Topic 4 Strengthening commitment to change: Strategies for Evoking Change Talk

  • This involves goal setting and negotiating a “change plan of action”. In the absence of a goal directed approach, the application of the strategies or spirit of motivational interviewing can result in the maintenance of ambivalence, where children and practitioners remain stuck. This trap can be avoided by employing strategies to elicit “change talk”.
    • Change talk is defined as statements by the client revealing consideration of, motivation for, or commitment to change. In Motivational Interviewing, the therapist seeks to guide the client to expressions of change talk as the pathway to change. Research indicates a clear correlation between client statements about change and outcomes – client-reported levels of success in changing a behavior. The more someone talks about change, the more likely they are to change. Different types of change talk can be described using the mnemonic DARN-CAT.

Strategies for evoking change talk

Ask evocative questions

Ask an open question, the answer to which is probably a change talk.

Ask for the pros and cons of both changing and staying the same.

Ask about the positives and negatives of the target behavior.

Ask for Elaboration/Examples

When a change talk theme emerges, ask for more details. “In what ways?” “Tell me more?” “What does that look like?” “When was the last time that happened?”

Look back

Ask about a time before the target behavior emerged. How were things better, different?

Look forward

Ask what may happen if things continue as they are (status quo). Try the miracle question: If you were 100% successful in making the changes you want, what would be different? How would you like your life to be five years from now?

Query Extremes

What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?

Ask: “On a scale from 1 to 10, how important is it to you to change [the specific target behavior] where 1 is not at all important, and a 10 is extremely important? Follow up: “And why are you at ___ and not _____ [a lower number than stated]?” “What might happen that could move you from ___ to [a higher number]?” Alternatively, you could also ask “How confident are that you could make the change if you decided to do it?”

Explore Goals and Values

Ask what the person’s guiding values are. What do they want in life? Using a values card sort activity can be helpful here. Ask how the continuation of target behavior fits in with the person’s goals or values. Does it help realize an important goal or value, interfere with it, or is it irrelevant?

Come Alongside

Explicitly side with the negative (status quo) side of ambivalence. “Perhaps _______ is so important to you that you won’t give it up, no matter what the cost.”

The table has been generated by the Hall, K., Gibbie, T., & Lubman, D. I. (2012). Motivational interviewing techniques—Facilitating behaviour change in the general practice setting. Australian Family Physician, 41(9), 660–667.

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How many people do everything their health professional tells them to, no questions asked? Indeed, in healthcare settings there is the flavor of that dynamic where the provider or counselor is the expert and the patient is a recipient of his knowledge and instruction.

Motivational Interviewing is effective because it does NOT have that dynamic. The individual is the expert because he will direct the whole intervention according to his daily life, behavior and motivation for change. To achieve this motivational interviewing has a specific technique that helps counselors share this information without turning into the expert, and the individual into a passive participant.

The technique is called Elicit-Provide-Elicit (Asking, Listening, Informing).

This technique may be particularly useful when:

  • You think the individual is misinformed
  • You think the individual lacks information
  • You’re thinking of an idea that might be useful to the individual
  • The individual is asking for information