Core Skills
Before you grab your metaphorical paddle – remind us what OARS stands for.
Open Questions, Affirmations, Reflections, Summaries.
Client says, 'I should probably quit… eventually.' Name the stage and one MI move that fits.
Stage: Contemplation. Move: Explore ambivalence.
Decode DARN-CAT (no, it’s not your therapist spirit animal).
Desire, Ability, Reason, Need – Commitment, Activation, Taking Steps.
What is ambivalence
Feeling two ways about change at once
Finish the mantra: When in doubt, ____ ('Google it' is incorrect).
Reflect.
You’ve just realized your session sounds like a police interrogation. What’s one line you could drop to pivot back into reflection mode?
Pause & reflect: 'Let me make sure I’m hearing you right...'
Client: 'I’ve tried everything.' Reflect exhaustion but keep the door open.
You’ve been trying hard and feel worn out, but you still want things to be different.
List three ways to elicit change talk.
Decisional Balance, Goals/Values Exploration, Elaboration, Importance/Confidence Ruler, Querying Extremes, Looking Back/Looking Forward, and Evocating Questions?
Client: 'I hate hangovers, but I love happy hour.' Reflect both sides without judging.
You love the social part of happy hour, but don’t love how it leaves you feeling.
Name 2 traps therapists can fall into when client is ambivalent.
Righting reflex, Q&A, Expert, Premature focus, Blaming, Confrontation, Taking sides.
Client: ‘I keep saying I’ll apply for jobs but never do.’ Respond with a reflection that says ‘I hear you’ instead of ‘Have you tried Indeed?’
‘Part of you wants change, and part feels stuck.’
Client slips from action to contemplation. How do you normalize this apparent step backward?
This happens for a lot of people—it’s part of learning what works and what doesn't. What do you think is the next best step?
I could probably manage if I had a plan. Name the type of change talk (clue: DARN-CAT)
ABILITY
Client reports having an on-going affair. Provide an example of how to Query Extremes to explore ambivalence.
What’s the worst that happens if it stays this way? What’s the best thing that happens if it changes?
Therapist: Well, you lied to your mom. Of course you got grounded. Name the trap and identify a more appropriate strategy.
Blaming Trap. Shift to empathy and evocation. You sound really upset. Tell me what this brings up for you?
Create a complex reflection to the statement: I really don’t think you understand where I’m coming from. I’ve already tried all those things!
You have been open to trying new things in the past, but you didn’t find any benefits in the things you tried. What would be helpful for you now?
Everyone I know smokes pot. Big deal. Name the stage and create an open-ended question to help move the client forward
Pre contemplative. Right now you're not seeing the problem with smoking pot. What might be different in your life if you were to cut back or stop smoking?
"I swear I'm going to do my homework this week." What type of change talk is it and how do you respond?
Commitment. You sound more confident than in the past. How are you going to ensure your success?
Client says, ‘Family’s everything.’ They also ghosted Thanksgiving. Provide 2 values-based questions.
What does being close to family look like for you?
How does that fit with what’s been happening?’
Client: nobody understands me. Therapist: that's not true. Name the trap and create an MI response.
Confrontation/Denial: Use complex reflection: “You’re feeling really misunderstood right now.” Validate their experience instead of defending others.
Client successfully took medication as prescribed: “I’m glad to hear this." Turn this into an affirmation followed by an open ended question.
You did a good job creating a routine for yourself to help with consistently taking your medication.
What benefits have you noticed over this past week?
I’m trying to feel happy but this depression just feels so heavy at times. Name the stage and create an open-ended question to help move the client forward.
Contemplative - You are struggling to find the tools that are helpful. Yet you are still trying. What are some of the things that brought you happiness in the past?
'I really should stop vaping.' What type of change talk is it; followed by a question that pulls motivation, not compliance.
Need. What feels important about quitting right now?
Use a scaling question to turn “I don’t know” into change talk.
“On a 0-10 where 0 is ‘no way I’ll do it’ and 10 is ‘I'm definitely doing it,’ where are you? …Why that number, not lower?”
Client: I don't know why I can't do it. Therapist: have you tried doing this or doing that? Name the trap and create an MI consistent response.
Righting Reflex. Let client lead. You're struggling to find what works for you. What has helped in the past?