When using the FRAMES technique, Dr. Weir said he prefers to sit on the small stool found in most exam rooms, with the patient sitting on the table, so the patient's position is higher than his. This arrangement makes him seem less of an expert and more of a collaborator in a patient's decision to change an unhealthy behavior.
If Not FRAMES, What About OARS?
The acronym OARS, adapted from the work of William Miller, Ph.D., and Stephen Rollnick, Ph.D., is another way to get the most from motivational interviewing:
▸ Open-ended questions. Motivational interviewing is the strategic use of open-ended questions, which can be the keys to a patient's decision to change a behavior. The goal is to encourage the patient to talk about his or her reasons for change. For example, “What has been hardest for you about living with diabetes?”
▸ Affirmations. Recognize the patient's strengths and express your belief in the patient's ability to change.
▸ Reflective listening. Listen without interrupting and without judgment, and use body language to acknowledge the speaker. Body language includes nodding, facing the patient, and making eye contact.
▸ Summarizing. Recap to make sure the patient has made the point. For example, “Let me see if I understand what you've said so far. You want to stop smoking, but you are afraid that you'll gain weight.”
Source: Presented by Betsey LaForge of Blue Cross/Blue Shield of North Carolina at the annual meeting of the American College of Preventive Medicine.