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Motivational Interviewing - Listening for Change Talk

Motivational interviewing (MI) is a counseling style that integrates an empathic, non-confrontational style of counseling with powerful behavioral strategies for helping clients convince themselves that they ought to change. MI is directive, but uses instruction as only a part of the counseling relationship. Motivational interviewing includes a number of techniques, which enable the clinician to develop careful, practiced listening skills which create a productive atmosphere in which the client can decide if, what, and when they choose to change.

An important aspect of motivational interviewing is the clinician’s reinforcement of change talk. Change Talk refers to the client’s mention and discussion of his or her Desire, Ability, Reason, and Need to change behavior and Commitment to changing. The point here is that when people talk about change themselves, they are more likely to change than if someone else (such as the clinician, a friend or relative) talks about it . In this way, change talk is self advocacy. You may have had the experience of struggling yourself with a problem, then discussing it with someone else and finding that when you state the solution, it is more powerful than when your listener does so. A part of the process of learning motivational interviewing is learning to recognize change talk when you hear it from your client, and then reinforce it.

Listening for and appreciating the client’s ambivalence about change is a key element of motivational interviewing. We are all ambivalent when confronted with the need for and possibility of making changes in our lives. To understand ambivalence, try thinking about a change you have been asked to make, or think you should make, in your own life. Are you sure you want to change? Are you sure you are able to change? For example, perhaps you would like to get more sleep, but find it hard to go to bed earlier. There’s just too much to do, or your favorite TV shows are calling you, or it’s just too nice being up after everyone else is asleep and the house is quiet. Another common example in people’s lives is wishing you could exercise more, to improve your health or to lose weight. It sounds like a good idea, but by the end of your work day, you’re tired and it’s hard to be motivated to exercise. You feel two ways in both examples. On one hand you have good reasons to make the change, but there are other equally compelling reasons not to. You are ambivalent about change, even if it is in your best interest. Our clients often feel the same way about the changes we are asking them to make. One key to listening for ambivalence is the “but” in the middle of the sentence. “I’d like to make that change, but…” When you hear ambivalence, you are also hearing change talk.

In substance abuse treatment, as in many other areas of health behavior change, we are asking clients to give up something very important in their lives, often for things they don’t understand or don’t like. It is important for the MI clinician to understand both sides of the client’s story, and to see things from their point of view, even if we disagree. Our goal as careful listeners is to selectively reinforce the client’s speech that is in the direction of change, or leaning towards change.

Change talk is heard in five categories, Desire, Ability, Reason, Need, and Commitment, or DARN-C. Learning to listen for the subtleties of meaning in your client’s conversation in these five categories is very important in Motivational interviewing. Using these questions can help to elicit change talk:

  • Desire: Why would you want to make this change?
  • Ability: How would you do it if you decided?
  • Reason: What are the three best reasons?
  • Need: How important is it? and why?
  • Commitment: What do you think you’ll do?

Here are some examples of how conversations might go:

Desire

Clinician: If you were going to change your alcohol use, why would you do it?

Client: Well, my doctor’s been nagging me, and I’m beginning to think she’s right. I’ve got to do something or my liver just won’t take it anymore. Besides, my blood pressure’s just too high.

Clinician: So, you’re thinking your doctor might be right about your drinking too much, because of your liver and your blood pressure.

Ability

Clinician: I know you’re not ready to begin to change your marijuana use, but if you were, what are some things you would do?

Client: It would be very hard for me, because I love my weed. I’d have to start by cutting back to just smoking after work.

Clinician: While it would be hard for you to cut back, it seems like just smoking after work might be a place to start.

Reason

Clinician: Can you give me three good reasons why you might consider changing your drinking?

Client: Oh, if you talked to my wife she’d tell you at least three! She’s been nagging again. She says I’m not reliable and don’t come home when I say I will and that I don’t remember some conversations. I guess she’s right about those things.

Clinician: It seems that things might be more peaceful in your marriage if you were drinking less.

Need

Clinician: How important would you say changing your drinking is right now?

Client: Not very.

Clinician: Why do you say that?

Client: I have so many other worries about my health.

Clinician: It seems to you that your drinking is not the most important thing right now. What would have to happen to make it more important?

Client: I think if I had another DUI and lost my driver’s license that might get my attention.

Commitment

Clinician: What do you think you’ll do about changing your drinking? What ideas do you have for yourself?

Client: I’m not sure. I could try what my best friend is doing, to go to one AA meeting just to see what it’s like.

In each of these conversations, the clinician responded with reflective statements, which summarize the change talk statements the client made. It is important to understand that the clinician would acknowledge the statements that are the “no change” side of the ambivalence, but reinforce the change talk.

Motivational Interviewing is a very powerful style of counseling for many health behavior changes. Once learned, the MI style of appreciating the limits of trying to persuade our clients to change their behavior makes our job much easier. We are not responsible for whether or not our clients change, but for helping them decided if they want to or can change, and if so, how to do so.

About the Author

Dr. Ellen Glovsky is a Registered Dietitian and a member of the Motivational Interviewing Network of Trainers, and co-owner of the Institute for Motivation and Change. She conducts workshops and consultations around the counntry.


( 5 Votes )
Comments (9)
9 Monday, 16 April 2012 21:37
shishe Mwale
I am very interested in the Motivational interviewing technique as i work with juvenile offenders.My only worry for its limitation to my line of work is.(Age Appropriate) what age would it be best for me to begin the change talk with my clients.They are usually one time offenders and if they are at risk recidivists would they be mature enough to understand decisional balance and change talk.
8 Monday, 16 April 2012 21:34
shishe Mwale
i work with juvenile offenders.My only worry for its limitation to my line of work is.(Age Appropriate) what age would it be best for me to begin the change talk with my clients.They are usually one time offenders and if they are at risk recidivists would they be mature enough to understand decisional balance and change talk.
7 Sunday, 08 January 2012 18:20
crystal
I would look into the rolling with resistance part of MI for mandated clients. It works really well too!
6 Tuesday, 17 May 2011 00:09
Tiffany Hopwood
In response to David Bryant: Embracing the spirit of MI in your interactions with those people needing immediate change is still very valuable. Especially in your situation, your clients are expecting to hear a lecture, expecting you to try to convince them of change. If you are able to take the side of not changing it will break down their defense and put them in the position to argue for change, enhancing their thought process. This doesn't mean that you will see immediate change but you will present a different approach that will make them think and allow for your relationship to build when can be very powerful if your positions lends itself to continued contact with the offenders.
5 Sunday, 06 September 2009 17:28
Kate Speck
There is actually a great deal of work and research going on with criminal justice clients and the use of Motivational Interviewing. I teach many probation officers and corrections systems how to use MI and it fits very well with the Judicial orders. Most of the individuals using MI are able to modify their approach to meet the needs of their probation client AND comply with the court orders.
4 Monday, 06 July 2009 07:48
Rich Rosing
In response to Mr. Bryant - the use of Motivational Interviewing even though your client needs to stay sober now MI is still more effective than the old approach of in your face.

A few of the questions you may ask is what is your goal? No doubt his would be to get the probation officer off his back or to stay out of jail. The next line of questioning could be to validate that and then ask him how he best might be able to do that? How would using get him to his goal?

I am attending a conference in Austin, TX put on by the state agency. The title is "Focusing in Evidence-Based Solutions of which MI is one of them.
3 Sunday, 05 July 2009 08:32
Rebecca Heil
In response to Mr. Bryant - the use of Motivational Interviewing, as I was trained to understand it, is not just to "stay clean." Other methods may be fine to maintain abstinence, in the meantime, without the motivation to change the final outcome can only lead to the client's return to jail or prison. The motivational interviewing process is to evoke from clients their own decision to reach decisional balance in their lives on all levels. The use of MI in your position could enlist the clent in supporting their self-efficacy and enhance the clients motivation to change. Resistance to resistance creates resistance. Roll with it!
2 Friday, 19 June 2009 17:15
Doug Shelley
I enjoyed the article by Dr. Ellen Glovsky, “Motivational Interviewing: Listening for Change Talk”. I was fortunate enough to attend a seminar on motivational interviewing shortly after beginning work as an alcohol and drug counselor in San Diego. The concept fit me well because it was designed to work from a positive posture and (as I was taught) began where the client was. Too me it supports temperate confrontation as well as awareness, which as Dr. Glovsky noted may help the client with her/his decisions.

I have cut out the DARN-C and added it to my tool box.

Many thanks.

Doug Shelley
1 Tuesday, 16 June 2009 00:12
David Bryant
I acknowledge that Motivational interviewing is a great technique. A problem lays in the client's treatment situation. Most client's I work with are referrals from the Judicial system and are required to remain clean and sober NOW! There is no room for client responses such as "I'd have to cut back to just smoking after work." Client's arriving from probation or parole to an outpatient environment are normally saturated with negative peer influences in their social networks. Change talk is fine, however it may be limited to an inpatient setting. Are there techniques that deal directly with an immediate jail or die consequence?

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