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English — Official English version of motivational-interviewing.

Motivational Interviewing (English)

OARS techniques, stages of change, and change talk: Fostering intrinsic motivation for change without pressure or manipulation

See: ETHICS.md

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Context

Motivational Interviewing (MI) was developed by William R. Miller and Stephen Rollnick. It is a client-centered, directive counseling approach for fostering intrinsic motivation for change. MI is used evidence-based in addiction treatment, health behavior, therapy adherence, and behavior change.

Evidence: Over 200 RCTs support the effectiveness of MI, particularly for addictive behaviors (Lundahl et al. 2010, Cochrane Review), health behaviors, and treatment adherence.

Note: This is support, not a substitute for professional therapy. Never implement: EMDR, Prolonged Exposure (PE), Narrative Exposure Therapy (NET)

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1. MI Spirit and Principles

The Four Principles

1. Partnership: Collaboration on equal footing, not expert authority
2. Acceptance: Respecting autonomy, acknowledging strengths, absolute worth of the person
3. Compassion: The well-being of the person comes first
4. Evocation: Motivation already resides within the person — it is elicited, not implanted

The Spirit of MI

MI is not a collection of techniques, but an attitude. The techniques only work within the context of this foundational spirit. Without it, MI becomes manipulation.

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2. OARS Techniques

OARS are the four core competencies of motivational interviewing.

O — Open Questions

Principle: Ask questions that invite reflection and storytelling, that cannot be answered with yes/no.

Examples:

• "What would you like to see change?"
• "How would your life look if you had made this change?"
• "What brought you to think about this?"
• "What is important to you about your health?"
• "What would you gain if you made this change?"

Avoid:

• Closed questions: "Do you want to quit smoking?"
• Leading questions: "You know that's harmful, right?"
• Why-questions: "Why did you do that?" (sounds accusatory)

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A — Affirming

Principle: Acknowledge strengths, efforts, and positive steps of the other person. Not praising ("You're great"), but specifically naming what was observed.

Examples:

• "It takes courage to speak openly about this."
• "You managed to hold on for three days — that shows you're serious."
• "Despite the difficult situation, you came today — that shows commitment."
• "You've clearly given this a lot of thought."

When to use:

• When the person describes steps toward change
• When they persist despite setbacks
• To strengthen self-efficacy

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R — Reflecting

Principle: Give back what was said in your own words — to show understanding and encourage further thinking.

Types of reflections:

Type	Description	Example
Simple	Repeat/paraphrase content	"You're saying it's hard for you."
Deepening	Pick up on what's beneath the surface	"It sounds like you're torn."
Double-sided	Mirror both sides of ambivalence	"On one hand you want to stop, on the other it gives you something."
Amplified	Slightly overstate (carefully!)	"So there's absolutely no reason to change anything?"

Double-sided reflection (ambivalence):

"On one hand, you say you'd like to drink less alcohol.
On the other hand, the social aspect of after-work drinks is important to you.
Both make sense."

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S — Summarizing

Principle: Bundle the conversation — especially highlighting change talk.

Types:

• Collecting: Summarize multiple points
• Linking: Connect earlier statements with current ones
• Transitional: At the end of a conversation, leading to next steps

Example:

"Let me summarize what I've heard so far:
You've noticed that your sleep has gotten worse and it's
affecting your work. You've tried reducing caffeine before,
and that partly helped. Being fit and productive is important
to you. At the same time, your morning coffee enjoyment matters.
Does that sound right? What would you like to add?"

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3. Stages of Change (Transtheoretical Model)

The Stages (Prochaska & DiClemente)

Stage	Description	MI Strategy
Precontemplation	No problem awareness, no intention to change	Inform, spark curiosity, don't push
Contemplation	Ambivalence: "Maybe I should..."	Explore ambivalence, foster change talk
Preparation	Decision made, making plans	Support planning, strengthen confidence
Action	Actively implementing change	Affirm, work through obstacles
Maintenance	Stabilizing the change	Relapse prevention, acknowledge successes
Relapse	Return to old behavior	Normalize, re-motivate, learn from experience

Important: Relapse is not failure, but part of the change process.

Recognizing the Stage

Guide questions:

• "Have you thought about changing something?" (Precontemplation vs. Contemplation)
• "What speaks for it, what against it?" (Exploring ambivalence)
• "Do you have concrete ideas about how you'd approach it?" (Preparation)
• "What have you already tried?" (Action experience)

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4. Recognizing and Strengthening Change Talk

What is Change Talk?

Change talk consists of statements by the person that point toward change. MI aims to increase change talk and not reinforce sustain talk (maintaining the status quo).

DARN-CAT Framework

Preparatory Change Talk (DARN):

• Desire: "I would like to..."
• Ability: "I could..."
• Reasons: "It would be better because..."
• Need: "I need to change something..."

Mobilizing Change Talk (CAT):

• Commitment: "I will..."
• Activation: "I'm ready to..."
• Taking Steps: "I've already..."

Fostering Change Talk

Strategies:

1. Ask open questions:

   • "What would you gain if something changed?"
   • "What gives you confidence that you could do this?"

2. Importance and confidence scaling:

   • "How important is this change to you on a scale of 0 to 10?"
   • "How confident are you that you could manage it?"
   • "Why a 5 and not a 2?" (strengthens existing motivation)

3. Exploring extremes:

   • "What could happen in the worst case if nothing changes?"
   • "What would be the best thing that could happen if you changed it?"

4. Looking back and looking forward:

   • "What was it like before this issue came up?"
   • "Where do you see yourself in five years if everything stays the same?"

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5. Dealing with Resistance

Resistance as a Signal

In MI, "resistance" is interpreted as a sign that the counselor is moving too fast or not adequately respecting the person's autonomy.

Strategies

Situation	Response
"I don't have a problem"	Accept, don't argue, show curiosity
"You don't understand me"	Reflect: "Being understood is important to you"
"That won't work anyway"	Explore past successes, strengthen confidence
Person becomes angry	Slow down, emphasize autonomy, reflect empathically

Golden rule: Never argue against resistance. Roll with the resistance, don't push against it.

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Ethics and Boundaries

An AI assistant may:

• Use OARS techniques to foster reflection
• Recognize and reflect back change talk
• Provide information about change processes
• Respectfully explore ambivalence

An AI assistant must NOT:

• Force or manipulate change
• Make decisions for the person
• Conduct addiction therapy or withdrawal support
• Use threats or fear appeals
• Undermine the person's autonomy

Core principle: The person decides. An AI assistant supports the reflection process.

In case of acute crisis, ALWAYS refer to:

• 988 Suicide & Crisis Lifeline (US): 988
• Crisis Text Line (US): Text HOME to 741741
• Samaritans (UK): 116 123
• Telefonseelsorge (DE): 0800 111 0 111 / 0800 111 0 222
• Emergency services: 911 (US) / 112 (EU)

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Ported from BACH v3.8.0 | Standalone Version Sources: Miller & Rollnick (2013), Prochaska & DiClemente (1983), Lundahl et al. (2010) — Not professional therapy