It is important to remember when working collaboratively with a consumer to develop a change plan, not to abandon the spirit of MI and the primary counseling strategy of OARS simply because you have moved into developing a specific plan of action with a person. It can be tempting to fall into the trap of taking the expert position or jumping in too quickly with target goals or advice about how the person might take steps toward change. As Miller and Rollnick (2013) suggest, “Often people don’t really want advice, but they want you to be there while they talk to themselves. The planning process in MI is to be with someone while they form a change plan that will work” (p. 268).
Difference Between a Treatment Plan and a Change Plan
Miller and Rollnick (2013) note that there is a difference between a treatment plan and a change plan. They state that a treatment plan “…is required in many service settings, but ‘treatment’ at most forms only one part of a person’s plan for change, and often a minor part. A change plan is broader, addressing how a person will proceed and how the change will fit into his or her life. What contribution (if any) will happen via treatment is just one part of the picture” (p. 269).
Miller and Rollnick (2010) describe the four elements of collaborating with a consumer/client to develop an effective change plan:
- Setting Goals
- Considering Change Options
- Arriving at a Plan
- Eliciting Commitment
Rosengren (2009) has created a handy acronym SOAR to identify these four elements:
Arrive at a Plan
Again, these four elements take place within the spirit of MI, so the conversation is collaborative and person-centered. For example, when setting goals for change with a consumer asking an open-ended question like “What would you like to see change?” elicits from the consumer his/her own ideas about what goals for change she/he would like to establish.
Here are some open-ended and scaling questions in the spirit of MI that will elicit consumer/client generated solutions and action steps toward change:
- What would the change look like? (Setting Goals)
- What is the first step? (Considering/Sorting Change Options)
- On a scale of 1–10 how effective do you think this strategy will be for you? (Considering/Sorting Change Options: Effectiveness)
- What are some additional steps you can take in order to accomplish your goal? (Arriving at a Plan)
- On a scale of 1–10 how likely is it that you will try this strategy? (Eliciting/Reaffirming Commitment: Intention)
- On a scale of 1–10 how confident are you that you will actually try this strategy? (Eliciting/Reaffirming Commitment: Confidence)
- Who in your life can help you take these steps? How can they help? (Eliciting/Reaffirming Commitment)
- What are some possible obstacles to changing? (Eliciting/Reaffirming Commitment)
- How could you handle these obstacles? (Eliciting/Reaffirming Commitment)
The last two questions are important because they can help the consumer identify any obstacles to following through on his or her commitment to change and focus the conversation on the consumer’s resilience and coping skills. They also are useful in troubleshooting the plan. “If you raise these points and ask the client how he or she could respond to them, the answer is likely to be more mobilizing change talk” (Miller & Rollnick, 2013, p. 273).