Discussion 3 Motivational Interviewing’s Concept of “OARS”

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Evoking: “why would You go There?” 103

person’s voluntary choice or change. Verbal efforts to encourage people to make particular choices are a mainstay, for example, in diabetes educa- tion, health promotion, politics, and probation, and there are many dif- ferent ways to do so.48 Advertising, sales, and marketing aim to influence what people want. A method unique to MI is the evoking task described in this chapter, selectively inviting and strengthening the person’s own change talk. By definition, this is not external motivation for change; it relies on and evokes the client’s own values and priorities. We do know from MI research that what you ask, reflect, affirm, and summarize matter. Con- sciously directional use of these OARS skills can increase clients’ change talk, which in turn is associated with actual choice and change.

When, then, is it appropriate to use MI’s evoking skills to encourage choice or change in a particular direction? This decision begins during the focusing task in identifying the intended goals for change because you can- not know what change talk to evoke until you know the intended direction of change. A first and the most common reason for encouraging a particu- lar change is that it’s what the client has asked you to do. In this case, the person’s goals are in accord with your own, which is a precondition of a positive working alliance.49

A second potential reason to favor a specific choice or change is that it is the announced purpose of the service in which you work, and which the client has entered voluntarily. Those walking through the doors of a weight-loss clinic assume that the focus is on weight reduction. Similarly, clients entering a smoking cessation clinic or an addiction treatment pro- gram will not be surprised that the topic of conversation is substance use. However, if the program only accepts particular goals (such as total life- long abstinence rather than harm reduction), this requirement should be made clear to clients from the outset. Similarly, pregnancy counseling set- tings should inform potential clients if certain outcomes (such as abortion) are not accepted there.

A third potential reason to encourage movement in a particular direc- tion is the client’s imminent well-being. This involves clinical and ethical judgments about what constitutes wellness and what is in the person’s best interests. Workers on a suicide prevention hotline, for example, typically have a clear hope of encouraging callers away from impulsively taking their own lives. Health care practitioners hope to help their patients to regain and retain health.

Finally, there are situations in which remaining neutral and not trying to influence the direction of change could be considered unethical or mal- practice. An obvious example is when a person’s behavior harms or endan- gers others as in domestic violence, alcohol- impaired driving, and sexual victimization. Those working in a smoking cessation or addiction treat- ment program are not doing their job if they aren’t working to diminish harmful substance use. Probation officers are seldom neutral about whether

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing : Helping people change and grow. Guilford Publications. Created from liberty on 2026-02-02 05:44:13.

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to favor departure from criminal behavior. The question is how best to encourage change if it is not the person’s initial intention. That is the actual context in which MI was first developed. The evoking task searches within clients to determine how change could be consistent with their own desires, hopes, and values.

Should you perhaps first construct a decisional balance to determine whether the person’s pro- change motivations outweigh their counterchange motivations and only if so, then proceed to evoking? A complexity here is that conducting a decisional balance procedure with ambivalent people is not an inert intervention. It tends to reinforce ambivalence and decrease motivation for change. The act of observing or measuring can itself influ- ence what you are examining. Equally evoking pro- change and counter- change motivations when someone is ambivalent appears to tip the balance against change even if that is not your intention.50

Decisions in the focusing task about the appropriate direction for choice and change are sometimes neither simple nor straightforward. Here are some recent ethically contentious examples on which people may differ passionately. Would you use MI to favor a particular choice or change in each of these situations? Why or why not?

• Vaccination. During the COVID-19 pandemic, it was clear that vac- cination had potential life-or-death consequences, not only for individuals but for their family and those with whom they come into contact. MI was used to encourage COVID-19 vaccination and can be used to address vac- cine hesitancy more generally.51

• Organ donation. Organ donation is an autonomous choice for the donor but a matter of life and death for the recipient of transplantation. If potential untoward effects for the donor are known, should MI be used to encourage organ donation to save a life?

• Euthanasia. Should a terminally ill patient be encouraged to endure suffering and await natural causes of death, or should they be assisted in a chosen ending of life?

• Harm reduction. Should a heroin user be helped to exchange used needles for clean syringes and engage in other safe- injection procedures?

• Pregnancy counseling. Should a pregnant woman be persuaded to carry her child to term rather than choosing an abortion?

• Contraception. Should a sexually active teenager be encouraged to use condoms?

• Interrogation. If an incarcerated detainee has vital knowledge that could save the lives of others, what should be done to obtain such high- value information?52