When most of us are faced with a need to change a behavior related to our health, we are ambivalent at first. This is true whether or not you believe you ought to change. In Motivational Interviewing, we begin our conversation with a patient assuming we need to help build motivation for change. Planning for change includes strengthening commitment to change. It follows, then, that knowing when to suggest beginning to actually make plans for change, is a critical skill in motivational interviewing.
Don’t expect a sudden moment of understanding or clarity from your patient. Most often “readiness” is a gradual process that reflects the resolution of ambivalence about the proposed change(s). The practitioner’s goal is to strengthen the commitment to change. Certain events can serve as “markers” as you talk with and listen to your patient. Here are a few simple signs of readiness to change.
- The client begins to talk, or increases conversation, about the importance of changing.
- The client asks questions about the possibility of changing, or how they might change if they decided to do so.
- The client states plans to change or asks for help in formulating such plans.
Sometimes you must be listening carefully to pick up on your client’s cues that ambivalence has been resolved, at least in part, which signals possible readiness for change planning. Remember that just because your client is ready for change, this does not mean you begin telling people what they must do, but rather involves eliciting their own ideas for change. Your first step toward planning can be to summarize the client’s current situation, and the reasons for making changes that s/he has told you.
Here are some examples of statements that could facilitate the client in formulating his/her own plans for change.
- “So far you’ve told me that you are tired of bingeing as a way to manage your feelings, but you still feel unsure about being able to do something else. It sounds like things can’t stay the way they are. What do you think you’ll do?”
- “It sounds like you’re really tired of worrying about your blood sugar and having your doctor nag you about your weight. What’s the next step?”
- “So, we’ve talked about the good things about smoking and some of the not-so-good things, like your worry about your blood pressure and your breathing. What are you thinking at this point about your smoking?”
