Motivation for Change

The definition below highlights the guidance and facilitation needed by the clinician to strengthen an individual’s motivation for and movement towards change as well as explore the person’s own reasons for change.

Motivational Interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change. It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person‘s own reasons for change within an atmosphere of acceptance, collaboration, and compassion.

Last month, we focused on asking evocative and open ended questions in order to resolve ambivalence and increase motivation for change. We also discussed the need to reinforce this change talk once it is expressed. Again, once we hear this language of change by the client we need to continue guiding the client toward the change they want. If the client is communicating that a behavior change is important and the client is feeling confident moving forward, the clinician can reinforce this motivation for change by using a technique called the “Importance and Confidence Ruler.” This approach assesses the client’s perceived importance and confidence related to changing a behavior and gives the clinician information about both the facilitators and barriers to this potential behavior change.

See below, the ruler, and questions asked in this approach. This can be a quick and easy way to talk about, and reinforce, importance and confidence:

     

                       

Importance and Confidence Ruler

 

Importance

1. To help me understand how important this is to you, on a scale from 0 to 10, with 0 being not at all important and 10 being very important, how important is it to you to (change specific behavior)?

0         1         2         3          4          5          6          7          8          9          10

2. Why are you a __ and not a [slightly lower number]?

3. Why are you a ___ and not a [slightly higher number]?4. What would it take for you to move from a __ to a [slightly higher number]?

Confidence1. How confident are you, using that same scale where 0 is no confidence and 10 is very confident, that you can (change specific behavior)?0         1         2         3          4          5          6          7          8          9          10

2. Why are you a __ and not a [slightly lower number]?

3. Why are you a ___ and not a [slightly higher number]?

4. What would it take for you to move from a __ to a [slightly higher number]?

I have found that using a visual (number scale or ruler) can be very helpful with clients. The first question asked gives you a sense of where the client feels they are related to the importance and confidence of this behavior change. It is the second question, asking for a slightly lower number that promotes change talk, and what may help the client create this change. We need to be careful not to spend too much time with the third question, because it encourages “sustain talk” but may give some insight into what resource or support is needed to move forward. The last question moves the exploration back to change talk and hopefully can advance the conversation into making a plan.  Again, once you have explored the facilitators and barriers, and there appears to be momentum to make a behavior change, you can move forward and make a plan.

Good luck and keep practicing!!!

 

For more information about Motivational Interviewing resources, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu