Find a partner - a classmate using skype or zoom, or a colleague close to home and ask the following:
Using only open-ended questions and reflections, ask –
What it was
like growing up in your home?
How did you come to
do the work that you are doing?
Find another partner, and continue:
Using only
Affirmations and Summary – ask:
What would you like to accomplish in the future?
What ways have you changed in the past?
Return to the blog here and share what you learned - what was it like? what were your partner's reactions? did it feel comfortable or different than your typical style? Be sure to also respond to a classmate or two.
I tried to use open ended questions in asking Annie what it was like growing up in her home and how she came to do the work she is doing.
ReplyDeleteOur conversation was that: a conversation. It was easy, warm and very interesting. Annie shared her life as a child and growing up in a loving home where she experienced unconditional love and support. As we neared the end of the talk she remembered an event which was poignant yet traumatic, with a positive outcome. She recalled the tenderness she received and maternal support, which influenced the memory more for that than the event itself.
When we switched and Annie asked me the two questions I felt open to sharing with her. It was easy for me to talk because I found Annie warm and accepting and interested in what I had to say. She was able to ask several open ended questions which seemed like carefully placed stepping stones to cross a brook- I could move seamlessly form one place to another. Annie offered reflections on my stories partly to clarify with me that that is what she had heard and partly to be affirming in what she was hearing.
Hi Gail,
DeleteI also enjoyed the conversation type nature of MI. I can see how professionals/clients would see/feel MI as a collaborative approach, almost a teamwork huddle.
It's great that we have been able to use these approaches on each other.
Christine
Gail, I agree that our conversation was very easy going and open ended. I actually felt I learned more about you during the open ended question part then I did about my second client who shared a clear "goal" which he was working towards
DeleteI interviewed Christine G. last night asking the Affirmation and Summary questions. I felt awkward because I was doing a interview that was seemingly a "mock interview." However, I quickly felt comfortable and really interested in Christine's story. It was natural to be affirmative and it was rather easier than I had thought it would be to summarize. Mostly, I really enjoyed getting to know Christine a little better and will remember that more than I will the practice if MI interviewing. I rather think that is the point. I think she felt affirmed and listened to and told me the summaries were right on. I think this is more my style than not.
ReplyDeleteYes Gail, I agree that MI is one of your strengths and style. I think your caring, nurturing and empathetic nature helps you naturally use OARS! I would imagine that you use affirmations and reflective listening in your every day conversations with family and friends.
DeleteChristine
I interviewed two of my colleagues here at Keystone. The first I have known for many years but had never truly discussed her home life as a child and how she entered the field of social work. I found that interviewing her felt comfortable, most likely due to the close professional relationship we have had over the years, and I was able to reflect on her responses, as well as ask open ended questions to clarify information or gain more information as necessary. Asking open ended questions has been something that I have struggled with in the past, so it was helpful to be able to remain insightful and actually think about the information I was looking to gather prior to actually opening my mouth. It was also comfortable and we clearly have a good rapport, which helped the process. It felt like a normal, non invasive conversation between two colleagues.
ReplyDeleteThe other colleague I interviewed I have also known for quite some time but rarely talk about personal life with, especially future goals around professional accomplishments. She consistently appears guarded and is very limited when sharing any sort of personal information, which I have become respectful of. I felt like I was asking invasive and personal questions and it was difficult for me to simply provide affirmations and summarize her information without being able to ask both close or open ended questions. It was also difficulty to not ask for clarification around her goals, for example, she mentioned wanting to eventually enter the field of private practice and I wanted more information about this potential venture (ie: when, what populations, etc), but simply was unable to ask due to the restrictions of the assignment. I found this portion more difficult and much less personal.
Hi Rebecca,
DeleteI think you bring up a good point in regards to the limitations of MI. I tried to use OARS with many patients on the unit, just to get familiar with the format, and I found that some patients were very guarded and almost "weirded" out by my questions and summaries. I think like any approach, MI is not meant for every client and there are some therapeutic relationships that may not benefit from the various elements found in this approach.
Christine
I chose one of my co-workers, who I am also friends with to start asking about what it was like growing up in his home and how did you come to do the work that you are doing now? Even though I have known him a few years, I have never really asked him questions like this, despite working close together on the same team and being in crisis situations. He was open to telling me about growing up with a brother and a sister, as well as the animals that he had as a child. His brother is no longer alive, he did not want to talk about that, but he did say that losing his brother, had something to do with him getting into the field of helping others. He got a degree for psychology first and now he is working towards becoming a social worker. I said, “I have seen your great interactions with clients and I am not sure what has happened in your past, but I know it will mold you into a great social worker”.
ReplyDeleteI found a case manager at my internship and I asked her “What would you like to accomplish in the future”? She let me know that she is in school to obtain her MSW and then she plans to get licensed. She is doing an internship right now with children and hopes someday to work full time with children as a therapist. I told her, “I have seen how you work with the clients we serve and their children; I feel you will make a great therapist with children or even in family therapy. So from working in this environment, it has given you a lot of hands on experience for the career you have chosen.
I asked her “what ways have you changed in the past”? I question whether from years of working with the population that you do, you are choosing to work with children, rather than adults in order to help solve their problems before they grow up? She agreed that she felt she could do more good by working with children in her professional career and it would also be a change of pace, as well as a chance to meet them were they were at, before they grew up and were faced with so many problems.
Christine Mc.
Hi Christine -
DeleteIt certainly is interesting talking with co-workers and not realizing that you knew so little about their past. I find it interesting that your first colleague chose to share about his brothers passing. I'm wondering if there was any indication that he wanted you to ask more open ended questions about this. I have always been taught that it is not important to find out how exactly the person died or the details of the passing, but then question if this may have had a direct impact on the client. I wonder if an open ended question may have been appropriate here? Sometimes it is difficult what bites and pieces clients (or in this case your colleague) throw out to see if you latch onto this information and dig deeper.
Rebecca
This activity really highlights how easy it is to ask the wrong kinds of questions. It was a fun activity. I initially completed this activity with another intern and she had not been trained in MI and really found it difficult to formulate the open ended and reflective questions. Once she had a "script" or reference guide it became much easier. When I tried this activity with a coworker who was trained in MI and it seemed to be a much easier process that flowed more naturally. It was a great reminder of how practice at new techniques is important.
ReplyDeleteWhat I learned is its really challenging to only ask open ended questions and it takes a lot of practice to get into the practice of doing so with every assessment. I keep a little cheat sheet with me when I was learning to use MI.
Maybe this will be helpful to others?
Examples of Open-Ended Questions
"Tell me what you like about your ………."
"What's happened since we last met?"
"What makes you think it might be time for a change?"
"What brought you here today?"
"What happens when you behave that way?"
"How were you able to not use [insert substance] for [insert time frame]?"
"Tell me more about when this first began."
"What's different for you this time?"
"What was that like for you?"
"What's different about quitting this time?"
Reflective responses
"It sounds like…."
"What I hear you saying…"
"So on the one hand it sounds like …. And, yet on the other hand…."
"It seems as if…."
"I get the sense that…."
"It feels as though…."
Jennifer,
DeleteI agree, it would be totally different interviews with people who did not have MI experience or at least some knowledge of it. I found it to be a fun exercise and a good learning tool. I personally find that using open ended questions really helps sessions to take a life of their own, as clients are more comfortable to open up and share more with open ended questions, rather than with a question that invokes a "yes" or a "no" response.
Christine Mc.
Hi Jennifer,
DeleteThank you so much for the cheat sheet. I am going to print this out and tape it to my clipboard. I agree that it is easy to fall into the close ended questions. I find that I really struggle with this. I am trying to make a more conscious effort to think before asking and slow down and be in the conversation (something that can be difficult in the fast paced environment of the hospital).
I also agree, practice makes perfect!
Christine
This was a great exercise. I have been reflecting on my use of OARS all week. I acknowledge that using open ended questions is not an area of strength. This is something that I have known for a while (thank you process recordings) and I continue to work on it. I recognize that I often find that my mind is going so fast or I am focused on other things when interacting with someone and I easily revert to close ended questions. Practicing OARS is a great test of my attentiveness to my patients and those I am talking with. I have found myself using different aspects of OARS in my every day conversation and even reflecting after the fact on ways I can summarize better or ask more open questions (ah, I'm doing process recordings in my head!). I will also admit completing this exercise with those I work with was somewhat awkward, but I am going to incorporate these questions the example questions included in the text in my work with patients, especially my daily DBT group!
ReplyDeleteI look forward to talking more about MI. This week's module was my only exposure to this technique and I am really interested and hope to be able to apply these skills into my work.
Christine George
Hi Christine,
DeleteI think we all probably struggle with consistently asking open ended questions. You are not alone. Sometimes it's hard in the moment, when you're meeting with a client, to remember everything you're supposed to be doing. I guess that's what process recordings are for, to remind you after the fact. So it's a good thing you're doing them in your head. :-)
Thanks Alice. It's about progress, not perfection!
Delete:)
Hi Christine -
DeleteYou are certainly not alone. Asking open ended questions has also been something I have struggled with and now am able to catch myself and rephrase a closed question into an open ended question prior to eliciting information from or asking the client a question. While process recordings can sometimes be a pain, they have allowed me to notice my progress and increased success in mastering this skill. Keep up the good work!
Your candor and transparency are very becoming, and helpful to our learning. Thank you.
DeleteThis was a really interesting assignment. I have gotten some experience with open-ended questions in my internships, naturally, but more practice is always good. And this time I was constrained to only using open ended questions, affirmations and summary, which really made me watch what I was saying and how I was saying it. My experience was that by employing these techniques, I elicited a lot more information than I would have ordinarily. Indeed, it put my partner in story-mode, which gave me a lot of ancillary information aside from the direct answers I was seeking. ( I used a coworker, because coordinating schedules with classmates proved difficult) if I had been talking to a client, this would have been fantastic because it would have helped me to determine the greater environmental factors surrounding the client's issue. My partner didn't seem uncomfortable with the conversational tack I was taking. I'd told her the point of the exercise, of course, but she said it still felt like natural conversation to her.
ReplyDeleteAs for me, I was appreciative of how well these techniques worked. Really, the difference in response is amazing. I think, however, that it will take time to make it habit to speak in this way. I was very aware of changing my natural conversational style from a less to a more therapeutic way of framing questions. I understand that for many therapists it becomes second nature.
Hi Alice,
DeleteI hope someday that open ended questions become second nature to me. I agree that the difference in response is pretty remarkable. I also think it takes the relationship between clinician and client to a new, more collaborative level.
Christine
it nice to hear you liked using the techniques- I imagine the more we practice this technique the more second nature it would become. I felt much more awkward with my interview!
DeleteI asked the first set of questions to Gail- the conversation felt open ended and Gail was prepared to talk about her early childhood years as well as what led her into the field of social work. I thought the first two questions were much more open and left more space for reflection. The tone of the conversation was calm and within answering the question I was able to say small things which let her know I was listening and thinking about her experience. For the second set of questions, I asked my friend Max who is a banker. I explained what the assignment was and the conversation with Max was completely different than the conversation with Gail. After explaining what OAR was, I then asked Max to share a goal which he would want to accomplish. His answer was very direct and he told me that he wanted to get a promotion within the next year. Since he understood what the assignment was, he prepared in his mind the steps he felt he has taken in the past to do well as work which he listed as put in more time, align my daily tasks with the goals of the company, stay later and get to know my colleagues. Max explained that these were strategies he has used in the past to advance at work and he plans to use the same strategies in the future at his current company. I thought the conversation with Max was much more straight forward and although I applied OAR techniques, it felt less therapeutic than when I was asking Gail about her childhood and what led her into the field of social work. I thought the first set of questions were much more analytical and forced Gail to reflect which I imagine long term, would be a great way to help a person understand who they are and why they do that they do. With Max, it felt more like a checklist and although I supplied him with affirmations, reflections and summarized what he was saying- it still felt like I was not helping him think deeply in a meaningful way. I imagine OAR being good for short term goals like weight loss, job promotions, or quitting a behavior. With that being said, I would still be more interested in helping a client understand why they over eat or why the drink or what a promotion means to them, then actually helping them reach these short term goals- perhaps if we understand why then maybe our chances for long term success go up.
ReplyDeleteThe open-ended question is a great tool for efficiently gaining a lot of information in a short period of time. The more people say, the more they tell you.
ReplyDeleteGood affirmation and summary technique both sustain the engagement and strengthen it.
Wonderful conversation here - you all did a great job of the task assigned as well as reflecting on how this style of intervention worked for you. I look forward too talking more about it.
ReplyDelete