The first approach we will explore together is Querying Extremes. This technique is designed to elicit change talk by asking the client to talk about the extremes of their (or others’) concerns or potential consequences about their particular condition or behavior. As well, it also asks the client to describe and imagine the best outcome or results that might occur from pursuing a change.
Concerns or potential consequences:
“What concerns you the most about your high blood pressure in the long run?”
“Suppose you continue on as you have been, without changing. What do you imagine are the worst things that could happen?”
“How much do you know about some of the things that can happen if you drink during pregnancy, even if you don’t imagine this happening to you?”
Best outcome or results:
“What do you think could be the best results if you did make this change?”
“If you were completely successful in making the changes you want, how would things be different?”
“Imagine for a minute that you did succeed in ___________________. What might be some good things that could come out of that?”
Looking Back
It can also be useful to have the client think about a time before problems existed, perhaps when things were going well:
“Do you remember a time when things were going well for you? What has changed?”
“What were things like before you started using drugs? What were you like back then?”
“What are the differences between the person you were 10 years ago and the person you are today?”
When “looking back” at the past, a client can remember a time before problems existed and compare how things are now…and perhaps see the possibility of how their situation could be better in the future. If, however, the client talks about a time when things were worse, the practitioner can discuss with the client what happened to improve the situation.
Looking Forward
If clients can imagine a changed future, it can be helpful in eliciting change talk. With this technique, the practitioner asks the client how things might be different if a change occurred:
“Tell me, how would you like things to turn out for you in 5 years or so?”
“If you were to have a week off from your symptoms/problems, what would you do first?”
The practitioner can also ask the client to imagine a changed future if no changes were made:
“Suppose you don’t make any changes, but just continue as you have been. What do you think you think your life will be like 5 years from now?”
“Given what has happened so far, what do you expect might happen if you don’t make any changes?”
As you see above, there is some similarity with querying extremes, but the difference is asking for the client’s realistic assessment of a possible change or of no change.
Again, techniques we focused on today included: Querying Extremes, Looking Back, and Looking Forward. And using these techniques in situations where there appears to be little interest on behalf of the client for change.
Next month, we will continue with a few more ways of evoking change talk.
For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.