One set of listening skills used in MI, is summarized with the acronym OARS, which stands for open questions, affirmations, reflections and summaries. Let’s say that your client has been talking to you, sharing information about herself and you have been listening carefully for change talk. That’s when the client is talking about change, and not you. Now, what do you say in response? The basic OARS skills are the way you guide the conversation to help your client resolve her ambivalence about change. Remember that we are all ambivalent when faced with change, and your job as a guide is to help your client resolve ambivalence and become ready to make a plan for change.
Here’s a conversation that I had recently with Marie, one of my clients. She is a woman who has struggled with binge eating disorder for many years. The disorder and her weight are causing her to be very distressed, and she is struggling also with depression. I’ve highlighted her change talk, and the OARS skill used in response.
Marie: I’ve really had it with bingeing. It doesn’t even work anymore to make me feel better. I used to be able to use food when I needed something to look forward to, or when I was upset, but now it just makes me feel crappy. [Change Talk]
Me: So, your bingeing isn’t getting you the relief you used to get. [Simple Reflection] This must be very disappointing. [Complex Reflection, Reflection of feeling]
Marie: It’s more than just disappointing! It’s really been making me panic that I won’t find a way to calm down when I’m upset. I have so much work to do, and need a way to focus. Food always did that for me. [Change Talk, reasons to change]
Me: The fact that bingeing doesn’t work anymore sounds like a bit of a crisis for you, and you’re wondering what might work in its place. [Reflection of feeling, “guess” at meaning]
Marie: My worst fear is that nothing will work. But I’m hoping you can help me find a solution. [Change Talk]
Me: I’d be happy to help you! I find you a very focused person, especially when you really want something. [Affirmation] Where shall we start? [Open question]
Marie: I don’t know, really. The whole subject has me very anxious.
Me: I have some ideas I could suggest, if you wish. What do you think? [Open question]
Marie: Yes, I really would like to hear them, thanks.
Me: Some of my other clients have found that this works…..
In this exchange, I used open questions, affirmation, and reflection. The summary would come later in the conversation, once we had begun to develop a plan. I hope you can see how these OARS skills can move a conversation forward, and help you as the clinician guide the client towards positive change.
Contact me at ellen@trainingwithdrellen.com or (781) 290-8886 for more information and to schedule a complimentary phone call to discuss your goals. If you have colleagues who want to do this with you, we can create a coaching group. This will minimize the cost per person.
