In our Motivational Interviewing (MI) series, we have looked at the basics of this counseling approach and the process that is often followed by patients when transforming a behavior.
In the last segment of our article series about MI, we’re breaking down the conversational strategies and techniques used by counselors to guide patients towards successfully transforming behaviors.
We’ll discuss the four core skills of MI (aka OARS) and how they can be used in counseling sessions to guide positive conversations towards change. Then, we will look at the difference between change talk and sustain talk.
The last segment begins below.
As an effective therapeutic technique with many proven benefits, MI helps counselors motivate their patients to constructively transform harmful behaviors into positive ones. In the previous segment of this article series, we broke down the Stages of Change (SOC) model and looked at the four fundamental processes of MI. These both describe the timeline of using MI and the patient’s stages of progression.
But how do counselors use MI in patient discussions? In the third and final segment of this article series, we’ll look at:
The four core skills (OARS) used by counselors to discuss and dissect feelings of ambivalence towards change
The process of steering conversations towards a positive perspective on change (change talk), rather than perpetuating negative perspectives on change (sustain talk)
The Core Skills of MI: OARS
The SOC model and the four fundamental processes of MI can be supported by a set of micro-counseling skills used to drive discussions and maintain a positive attitude while exploring the patient’s feelings of ambivalence. To ensure MI is effective, counselors should maintain the mindset that ambivalence is not denial nor resistance, but rather a normal occurrence in the process of change.¹
Abbreviated by the acronym OARS, these skills can help elicit discussions without the patient fearing judgement or negativity towards their ambivalence.¹˒²
The table below breaks down the four core skills of MI³˒⁴:
OOpen-Ended Questions |
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|---|---|---|
AAffirmations |
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RReflections |
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SSummaries |
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Using Change Talk (vs. Sustain Talk): DARN-CAT
Sustain talk pertains to a patient’s comments that do not support an adjustment to a health-risk behavior, like substance misuse, whereas change talk relates to a patient’s comments that do support an adjustment to a behavior.
Imagine these two systems each on opposite sides of an ambivalence spectrum. Wherever the patient lands on the spectrum represents their willingness to change.¹
A counselor can use MI tactics to evoke change talk and minimize a patient’s use of sustain talk.¹ Practicing change talk is crucial for successful behavioral transformation and is proven to be correlated to positive patient outcomes.
The different types of change talk can be described using the acronym DARN-CAT.² The first half of the acronym relates to how change talk should be prepared while the second half relates to how the change talk should be implemented.¹˒²
Through the use of person-centered techniques, core skills of OARS, and methods of sustain talk vs. change talk, MI can be utilized either independently or alongside other treatment approaches to help counselors facilitate progress in a patient’s goal to overcome ambivalence and create positive adaptations to behavior.⁵
DARN – CAT
Preparatory change talk
Desire – I want to change
Ability – I can change
Reason – It’s important to change
Need – I should and need to change
Implementing change talk
Commitment – I will make changes
Activation – I am ready, prepared, and willing to change
Taking steps – I am taking specific actions to change
By using the four core skills of MI (OARS), counselors can ensure patients are understood, supported, and empowered in their perspective and ambivalence towards change. After these feelings of ambivalence have been explored, counselors can guide patients into a more positive headspace by using change talk techniques (DARN-CAT), and turning the patient away from negative, sustaining talk. Combining these strategies in MI can lead to a greater chance for a successful transformation in behavior.
References
Substance Abuse and Mental Health Services Administration. Chapter 3 - Motivational interviewing as a counseling style. In: Enhancing motivation for change in substance use disorder treatment. 2019.
UMass Amherst. Definition of motivational interviewing. Umass.edu webpage PDF. Updated Unknown. Accessed January 19, 2024.
National Institute of Corrections. OARS in motivational interviewing. NICIC.gov webpage. Updated Unknown. Accessed February 29, 2024.
Motivational Interviewing Network of Trainers. Understanding motivational interviewing. motivationalinterviewing.org. Updated 2021. Accessed January 19, 2024.
Homelessness Resource Center (HRC). Motivational interviewing: open questions, affirmation, reflective listening, and summary reflections (OARS). homelesshub.ca. Updated Unknown. Accessed March 1, 2024.
Motivational Interviewing Network of Trainers. Understanding motivational interviewing. motivationalinterviewing.org. Updated 2021. Accessed January 19, 2024.
