Monday, September 7, 2015

Motivational Interviewing Part III

This is part three in a series regarding Motivational Interviewing.  The goal of Motivational Interviewing (MI) is to increase client awareness and decrease ambivalence or resistance towards change.  For those in private practice, you may already be aware of how important your relationship is with a client.
Case Western Reserve University’s Center for Evidenced-Based Practices (CEBP) is a resource for MI and focuses on practitioner’s changing their service approach and culture towards MI.  These benefits include positive outcomes and client engagement/ retention. 
The focus of this post builds on avoiding and dealing with client resistance.  This link focuses on OARS (open ended questions, affirmations, and reflections) and DARN CAT (desire, ability, reason, need, commitment, activating step, taking steps).  Part Two focused on OARs while this post will look at “DARN CAT.”
“DARN CAT” can be split into two areas.
The “DARN” focuses on what we call “change talk” the client is in a contemplative state (here is additional information on the stages of change model, please note that a lot of this information comes from chemical dependency and substance abuse counselors and researchers but can be effectively applied to many areas of practice) and may say, “I’m interested in losing weight.” The following information is adapted from C. Delos Reyes.  This post will focus on seeing how interested the client is in lifestyle changes.  The next blog post will discuss implementing changes and adding action.

D—Desire to change
                “I want to lose weight”
                You will want to inquire why
A—Ability to change
                “I think I can eat less candy after work or avoid it.”
                How might you be able to do this?
R—Reasons to change
                “If I lose weight, I’ll have more energy to play with my kids…”
                You may want more specific reasons.
N—Need to change
                The client will use words such as “need, have to…”

You can always ask how interested they are in changing a habit based on a scale from 1-10 (this is called the readiness ruler, check out more information here).  Your client may say that quitting their daily Frappucino habit is about a 5 on their scale…they’re aware of it but it’s not that 10 where they starting drinking black coffee.  This number gives you valuable information to ask the questions, “What keeps you from being a 7 versus a 5?  What keeps you from being a 2 versus a 5?”