaker.

StemslistadaptedfromCommunityCareofNorthCarolinaMIResourceGuide

Yourconcernisthat…

Yourfearisthat…

Itseemsthat…

You’renotterriblyexcitedabout…

You’renotmuchconcernedabout…

Thisreally…

Youfeelso…

It’sreallyimportanttoyouthat...

You’renotreally…

Youfeelasthough…

WhatIheardyousaywas…

(Others)

Soundslike…

You’resayingthat…

You’refeelinglike…

Almostasif…

It’slike…

Itfeelslike…

Foryou,it’samatterof…

Fromyourpointofview…

Asyouseeit…

You…

You’rewondering

Youreally…

Youbelieve…

DirectiveReflecting

Readthesentencestemandwritedown(orspeakaloud)atleastthreedifferentresponsestoeachitem.Eachshouldemphasizeadifferentaspectofthestatement.Hereisanexample.It’sbeenfun,butsomethinghasgottogive.Ijustcan’tgoonlikethisanymore.

- You’veenjoyedyourself.- You’reworriedaboutwhatmighthappen.- It’stimeforachange.

IknowIcoulddosomethingsdifferently,butifshewouldjustbackoff,thenthesituationwouldbeawholelotlesstense;thenthesethingswouldn’thappen.I’vebeendepressedlately.Ikeeptryingthingsotherthandrinkingtohelpmyselffeelbetter,butnothingseemstowork,excepthavingacoupleofdrinks.So,I’mnottooworried,butit’sbeenoverayearsinceI’vehadanHIVtest.IknowI’mnotperfect,butwhydotheyhavetoalwaystellmewhattodo.I’mnot3!Iprobablyshould,butIdon’tusecondoms.It’snotmything.Imighthaveaproblem,butwhoareyoutobegivingmeadvice.Whatdoyouknowaboutdrugs?Ibetyou’veneverevensmokedajoint!Idon’tthinkIhaveadrinkingproblem.It’sjustthatmypartnerisoverlysensitivebecauseherdadwasanalcoholic.AdaptedfromRosengren,DB.(2009).BuildingMotivationalInterviewingSkills:APractitionerWorkbook

FormingSummaries

Overview:Incirclesof3-6,practiceformingcollecting,linking,andtransitionalsummaries.HaveaSpeakerandInterviewerengagein3-5minuteMIconversation.Then,1.Haveapersoninthecircle(otherthantheInterviewer)provideacollectingsummaryfollowedbyabriefresponsefromtheSpeakeraboutthegeneralaccuracyofthesummary.2.AsecondpersoninthecirclethenoffersalinkingsummaryfollowedbyabriefresponsefromtheSpeaker.3.AthirdpersonthenprovidesatransitionalsummaryfollowedbyabriefresponsefromtheSpeaker.4.Debrief5.RepeattheexercisewithadifferentSpeakerandInterviewerengagingina3-5minuteconversation.BasicFrameworkforOfferingSummaries1.Beginwithstatementindicatingyouaremakingasummary2.Givesummaryofselectedcontent3.EndwithaninvitationfortheSpeakertorespond–e.g.Whatwouldyouaddtothat?WhatdidImiss?TypesofSummariesCollectingsummariespulltogetherinonebasketvariouschangetalkstatementsthatthepersonhasmentioned.Linkingsummariesconnectwhattheindividualhassaidwitharelevantstatementorideathatcameupinapriorconversation.Transitionalsummariesareusedasawrap-upattheendofaconversation,oratapointoftransitionintheconversation.Inallthreecases,emphasisisplacedonshiningalightonthepersonschangetalk.

RowingwithOARS(withObservers)Purpose:InterviewerspracticehowtouseOARSstrategicallytomovetowardaparticularchangegoal.Overview:OnceoneiscomfortableusingOARSinanondirectivemanner,thenexttaskistolearnhowtouseselectivequestions,affirmations,reflectionsandsummariestoevokechangetalk.Guidelines:Workingroupsoffour:Onespeaker,oneinterviewer,andtwoobserversatatime.Thespeaker’stopicis“Onethinginmylife(oraboutmyself)thatIwouldliketochange…”Thisinstructionistostartwithatopicaboutwhichthepersonalreadyhassomedesiretochange,andthereforesolicitingchangetalkshouldbebotheasierandnatural.Theinterviewer’staskistouseOARStoevokechangetalk(e.g.desire,ability,reasons,need,important,confidence,andcommitmenttochange).Itmaybeusefultodiscussbeforehandvariousmethodsforelicitingchangetalkorhaveamenufromwhichtochoose(seeMethodsforEvokingChangeTalkbelow).Theinterviewershouldrefrainfromgivingadvice,andsticktotheOARS,beingcarefultooffermorereflectionsthanquestions.OneobserverusesanOARSsheetandrecordsoccurrencesofeachoftheseresponses.TheusualprocedureistomakehashmarksnexttoO,A,R,andSastheseoccur,andalsotowritedownwhattheobserverregardedtobeparticularlygoodexamplesofeach.Thesecondobserverlistensforchangetalkfromthespeaker.Youcanassignthiscodertoworkinvariousways,suchas(1)simplecountingofchangetalkstatements,(2)placinghashmarksinDARNandCcategories,(3)writingdownparticularlygoodexamplesofchangetalk,(4)ratingthestrengthofchangetalk,(5)alsotrackingsustaintalk,or(6)alsonotingwhattheinterviewerdidrightbeforeeachchangetalkstatement.Theinterviewermaypauseatanypointintheconversationtoconsultwiththeobservers.Allowtheconversationtoproceedforabout8-10minutes,andthengivea2-minutewarningatwhichtimetheinterviewershouldofferabouquetsummaryofthespeaker’schangetalkandaskwhatthespeakermightaddtothat.Debrieftheexerciseby1)havingtheinterviewertalkaboutwhathe/shedidwellandonethingtoimproveupon,2)havingthespeakertelltheinterviewerallthethingstheinterviewerdidwell,andonesuggestionforimprovement,and3)havetheobserversreportwhattheyobservedusingtheircodingsheetstosummarizetheirobservations,andmentionparticularlygoodexamplesthattheynoted.MethodsforEvokingChangeTalkAskingevocativequestions Whatworriesyouaboutyourcurrentsituation? Whywouldyouwanttomakethischange? Howmightyougoaboutit,inordertosucceed?

Usingtheimportanceruler(alsouseregardingperson’sconfidencetochange) Onascaleof0to10,howimportantisitforyoutomakethischange?Tellmeabout beingat___comparedto(severalnumberslower)?Whatwouldittaketomovefrom ___to(nexthighestnumber)?AndhowImightIhelpyouwiththat?

Exploringextremes–Whatconcernsyouabsolutelymostabout____?Whataretheverybestresultsyoucouldimagineifyoumadeachange?

Lookingback–Whatwerethingslikebeforeyoubegandrinkingmorefrequently?

Lookingforward–Howwouldyoulikethingstobedifferentinthefutureregarding_______?

Exploringgoalsandvalues–What’smostimportanttoyouinlife?Whataretherulesyou’d sayyouliveby?Howdoesdrinkingfitwithyourpersonalgoals?Notes:Thisisquiteacomplexexercise,andbenefitsfromthetrainer/facilitatorcirculating,observing,andcoaching.Theexercisecanberepeatedifdesired,sothateachparticipantgetstoplayeachrole.AdaptedfromDavidRosengrenandBillMiller

0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely important important

ChangeTalkQuizModifiedfromMoyers&Martin,2005

Instructions:Underlineanypartsoftheclientstatementsbelowthatsoundlikechangetalk,includingthelessobviousstatementsthatonlyhintatchange.Thisisnotanexactsciencesodon’tbeconcernedaboutbeingrightorwrong.

1 Interviewer:Tellmeaboutyourdrinking.

2 Client:Well,Ijustlovethewayitmakesmefeel.Itmakesmefeelgreat.Ican’treallyimagineadaywithoutthatfeeling.

3 I: Adaywithoutalcoholwouldbedifficult.

4 C:Yeah,Idon’tthinkIcouldcope.Imean,Igetreallystressedbymywork,andIneedafewdrinkstocalmdown.

5 I: Soyouusealcoholtodealwithstress.

6 C:Yeah,Idon’tthinkI’lleverquitdrinking.Ireallydon’twanttoquitandImean,whatwouldbethepoint?

7 I: Youdon’tseeanyreasontoquit.

8 C:Yeah,Itellyou,justthisweekIboughtapackofbeersfromaroundtheworld,andIstarteddrinkingadifferentoneeachday,tostarttheeveningouteachnight.

9 I: What,ifanything,doyounotlikeaboutalcohol?

10 C:Wellcertainly,itcostsalotofmoney.Imean,I’msureIcouldspendthemoneyinbetterways.

11 I: Themoneyisanissueforyou.Isthereanythingelseyoudon’tlikeaboutit?

12 C:Yeah,thewayIfeelwhenIwakeup.Istillfeelprettygroggyalldayatwork.Iwouldliketofeelalittlemoreclear-headed.

13 I: Thegrogginessaffectsyourwork.

14 C:Well,certainlyI’malittlemoreshort-temperedthanImightbe.Ireallygottagetahandleonthat.Imean,I’masalesperson,soifI’mnotpatientwiththeidiotswhocallupwantingsomething,thenIlosethesale.

15 I: So,alcoholhasaffectedyourabilitytodoyourjob.

16 C:Yeah,Iguessso.

17 I: So,onascalefrom0-10,with0beingnotatallmotivated,and10beingextremelymotivated,howmotivatedwouldyousayyouaretocutdownorquitdrinking?

18 C: I’dsaya2.

19 I: So,whynota0?Whynotthelowestpossiblemotivation?

20

C:Well,Ireallywanttofeelbetteratwork.And,Ineedtomakemoresales,whichmeansIneedtodrinkless.AndthingswouldcertainlybebetterfinanciallyifIwasn’tspendingsomuchmoneyonalcohol.Infact,I’dsayI’mmorearounda3thana2.Ijustdon’tthinkIcandoit,youknow.Idon’tthinkIcancutdown.

21 I: So,I’mreallyhearingtwothings.Youwanttocutdown,youneedtocutdownandyouhavereasonstocutdown,butyou’renotsurethatyouwillbeabletocutdown?

22 C:Yeah,I’mafraiditmightbetoohard.

23 I: Itsoundslikedrinkinghasbeenpartofyourlifeforalongtime.

24

C:SinceIwasfourteen.MyfriendsandIusedtoshopliftitfromtheQuickieMartdownthestreet.Wegotcaughtafewtimes,butwejustkeptdoingit.Thenafterhighschool,Ihadafriendatworkthatwouldbuyitforme,butonlyifIpaidandhegothalfofthebooze.ThatwashardbecauseIwasspendingalmostallmypaycheckjusttogethalfthebooze.

25 I: Soitcostquiteabitbackthen.Howaboutnow?Youmentionedthemoneybefore.

26 C: I’dsayIspendwaytoomuchonitthesedays.But,Igottahavethatbuzzafterwork,likeIsaid.

27 I: Withoutityou’dbetoowounduptofunction.

28 C:Well,Idon’tknowaboutfunction.I’dfunctionOK,Iguess,Ijustwouldn’tbeashappy.

29 I: Whatotherthingsdoyouliketodo?

30 C: IliketowatchTV,hangoutwithmyfriends,buttheyalldrinktoo.AndIliketogoseemovies.

31 I: Andyou’renotdrinkingwhenyouseemovies.

32 C:No,amovieisusuallydistractingenoughthatIcangowithoutuntilIgethome.IsupposeIcouldgoseeamovieeverynight!IthinkI’lltrythat.Twohourswithoutdrinkingislike4lessbeersanight.

33 I: Andcheaperthan4beers,Iwouldimagine.

34 C:NotwhenyoudrinklikeIdo.Igetthecheapestbeerpossible,becauseIdrinksomuchofit.Amoviecosts$10thesedays,but4beersonlycostsmelike2bucks.

35 I: So,seeingamovewouldn’treallyhelpfinancially,butyouwouldprobablyfeelbetterthenextday.

36 C:Yeah,andIwouldprobablybemorepatientonthephonewithcustomers,whichmightmeanmoresales.Thatwouldhelpfinancially.Igetpaidoncommission.

37 I: Arethereperiodsinyourlifewhenyoudidn’tdrink?

38 C:Yes,onceIquitforacoupleofweeks.

39 I: Itwasn’tsomethingyouwantedtokeepdoing.

40 C:Well,Iwasmoreproductive,butthestresswasterrible.Istartedtoexercise,andthathelped.

41 I: So,youwereabletoquitfortwoweeks,andexercisehelpedreducethestressthatyoufeltfromwork.

42 C:Yep.Youknow,IbetIcoulddothatagain.Icouldexercise.

43 I: So,itsoundslikeyouhavetwoplansinmind,togotoamovieeachnightandtoexercisetorelievestress.Doyouthinkyoucoulddoboth?

44 C: Idon’tseewhynot.Itmightevenhelpmetoeventuallyquit.

Instructions:Afterunderliningallofthechangetalk,gobackandnoteintheodd-numberedsquareswhichoftheO-A-R-Stheintervieweruses.Noticehowtheyareusedtobothelicitandrespondtochangetalkthroughouttheconversation.

SnatchingChangeTalkfromtheJawsofAmbivalenceAdaptedfromBillMiller&TerriMoyers

Instructions:I.Underlinethechangetalk(desire,ability,reason,needorcommitment)instatements1-10.II.Formtriads:Client,Listener1,Listener2

• Clientreadsentirestatementofambivalence.Listener1respondstochangetalkwithreflectivestatement.Clientrespondswithmorechangetalk.

• Listener2respondstonewchangetalkwithreflectivestatement.Clientrespondswithevenmorechangetalk.(Rotaterolesandgotonextstatement.)

Example:Ireallydon’twanttostopsmoking,butIknowthatIshould.I’vetriedbeforeandit’sreallyhard.Options:A.Youreallydon’twanttoquit.B.It’sprettycleartoyouthatyououghttoquit.C.You’renotsureifyoucanquit.(OptionBisthereflectionthatreinforcesthechangetalk.)

1 Idon’tdrinkanymorethanmostpeopleIknow.Sure,Isometimesfeelalittlefoggythenextday,butitwearsoffquick.It’snobigdeal.

2 Sure,Iwantmykidsback,andIwanttobeagoodmother,butthecourt’smakingitimpossible.There’snowayIcandoallthosethingsthey’remakingmedo.

3 Iwasn’tdoinganythingwrong!Ijustwentalongfortheride,andIdidn’tknowtheyweregoingtograbthatlady’spurse.Nowthey’resayingthatIviolatedmyprobation.Iguessit’snotsmarttobecruisingaroundat2inthemorningbutithappenedsofast,therewasnothingIcoulddoaboutit.Ididn’tbreakanylaws,andI’mnotgoingbacktojailforthis.

4 It’ssuchahassletotakethosepills.I’msupposedtoremembertotakethem4timesadayandhalfthetimeIdon’tevenhavethemwithme.Iguessthere’sagoodreasonforit,butit’sjustnotpossibleforme.

5 LasttimeItriedtoquitsmoking,Iwasreallybadtobearoundfor5days.Iwasjustgoingoffoneverybody.But,then,afterthatIwasprettycoolandthenafter2weeks,Iwasabletobecoolallthetime.But,Ican’tbelosingmycoolwithpeoplefor5daysyouknow.Inmysituation,ifIgooffonthewrongpeople,itcouldbebadman,realbad.

6 Sometimes,doingmyritualsmakesmewanttoscream.But,thenIthink,ifIdidn’thavemyOCD,I’dprobablybealotlessconscientious.IthinkmyOCDispartofwhatmakesmeagoodperson.

7 Hey,Ican’tgoinpatient.IfI’vegottogosomeplace,whycan’tIgotoAAorsomething?IfIgoinpatientfor28days,I’mgoingtolosemyjob,plusalotofotherbadstuff.YouunderstandwhatI’msaying.

8 Whenyoutakethatfirsthitman,there’snofeelinglikeit.Atthatmoment,youjustdon’tcareaboutallthebadstuffdrugsdotoyourlife;it’sjustthisamazingrushandnothingelsematters.

9 Yeah,Iwasgoingtonightclasses.Iwenteveryday,didmyhomeworkandIadmit,Iwasfeelinggoodaboutthat.But,it’sgottenjusttoohard,youknow,it’scausingmetobetiredatwork,andeventhoughmywifesaysshe’sformefinishing,Icantellsheisgettingtiredofhavingtheextraburdenwiththekidsandall.Man,Iwouldliketohavethatcertificate,though.

10 Ihavenotimetogotocounseling.IreallyhatethatI’msomuchmoreimpatientwithmykidsthanIusedtobebecauseI’msomiserable.But,Ican’tleavethemalone.Idon’ttrustanyoneelsetotakecareofthemthewayIdo.

ChangePlanWorksheet

Onceanindividualisreadytotakeactiontowardsmakingachange,itcanbeusefultousethisworksheetasaguidetostrengthencommitmentanddeterminenextsteps.AgoalIhaveisto:Mymostimportantreasonstomakethischangeare:Somethingsthatcouldgetintheway:PersonalstrengthsIcandrawupon:ThenextstepsIplantotakeandwhen:1)2)3)Otherpeoplewhocouldhelpme:Person Possibleway(s)tohelpI’llknowmyplanisworkingif/when:WhatIwilldoiftheplanisn’tworking:

FourProcessesIntheRoundSet-up1.Practiceingroupsofapproximately4-8.2.HavethegroupcomeupwithaclientscenariotopracticeMIskillsthroughthefourprocessesofEngaging,Focusing,Evoking,andPlanning.UselesschallengingscenariosforgroupswhoarenewertoMI,andmorechallengingonesforgroupswithmoreadvancedskills.Choosesomeone,perhapsthepersonwhoidentifiedthescenario,totakeontheclientrole.3.ExplainthatthegroupwillgoaroundthecircleandtaketurnsusingthecoreinterviewingskillsofMI(OARS)tomovethrougheachofthefourprocesses.Beforeeachprocess,thegroupwillfirstdiscusspossiblewaystoapproachthatprocess,andthendebriefwhathappenedaftereachprocessiscompleted.Itmayalsobeusefulinthemidstofpracticetopauseforbriefdiscussion,feedbackorcoaching.ExerciseexampleAfterbrieflydiscussinghowwemightproceedinEngagingwiththis"client,"thepersontotheleftofthe"client"beginstheconversationandstartswithEngaging.Theaimistogoforafewexchanges(usingmorereflectionsthanquestions)beforepassingitontothenextpersontotheleft(aclock-wisemovementaroundthecircle).SeveralpeoplecontinuepracticingEngaginguntilthetrainer/facilitatorcallstimeandthegroupthendebriefs.ThisstructureisfollowedforeachoftheremainingprocessesofFocusing,Evoking,andPlanning.Duringeachprocesspractice,thetrainer/facilitatorallowstheflowtocontinue,ormaychoosetobrieflystopactionandcoachinthemoment,ormayallowthegrouptobrieflydiscussaquestionthatemerges,orsomeonemayofferasuggestiontheyhaveforhowsomeonemightproceed.Thetrainer/facilitatorkeepsaneyeontheclockandmovesthingsalongtoensureallparticipantshaveanopportunitytopractice.AdaptedfromandwiththankstoSandyDowney

MIConversationExerciseInstructions:Considerdoingthisexercisewithalearningpartner.Haveonepersonreadtheclient’spartandonereadthehealthcoach’spart.Initiallyreadthroughtheentireconversationtomakeit“comealive.”ThengobackanddiscussyourobservationsandrespondtothepromptsinColumnB.Key:CLis“client;”HCis“healthcoach.”Assumethatintroductionshavebeenmadeandtheconversationisstarting.ReadtheconversationinColumnAandinColumnBwriteyourobservationsfocusingon:

• Typeofclientspeech:isitsustainorchangetalkoramixofboth• Method(s)usedbythehealthcoachfromOARS+Eandanyspecifictypeof

methodfromtheskillslist:theremaybemorethanoneusedintheexchange,reflection,openquestion,affirmation,summary,exchanginginformation,etc.

• WhatMIprocessisrepresented:Engaging,Focusing,Evoking,Planning• Identifythetypeofsummary(gathering,linkingortransitional)when

instructed:gatheringorcollectinginformationofferedbytheclient;linkingdifferenttopicsexploredtoshineanewlightonthesubject;andtransitional,usuallyaccompaniedbyakeyquestion,whichmovestheconversationfromoneprocesstothenext

• Commentonhowtheclient’schangetalkisacknowledgedandinvitedwhereyounoticeit.

A.Conversation B.ObservationHC:Whatareyourmainconcernstoday?

Method(s):

CL:MydoctorsaidIneededtofocusonmystress,thatthewayIdoordonothandleitiscausingmehealthproblems.

HC:Itwasmoreofyourdoctor’sideaforyoutobeherethanyours.

Method(s):

CL:Well,Iwouldnotbehereotherwise,butIdon’tthinkitisabadidea.

HC:Youhavesomeconcernsyourself.

Method(s):

CL:I’m55yearsold,workatahighstressjobwhereIseeothersmyageoryoungergettinglaidoff.Iworklotsofhourstomakesuretheyseemeasproductive.ThiskeepsmeprettytenseandIguessmydoctorthinksmyhighbloodpressurestaysupbecauseofthisandhowIdoordonothandlethestress.

HC:Youmentionedthatearlier.Tellmewhatgoesonwithyouandstress.

Method(s):

CL:IguessIamlikealotofpeopleIknow.Idon’ttaketime

forlunch,justeatsomethingfast,likeasliceofpizza;Idrinkcoffeeorsomekindofcaffeineallday.OnceIleaveworkandgethome,IhaveafewdrinksatnightandjustsitonthesofaandwatchTVuntilbedtimeandthenIdon’tsleepwell.ThenIgetupanddoitallagain.Ioftenworkonatleastonedayontheweekendandtheotherday,Ijustsitaround,drinksomebeerandwatchsportsonTV.HC:Averytiring,viciouscycleofyourlifewhereyouareneverquiteoffduty,neverrelaxed.Youdothingsduringthedaytokeepgoingandthenjustcollapseathome.Andyourdoctorhasconcernsaboutyourbloodpressureaswell.

Typeofsummary:

CL:Yougotitright!AtthisrateImaynotevenmakeittoretirement.Imighthaveaheartattackorstrokebeforetheycanevenlaymeoff!

HC:Thisisseriousfromyourpointofview.Whatconcernsyouthemost?

Method(s):

CL:Well,myownfatherdiedwhenhewas59fromaheartattack;hehadhighbloodpressure,nevertookanytimetorelax,andheworkedhimselfintothegrave.

HC:Youcanseeyourselfonthesamepathandthatreallyhasyourattention.

Method(s):

CL:Right!Idon’twantthattohappentomebutIdon’thaveacluewhattodo.Likeyousaid,Iaminacyclehereandjustkeepdoingthesamething.I’mgainingweight,andIfeeltiredallthetime.

HC:Anditseemslikeevenmorethanwhatisgoingonwithyouthathasyouthinkingaboutit;alsowhatyousawhappentoyourfatherhasyouconcerned.Youwanttoavoidthesameoutcomeandarenotsureyetwheretostart.

Typeofsummary:

CL:WhenDr.Jonestoldmeitistimetogetserious,tocometalktoyou,IguessIwasalittlerelieved,thathewassayingIdidn’thavetojustletthishappen,thatmaybeit’snotinevitable.

HC:Yourecognizeitistimetodosomething.Youaretakingresponsibilityandarehopefulwecanfigureoutsomethingthatwouldbehelpful.LetmeseeifIunderstandthusfar,youwanttobehealthier

Whatistheprocessthusfar?Method(s):

andreducestress,andthewayyouhavebeenhandlingthestressfromyourjobhasn’tbeenhelpingmuch,youfeelevenworse.Youmentionedbeingconcernedaboutyourfoodchoices,sittingaround,notgettingadequateexerciseanddrinkingeachevening.Wheredoyouthinkweshouldstart?

Typeofsummary?Whatprocessisnextwiththisquestion?Whydoesthehealthcoachasktheclient,ratherthandecideorbecomedirective?Whatwayofrespondingcouldhavecreateddiscord?

CL:MydoctorthinksIshouldmakeachangeinhowmuchIdrink,kindofashocktome.

HC:Youweresurprised.Whatisyourunderstandingaboutwhyheisfocusingonalcohol?

Method(s):Howisclient’schangetalkacknowledgedorinvited?

CL:Thisiswhathetoldme:alcoholcanraisebloodpressure,disruptsleep,andcauseweightgain.HesaidifIdidbetterwithhowmuchIdrink,thatmighthelp.Nowhedidn’tsayIamanalcoholicandIdon’tthinkIam,justthatsomechangeswouldhelpmeinalotofways.

Typeofclientspeech:

HC:Youdon’twanttobelabeledandatthesametime,youarepayingattentiontowhatyourdoctorsaid.

Whatspecifickindofreflectionisthis?Howcoulddiscordhavebeencreated?

CL:IlikedrinkingbutIdon’twanttomakethingsworseformyself.

Typeofclientspeech:

HC:Youfeeltwowaysaboutthis,notwantingtogiveupapleasureandalsonotwantingtoriskyourhealth.

Whatprocessisstartingnow?Howisclient’schangetalkacknowledgedorinvited?

CL:Drinkinghelpsmerelax,unwindsoifIdon’tdothatasmuch,whatwillIdo?

Typeofclientspeech:

HC:Youdon’twanttobeleftwithnowaytounwind,since Method(s):

yourlifeisprettystressful.Ifyouwereconsideringchanginghowyouusealcoholandlookingatsomeotherwaystorelax,whataresomeideasyouhave?

Howisclient’schangetalkacknowledgedorinvited?

CL:InthepastIexercisedandthathelpedinlotsofways:weight,stress,evensleep.Ijuststoppedwhenthisjobbecamesostressful.IgotsoworriedaboutbeinglaidoffatmyagethatIjustletmyselfgo.

Typeofclientspeech:

HC:Notlosingyourjobisanimportantpriorityandyouareaseriousworker.Youhaveusedexerciseinthepasttoreducestress;tellmewhatyoudidandhowthatworkedforyou.

Method(s):

CL:Afterwork,IhadseveralthingsIcoulddointhepast.Iusedtoenjoytennis,goingonavigorouswalk,ridingmybikeintheneighborhood,orevenayogaclasseverynowandthen.

Typeofclientspeech:

HC:Quiteavariety!Ifyouwereconsideringanythingnow,whatmightyouwanttodo?

Method(s):Howisclient’schangetalkacknowledgedorinvited?

CL:Iguessgettingbacktoanyofthosebutitseemsveryhardtothinkabout.

Typeofclientspeech:

HC:Whatgetsintheway,outsideoftheworryaboutthejobsecurity?

Method(s):

CL:Ithinkjuststartingback;ithasbecomesoeasytogohome,openabeerormakeadrinkandturnonthetelevision.

Typeofclientspeech:

HC:Easytoslideintohabitsthatarenotsogood,you’vegotaccustomedtoitandatthesametimeyouarerecognizingthatthismightbeatimetoconsiderwhathasworkedforyouinthepast.LetmeseeifIhaveitright,theconversationwithyourdoctorgotyourattention,youareconcernedaboutyourhealthandhowthewayyouhandlestressisnothelpingyou,thatyoudon’twanttoenduplikeyourfatherandarestartingtolookatthepatternsyouhavedevelopedwithdrinkingandenjoyingthesofaandTVafterwork.Wheredoyouthinkyouareinbeingreadytoplanonsomechanges?

Method(s):Typeofsummary:Movingintowhatprocess?Howcoulddiscordhavebeencreated?

ThankstoCathyColeandAliHallforthisexercise.

ObserverSheet:SpiritofMI

ListenforhowtheinterviewerconveysthespiritofMIinbodylanguage,wordsandactions.Writedownexamplesintheappropriaterow.Rateeachelementfrom1(low)to5(high). ElementsofMISpirit

Examples

PartnershipDemonstratingprofoundrespectfortheother;bothpartieshaveexpertise;dancingratherthanwrestling12345(low)(high)

AcceptancePrizingtheother’sinherentworthandpotential;providingaccurateempathy;supportingautonomy;affirmingstrengths12345(low)(high)

CompassionComingalongsideinaperson’ssuffering;activelypromotingtheother’swelfare;givingprioritytotheother’sneeds12345(low)(high)

EvocationElicitingtheperson’sownknowledge,wisdom,strengths,andmotivation;“youhavewhatyouneedandtogetherwewillfindit”12345(low)(high)

ObserverSheet:FourProcessesofMI

Listenforhowtheinterviewerguidestheflowoftheconversationamongthefourprocesses.Writeexamplesofwhattheinterviewersaysanddoeswithineachprocess.

FourProcessesofMI

Examplesofwhatinterviewersaysanddoes

EngagingProvidingwarmwelcome,establishingsafetyandtrust,demonstratinggenuineinterest,offeringhopefulpresence

FocusingClarifyingaparticulargoalordirectionforchangetoexplorefurther

EvokingElicitingtheperson’sownmotivationforchange,exploringambivalence,drawingoutdesire,reasons,need,ability,commitmenttochange;askingaboutimportanceandconfidencetochange

PlanningDevelopingaspecificchangeplanthatthepersoniswillingtoimplement

ObserverSheet:OARS+I

Asyouhearexamplesoftheinterviewer’suseoftheOARS+Iskills,placeahashmarkinthatrowandwritedownexamplesofeach.Alsonoteanyroadblocksyoumighthear.InterviewerResponses

Count

Examples

Questions

Open

Closed

Affirmations

ReflectiveStatements

Simple

Complex

Summaries

ProvidingInformationandSuggestionswithpermission

Roadblocks–advising,confronting,teaching

ObserverSheet:ChangeTalk

Listenforexamplesofthefivekindsofclientchangetalk.Asyouhearthem,placeahashmarkintheappropriaterow.Writedownexamplesofeachtypeofchangetalkyouhear.

ChangeTalkType

Count Examples

DesireWant,wish,wouldliketo

AbilityCan,could,wouldbeableto

ReasonsSpecificargumentsorreasonstochange

NeedUrgency,importantto,haveto(withoutstatingspecificreasons)

CommitmentWill,planto,intendto,goingto,willing,ready

MISelf-Appraisal

Astheinterviewer,I…

0-not5-extremelyatallwell

1.Providedasafe,welcomingpresencewithmywordsandactions.Example:

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2.Engagedwithandshowedgenuineinterestintheperson,e.g.,whatsheorheenjoys,needs,values.Example:

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3.Foundoutandclarifiedwhatthepersonwantedtofocusoncurrently.Example:

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4.Helpedexplorebothsidesoftheperson’sdilemma,e.g.,what’sworkingandwhat’snot;upsidesanddownsides.Example:

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5.Avoidedtryingto“fix”theproblemorgetthepersontochangebyadvising,confronting,warning,orteaching.Example:

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6.Elicitedwhatmightbesomepossiblereasonstochange,ifthepersonweretodecidetochange.Example:

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7.Learnedaboutpossiblewaysthatheorshemightgoaboutmakingthischange.Example:

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8.Askedhowimportantitisatthistimeforthepersontomakethischange.Example:

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9.Askedhowconfidentsheorhefeelstobeabletomakethischange.Example:

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10.Inquiredaboutwhatsteps,ifany,thepersonmighttakenext.Example:

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11.Askedpermissionbeforeprovidinginformationorsuggestions.Example:

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12.UsedthecoreskillsofMI(openquestions,affirmations,reflectivelistening,summaries)throughouttheconversation.

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13.ConsistentlydemonstratedthespiritofMI:>Partnership

>Acceptance

>Compassion

>Evocation

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DevelopedbyKenKraybillbasedonMiller,W.R.&Rollnick,S.,MotivationalInterviewing:HelpingPeopleChange,2013