Thursday, April 12, 2012

Change Talk

One of the principles of Motivational Interviewing (MI) is that people are more likely to change if they hear themselves arguing in favor of change. However, most people considering change have some degree of ambivalence - arguments both in favor and against change. When someone around them voices only one side of the ambivalence, they are likely to voice the other. All too often, other people who are concerned about someone argue in favor of change, which causes them to voice the other (anti-change) side of the ambivalence. Hearing themselves argue against change then makes change less likely.

Since the goal of therapy is generally to facilitate change, it's important for therapists to avoid that trap, and instead find ways to get clients to voice the pro-change side of their ambivalence. MI includes the follow techniques designed to facilitate this process, which it refers to as "eliciting change talk."

1) Evocative Questions

Assume that the client is ambivalent, and therefore has some concerns suggesting change may be necessary. Ask open-ended questions designed to evoke these concerns. Specifically, ask about the disadvantages of the status quo ("What worries you about this problem? How has this problem gotten in your way?"), advantages of change ("How might things be better if you made a change? What would you like to be different about your situation?"), optimism about change ("What do you think would make it possible for you to change? What supports and abilities do you have that you could draw on? How have you made changes successfully in the past?") and intention to change ("What would you be willing to try? What do you think you might do next?"). Then, when the client offers change talk in response, reflect it back to them (so that they hear themselves saying it again), and reinforce it, while not reflecting or reinforcing aspects of their response that are not change talk.

2) The Importance Ruler

Ask the client to rate how important it would be for them to change, on a scale of 0 - 10 (where 0 = not at all important, and 10 = absolutely crucial). Then ask why they chose that number, rather than 0. (Note that asking the reverse question, why they chose that number rather than 10, elicits arguments against change, and is therefore counterproductive). You might also ask what it would take for them to move from the number they chose to a slightly higher number (e.g., from 3 to 6 or 7).

4) The Decisional Balance

Ask clients what the advantages of the problem are. Sometimes asking about the advantages will lead people automatically to the other side. If not, follow up by asking about its disadvantages. You might also ask about the disadvantages of change, followed by the advantages (note the reverse order - the idea is to end with change talk rather than arguments against change)

5) Elaborate

When a client identifies a reason for change, don't just rush on to find other reasons. Asking the client to elaborate, or provide supporting information for the reason they've identified, reinforces the motivation, and can also elicit more change talk. Ask for clarification, specific examples, descriptions. Make sure that the topic has been completely tapped before moving on.

6) Querying Extremes

If nothing comes of other techniques, try asking about extremes: the most extreme concern the client or others in their life have about the problem ("What concerns you most about this problem in the long run?"), the most extreme possible consequences ("What would be the worst thing that might happen if the problem continues?"), or the best possible outcome of change ("If you changed, what would be the best thing that might happen?").

7) Looking Back

Clients may be able to remember life before the problem began. Ask them to compare these memories with the present situation. This strategy can help develop the discrepancy between the problem, and how life can be without the problem. It may also increase optimism that life can actually improve.

8) Looking forward

Ask the client to describe how they imagine life would be if they were able to successfully change, and what it would be like if they did not make a change.

9) Exploring Goals and Values

Ask about what is most important in the client's life. Exploring what is really important helps develop the discrepancy between the problem and their real goals and values.

To learn more about these techniques, see Motivational Interviewing: Preparing People for Change. Have you tried any of them? How have they worked or not worked with your clients?

No comments:

Post a Comment