Questions where your client has little desire for change

 There will be occasions when, despite your best efforts, you can see your client just does not 'get' that they need to change. In this situation you could then get them to describe in their own words what would be the extreme consequences of continuing on this path, and then what would be the consequences if they decided to change.

 Examples of the kind of questions you could use:

• “Suppose you don’t change, what is the worst thing that might happen?”

• “What is the best thing you could imagine that could result from changing?”

 Another technique would be to ask your client to compare their current situation and what it would be like to not have the problem in the future.

 These types of questions may help:

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“If you make changes, how would your life be different from what it is today?”

• “How would you like things to turn out for you in two years?”

Exploring importance and confidence

 Gauging how important a patient considers change and how confident they are about that change, are vital to change talk. These two ratings help us to understand how our patient's feel about the change and to what extent they feel it is possible.

 You can continually check these in your conversation with your clients (although don't overdo it) Importance and confidence ratings can be used to get patients to talk about what they would need to do to change. You can use their scores to explore their behaviour.

 Examples of how you can explore importance/confidence ratings:

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© Annie Barr

“Why did you select a score of [insert #] on the importance/confidence scale rather than [lower #]?”

The real challenge is to recognise whether the person is ready to make a change in the first place and to ensure they are making the decisions for themselves. We are so used to telling people what to do that often we don’t recognise that it might be the patient’s own fault when the change process does not work well.  Some of the techniques in this resource will help you to improve your communication skills and your ability to see where you client is on their change journey.

 Remember that you are not:

• arguing that a person has a problem and needs to change

• offering advice without a client’s permission

• doing most of talking

• diagnosing a person’s problem

• responsible for making that person change.

© Annie Barr

If they are not ready to change, leave the door open and part on good terms.

 The model shows that before any change can take place, a person needs to believe there’s an advantage to changing and must be willing to put an effort into making this happen by deciding when, what and how to do it.

 Assessing your client's readiness to change is a critical aspect of MI. Motivation is not static and can change rapidly from day to day. If you can understand where your client is in terms of their readiness to change, you will be better prepared to recognise and deal with their motivation to change.

Motivational Interviewing (MI) is a conversational style that facilitates collaboration between the healthcare provider and their patients. Its ultimate goal is to solve a healthcarerelated problem through patient introspection and empowerment. It combines technical aspects, such as openended questions and empathy, with a view toward a patient-centered approach

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