As the clinician evokes and responds to change talk, he or she will begin to see these signs of readiness to change:
Deceased Sustain Talk
The consumer/client stops arguing, interrupting, denying, or objecting.
Decreased Questions about the Problem
The consumer/client seems to have enough information about his or her problem and stops asking questions. There is a sense of being finished.
The consumer/client appears to have reached a resolution, and may seem more peaceful, relaxed, calm, unburdened, or settled. Sometimes this happens after a client has had an emotional catharsis.
Sustain talk decreases and change talk increases, particularly commitment and activation change talk. The consumer/client talks about disadvantages of not changing, advantages of changing, some optimism about change, and an intention to change.
Increased Questions about Change
The consumer/client asks what he or she could do about the problem, how people change if they want to, etc.
The consumer/client begins to talk about how life might be after a change, to anticipate difficulties, or discuss the advantages of change. (At this point some solution-focused questioning might be helpful. E.G. the miracle question.) Envisioning requires the ability to imagine something different, not even necessarily how to get to that something different, but simply an image of how things could be different.
The consumer/client can begin to experiment with possible change approaches between sessions. (e.g. going to an AA meeting, going without drinking for a few days, reading a self-help book.) (Miller & Rollnick, 2002)
When the clinician notices these signs of readiness to change it is a good time to offer the consumer a recapitulation summary in which the clinician summarizes change talk and minimize reflections of sustain talk. The recapitulation summary is a prelude to asking a key question.
Purpose of Recapitulation Summary:
- Consumer hears herself/himself express desire, ability, reasons for change, need and intention to change.
- Consumer hears it again when clinician reflects it back
- Consumer hears it a third time when clinician summarizes
- Highlights change talk (expressions of growth, progress, intention to change)
- Correction of the summary by the consumer should be invited
Key questions move the consumer from preparing to change to mobilizing to make a change.
Examples of key questions include:
- What do you think you will do about the drinking?
- After reviewing the situation, what’s the next step for you?
- What do you want to do about the drug use?
- What can you do about the smoking?
- Where do you go from here?
- I am wondering what you might do?
Once the consumer has expressed an intention to change, elicit a commitment to change by asking the consumer to express his/her commitment to change to you and someone else in his or her life. This enhances the motivation to take action.
What Promotes Change in MI
- First and foremost, manifest the overall spirit of MI (i.e. demonstrate empathy through reflective listening)
- Helping the client to develop and verbalize arguments for change increases the likelihood of change
- Helping the client when ready to develop a specific change plan also increases the likelihood of change
- Remember: It is commitment and taking some action that predict durable behavior change
Source: Miller & Rollnick, 2013
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