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beginnermotivational interviewingOARSstages of changecontemplationsubstance useambivalence
A 34-year-old male presents to the outpatient psychiatric clinic after his wife insisted he seek help for his alcohol use. He drinks 5-7 drinks nightly and has missed work twice in the past month due to hangovers. He states, 'I know my drinking has gotten out of hand, but I'm not sure I'm ready to quit completely. Part of me wants to change, but another part of me worries I won't be able to handle stress without it.' The PMHNP identifies the patient as being in the contemplation stage of change. Which motivational interviewing response is MOST appropriate at this point?
Explanation
Matching the MI technique to the correct stage of change is a fundamental clinical competency. A contemplation-stage patient is ambivalent, aware of the problem but not yet committed to change. The correct MI strategy is to explore that ambivalence using OARS techniques, especially open-ended questions and reflective listening, to draw out change talk. Psychoeducation fits precontemplation, relapse prevention fits action/maintenance, and unsolicited advice violates MI spirit at any stage.
Key Takeaway
In the contemplation stage of motivational interviewing, use open-ended questions to explore ambivalence and draw out the patient's own change talk rather than providing directive advice or jumping to action planning.