102.2 Listening, Interviewing and Motivational Interviewing

Active listening starts before words

People can tell when we are really with them.

• Be present: Put the phone down, face the person, and give them your full attention.
• Pause: Let silence sit. People often share the important part after a pause.
• Listen for feelings: Hear the worry, hope or anger under the words, not just the facts.
• Talk less: In a good helping talk, the client does more of the talking than you.

OARS: four core skills

The spirit of motivational interviewing

Motivational interviewing (MI) is a way of talking that helps people find their own reasons to change.

• Partnership: We work with the person, not on them. They are the expert on their own life.
• Acceptance: We respect the person's worth and their right to choose, even when we disagree.
• Compassion: We keep the person's well-being and needs first.
• Empowerment: We draw out the person's own strengths, ideas and wisdom instead of lecturing.

The four processes of MI

• Engaging: Build a trusting, respectful working relationship first.
• Focusing: Agree together on what to work on.
• Evoking: Draw out the person's own reasons for change.
• Planning: Make a plan together when the person is ready.

Hearing change talk

Change talk sounds like

• Desire: I want to feel better
• Ability: I could walk after work
• Reasons: I want to see my grandkids grow
• Need: I have to do something
• Commitment: I will call the clinic tomorrow

Sustain talk sounds like

• I have always eaten this way
• I do not have time
• It does not matter anyway
• My doctor does not listen

Upstream: more than willpower

• What we see: Mr. Greene in Slavic Village says he knows he should cook more, but keeps buying fast food.
• Why it happens (upstream): He works nights, the nearest full grocery store is a bus ride away, and his kitchen stove has been broken for months.
• What we can build on (assets): A neighbor with a car, a church meal program, the Greater Cleveland Food Bank network, and his own wish to stay healthy for his daughter.

Running an intake interview

• Welcome and explain: Say who you are, why you are meeting, and how long it takes.
• Explain privacy and consent: Share what stays private and when you must report. Get consent.
• Start with strengths: Ask what is going well and who supports them.
• Ask the form questions: Use open questions and reflections between items. Let them skip any question.
• Ask about their goals: What would make the biggest difference for you right now?
• Summarize and teach-back: Summarize the next steps, then ask them to say the plan back.

Situation: the righting reflex

Situation: Ms. Robinson in East Cleveland tells you she smokes when she is stressed. She says, I know it is bad, but it is the only break I get all day. You feel the urge to list the dangers of smoking.

What could you say instead?

• Reflect: smoking gives you a real break in a hard day
• Ask: what would a different kind of break look like for you
• Ask permission before sharing any information
• Offer quit support resources only if she is interested

Talk it over

• When has someone pushing you to change made you want to change less?
• Which OARS skill feels easiest, and which one will you practice this week?
• How can we listen for upstream barriers inside a client's story?