How to Use Motivational Interviewing to Elicit Change Talk

As a behavioral health professional, knowing how to recognize and respond to change talk, or clients expressing their desire to change, is crucial, as it can significantly influence positive behavior changes for your clients. By guiding individuals through reflection and exploration, motivational interviewing seeks to empower them to embrace positive transformations in their lives. To help you aid your clients in achieving positive change, we’ll explore the various techniques employed to elicit and reinforce change talk in motivational interviewing.

What is motivational interviewing?

Motivational interviewing aims to facilitate a client-focused, cooperative dialogue aimed at enhancing an individual’s readiness for change. Rooted in empathy, attentive listening, and a non-adversarial stance, this approach fosters a supportive environment where individuals can delve into and express their personal motivations for change.

Change talk vs. sustain talk

During motivational interviewing sessions, you’ll likely encounter both sustain talk and change talk from your clients.

Sustain talk is any language in favor of the status quo. You may hear sustain talk as the individual thinks about the benefits of not changing and the possible dangers of making a change.

The key principle with sustain talk is to remember the natural tendency for people to continue to use sustain talk when they are ambivalent about change. You should remain nonjudgmental and accepting and avoid confronting or challenging sustain talk. However, you should try to shift the focus away from sustain talk to change talk.

Change talk is any talk provided by the individual that favors change. Change talk can come in many forms. The more a person engages in change talk, the more likely they are to make and sustain behavioral change.

The first step in being able to respond and reinforce the individual’s change talk is to consistently recognize statements that favor change, often outlined by the acronym DARN-CAT.

• (D)esire: Statements that indicate a person would like to be able to make a change.
• (A)bility: Statements showing a person’s belief that they could accomplish a change if they tried.
• (R)eason: Statements describing a motivating factor in making a change.
• (N)eed: Statements in which the person indicates they see the need to change.
• (C)ommitment: Statements indicating they are committed to the change process.
• (A)ctivation: Statements indicating they feel ready to examine specific steps toward change.
• (T)aking Steps: Statements indicating they have taken concrete actions toward change.

Sometimes you may hear change talk statements that fit in more than one category. Ultimately, what is most important is that you start developing an ear for recognizing change talk in all its forms.

Motivational interviewing techniques to elicit change talk

Now that we understand how to recognize change talk, let’s explore some techniques you can use to elicit or respond to change talk from your clients.

The importance/confidence ruler

One method of responding to change talk is to use a scale or ruler when asking a person about importance and confidence:

• “How important would you say it is for you to change this behavior? On a scale from 0 to 10, where 0 is not at all important and 10 is extremely important, where would you place the importance of this change?”

This number by itself may be somewhat informative, however, the key step is to follow up with an open-ended question designed to elicit further desire, reasons, and need to change. For example, “Why are you at a ___ and not a zero?”

After you have reflected and elaborated on their reasons for change, you can then ask the person about their confidence in being able to change the behavior:

• “How confident would you say you are that, if you decided to make the desired change, you could do it? On the same scale from 0 to 10, where 0 is not at all confident and 10 is extremely confident, where would you say you are?”

Again, the key is to follow up with a question to elicit change talk, usually more related to the ability to change, such as: “Why are you at a ___ and not a zero?

Looking back

Have the person think back to the time before the problem they are currently dealing with arose and compare them.

• “What was it like before ___?”

Use OARS to keep the momentum going. You are seeking to elicit any previous strengths, attitudes, or beliefs to determine how they might be used to help in the current situation or problem. For some, asking how they have made other difficult changes can be a helpful way to support autonomy and self-efficacy.

Query extremes

Ask the person to describe the extremes of their situation, including the most extreme consequences that might occur. For example:

• “What’s the best that could happen?”
• “What’s the worst that could happen if _____?”
• “What concerns you the most about _____?”

Listen for change talk showing reasons why they might want to change and use reflective statements to keep them exploring the possibility of change.

Explore goals and values

People may be more motivated to make difficult changes when the new behavior they are considering aligns with one of their underlying values or a concrete goal.

For example, consider the following exchange. The first reflection is simply reflecting the individual, and the second reflection is adding a greater emphasis on the value of honesty.

• Individual: “I’ve been telling my partner I’ve been working late on a project at work every night, but the truth is that I’ve been stopping by the bar on the way home for a drink or two, just to relax and get my head in the right place.”
• You: “You’ve been telling him one thing and doing something else.”
• Individual: “Yeah, and that isn’t like me.”
• You: “Being honest is really important to you.”
• Individual: “It is! I hate that I’m living a lie, I wish I could stop.”

Looking forward

Ask them to look to the future and explore two options:

• What their situation might look like after changes are made.
• What their situation might look like if no changes are made.

Your job is not to take a position, but rather to facilitate their exploration of how changing this behavior might affect them in the future.

Establish a language of commitment

If an individual is engaging in significant change talk, you should explore their willingness to make concrete commitments to specific behavior changes. For example, when you hear change talk, move forward with developing a case plan goal around the indicated change.

Simply having the person elaborate on a statement before moving on often elicits change talk that can translate directly into specific commitments. Getting them to elaborate can help the individual move from superficial to deeper thinking. You can use elaboration by:

• Asking for clarification
• Asking for specific examples
• Asking for a description of the last time the target behavior occurred

Some questions to consider when helping your clients establish a commitment to a goal are:

• When will this happen?
• Where will this happen?
• Who will be involved?
• What has prevented you from doing this in the past?
• What will be different?

If you used the Importance/Confidence Ruler technique around this behavior change in the past, consider using it again at this point to see whether their rating has changed because of having engaged in specific change talk and having made a commitment to change around the specific behavior.