When clients who show signs that they might be treatment resistant motivational interviewing that uses open questions can be useful. This method can help move things along and encourages the person to take the steps required for active change.

This technique helps to identify clearly the client’s goals and how to reach these; basically they would put self-talk to action. For instance, a desire, ability, reason and need for making lower level change (commitment) would be the first step and then moving on to higher level change for reaching target goals would follow.

Here are two examples of motivational interviewing.

EXAMPLE 1: CONTAMINATION FEARS

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Therapist: “So you say you did your homework task yet feel bad because you gave into the compulsion to wash your hands after touching the door handle. Tell me what it is that makes this a challenge for you?”

Client: “I just wished I could not let germs bother me so much” (DESIRE)

Therapist: “Okay, so what do you think you could do to resist giving into the compulsion next time?”

Client: “I could remember that anxiety reaches a peak and decreases naturally after it’s reached that level.” (ABILITY)

Therapist: “What other things can you think of to make this work for you?”

Client: “To try not to let my family accommodate my behaviours; like asking them not to open doors for me.”

Therapist: “Very good. What else could help you face your obsession?”

Client: “To keep practising.”

Therapist: “Excellent, and what would this mean to you?”

Client: “I would feel better about my life, I mean, if I was able to overcome my contamination fears it would be liberating (REASON).

Therapist: “What things about your life would improve?

Client: “Well I really want to do things and get on with my life, like going back to college, visiting friends, even sleeping without all the worry that OCD brings with simply trying to rest.” (NEEDS)

Therapist: “Great! Okay, so how do you feel about doing the homework task again this week and see how you get on this time?”

Client: “Much better. I’m going to think more about bearing with the anxiety (COMMITMENT) and try to live with risk and uncertainty about catching and spreading germs.” (Or a higher level of commitment might be on the lines of: “I’m determined to do my exposure and will live with the risk and uncertainty of catching and spreading germs.”)

Following week:

Therapist: “How did it go?”

Client: “I touched the door handle and resisted the compulsion whilst tolerating anxiety. It didn’t go as high as I expected, and I was able to bear with it until it reduced naturally.” (TAKING ACTIVE STEPS TOWARDS CHANGE)

Therapist: How has this encouraged you?

Client: “It’s made me more determined to continue doing my exposures to get myself out of this vicious circle and to work towards recovery.” (HIGHER LEVEL COMMITMENT)

EXAMPLE 2: HARM OCD WITH SOCIAL ANXIETY

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Therapist: “So you say you’ve been invited to your friend's house party. Tell me what it is that makes this a challenge for you?”

Client: “I really want to be less socially awkward because I actually want go to the party.” (DESIRE)

Therapist: “What do you think you could you do to help make this happen?”

Client: “I could go to the party and stay just half-an-hour to begin with (ABILITY)

Therapist: “What plans could you think of to make this work for you?”

Client: “I could ask my brother to go with me, you know, for making that initial entrance.”

Therapist: “Who would be there at the party to make you feel less comfortable afterwards?”

Client: “My friend who invited me I guess. I would feel a lot better about myself if I was able to join in and learn to enjoy socialising (REASON). Plus, I really should get out and socialise more anyway, because I desperately want friendships and company despite my harm OCD and social anxiety holding me back.” (NEED)

Therapist: “All right. So you have some plans to make this happen. How do you feel about putting these into action?”

Client: “Better I think. I’m going to consider accepting the party invitation.” (COMMITMENT) (Or a higher level of commitment might be on the lines of: “I’m going to accept the party invitation.”)

Following week:

Therapist: “How did it go?”

Client: “I actually went to the party and stayed for 45 minutes!” (TAKING ACTIVE STEPS TOWARDS CHANGE). I was able to let the harm thoughts fade into the distance with the echo technique.

Therapist: “Excellent! How has this encouraged you?”

Client: I’m still anxious about socialising, but I’m glad I went to the party. I guess I’m feeling a bit more confident about this, even with anxiety.” (HEADING TOWARDS HIGHER LEVEL COMMITMENT)

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