In previous blog posts, we have explored change talk and discussed several strategies to elicit and listen for the client鈥檚 own motivations for change. Some of the most common ways clinicians listen for change talk is when a client talks about or mentions:
Desire: 鈥淚 would like to lose some weight.鈥�
Ability: 聽鈥淚 would be able to take my medications each morning with breakfast.鈥�
Reasons: 鈥淚 would have more energy if I exercised.鈥�
Need: 鈥淚 need to make better choices because I can鈥檛 keep living this way鈥�
The acronym is DARN and these statements refer to the preparatory change talk by the client and their movement towards change. However, if you are not hearing this language from the client, or there appears to be little interest to change at the moment, are there other questions you could ask the client to elicit change talk? Please see below some additional strategies that may be of benefit.
Querying extremes
This strategies focuses on having the client think about or reflect on the extreme consequences that could occur if changing of behavior does not happen. For example, questions could be asked such as:
If you continue to go on as you have been, what are the worst things that could happen?
Even if you don鈥檛 ever image doing this, do you know what can happen if someone uses drugs and alcohol during their pregnancy?
At the same time, it can also be useful for the client to think about or reflect on the best consequences that could occur from changing behavior. For example, questions could be asked such as:
If you were able to make this change, what are the best things that could happen or how would things be different for you?
What are you most excited about if you were able to make this change in your life?
Looking back
Another strategy is to have the client talk about a time in their life when they were not having problems and comparing these times to what they are dealing with now. This can allow the client to become aware of the discrepancy between past and present and offer the possibility of things getting better. For example, questions could be asked such as:
Tell me about your life before you started using drugs, what did you enjoy doing, what was going well, and what were you like?
How have you changed as a person since these problems started? And how have your relationships changed?
Looking forward
Having a client focus on what it might be like in the future (if behavior change were to occur) can give the client the opportunity to hear themselves talk about life being different and a future that is more meaningful. For example, questions could be asked such as:
If you were to think about your life 5 or 10 years from now, how would you like for things to be and how would you be different?
I know this has been a challenging issue for you to navigate. How would you like to deal with this issue and what would your future look like if this wasn鈥檛 an issue you were dealing with right now?
Exploring goals and values
Lastly, an approach we have discussed in an earlier blog post is exploring the client鈥檚 goals and values. To ask the client what is most important in their life; by perhaps using a menu of options, a values card sort, etc. Again, allowing the client to think about what is most important and how it relates to their current behavior. And if you experience any defensiveness or discord when asking the questions just back off and use another approach. For example, questions could be asked such as:
Tell me about what is most important in your life鈥nd are there important people in your life?
What would a meaningful life look like for you鈥nd what goals would you like to accomplish?
Remember, all of these strategies are an attempt to have the client come up with their own reasons and motivation for change. If the client is able to come up with their own ideas there is much a greater likelihood for success.
For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.