Counseling study sheet: motivational interviewing, stages of change and genogram symbols

1 · Motivational interviewing

Motivational interviewing techniques: four steps and four core skills

Motivational interviewing is a conversation style a counselor uses to help a person explore their own reasons for change. Training materials describe a four-step process and four core skills known as OARS. The example clients below are made up.

1. Step 1Engage
2. Step 2Focus
3. Step 3Evoke
4. Step 4Plan

• OOpen questions

  Questions that ask for more than yes or no. They often start with how, what or tell me about, and they tend to go from general to specific.

  They let the person give more information, encourage engagement and open the door to exploring ambivalence. They also help avoid the question-answer trap, where the person is left in a passive role.

  Client: I keep thinking about going back to school.
  Counselor: What draws you to the idea?

• AAffirmations

  Compliments or statements of appreciation and understanding that praise a positive behavior or support the person as they describe a hard situation. They must be sincere.

  They support self-efficacy, prevent discouragement, build rapport and reinforce open exploration.

  Client: I missed two sessions, but I came back today.
  Counselor: You came back even though it was hard to. That shows commitment.

• RReflections

  Reflective listening: saying back what you understood the person to mean. In the deck’s quotation from Miller and Rollnick, it is a way of checking rather than assuming that you know what is meant.

  It shows the person was heard accurately, strengthens the empathic relationship and encourages further exploration of problems and feelings.

  Client: My sister keeps telling me what to do.
  Counselor: You would like to make this decision yourself.

• SSummaries

  A periodic recap of what has happened in the session. It can begin a session, end a session or mark a transition. A strategic summary chooses what to include and what to minimize or leave out.

  It pulls the person’s own words together, and a double-sided reflection used as a summary can show ambivalence.

  Client: (after several minutes of talking)
  Counselor: Let me see if I have this right: you want a change, and you also worry about the time it would take.

2 · Reflections and questions

Levels of reflection and open question examples

• Simple reflection

  Stays close to what the person said by repeating it or rephrasing it with synonyms.

  Client: I’m tired of being the one who cleans up every night.
  Counselor: You’re tired of doing the cleaning alone.

• Complex reflection: paraphrase

  Makes a guess: a major restatement that infers meaning, like continuing the paragraph.

  Client: I just got my third reminder email from the registrar.
  Counselor: It feels like the deadline is closing in on you.

• Complex reflection: reflection of feeling

  The deepest level: names the feeling behind the words.

  Client: My brother said he would not come to the family meeting I set up.
  Counselor: His staying away was a real disappointment.

• Double-sided reflection

  Reflects back both sides of the ambivalence the person is describing.

  Client: I want the degree, but I can’t picture fitting classes in.
  Counselor: You want the degree, and at the same time you are not sure how it would fit your week.

Closed question, open question

Open questions often start with how, what or tell me about. Closed questions tend to draw yes or no answers.

• Closed: Do you want to go back to school?

  Open: What would going back to school mean for you?

• Closed: Are you nervous about the schedule?

  Open: How do you picture the schedule working?

• Closed: Do you have support at home?

  Open: Tell me about the support you have at home.

• Closed: Did you finish the reading?

  Open: How did the reading go this week?

3 · Stages of change

The stages of change model, stage by stage

1. 1Precontemplation

   No plans to change in the foreseeable future. The person may be unaware of the problem.

   Example: “I don’t see why anything needs to change.”

2. 2Contemplation

   Aware that a problem exists and seriously considering change, but not yet committed to acting.

   Example: “I know I should do something. I just haven’t decided.”

3. 3Preparation

   Intending to take action in the next month.

   Example: “I’m starting next month and I’m getting ready.”

4. 4Action

   Actively changing behavior, experiences or environment. The most overt stage, and it takes considerable time and energy.

   Example: “I’ve been making the change every week.”

5. 5Maintenance

   Working to prevent relapse and keep the gains made during action.

   Example: “My job now is to keep it going.”

The model is a teaching framework. Textbooks differ on details such as time windows and extra stages, so follow the version your course uses.

4 · Genogram symbols

Genogram symbols chart

A genogram is a family diagram used in social work and other helping professions. Here are the basic symbols and what each shows. Check the key your course uses; textbooks vary.

• Male

  A square. Write the person’s age inside the figure and the date of birth beside it.

• Female

  A circle. Age goes inside, date of birth beside it.

• Deceased

  An X through the figure. Note the cause of death, the date and the age at death.

• Identified client

  A figure within a figure marks the “identified patient,” “identified client” or “family star.”

• Marriage or coupling

  A horizontal line connecting two people. Add the date of marriage.

• Separation

  A single diagonal line across the marriage line. Add the date of separation.

• Divorce

  Two parallel diagonal lines across the marriage line. Add the date of divorce.

• Common-law relationship

  A dotted horizontal line between the two people.

• Household membership

  A dotted line drawn around the people who live together.

• Adoption or foster care

  A dotted vertical line from the parents to the child.

What to put on one

• Show at least three generations.
• Record dates of birth, marriage, separation, divorce and death, and the sex and birth order of each member.
• Note ethnic background, religion, occupation, education and where family members live.
• Depict the nature of important relationships, for example distant, enmeshed or conflictual.