The Heart's Way

What is Change Talk?

jeaninemjones

What is Change Talk?

The Heart’s Way for Creative Clinicians

In a recent blog article on The Heart’s Way for Creative Clinicians we explored the therapeutic model of Motivational Interviewing. This article, titled What is Decisional Balance, discussed the concepts of Decisional Balance and Stages of Change. For a more in-depth look into this article, I’ve included a link here: What is Decisional Balance?

In today’s blog article we will continue to examine Motivational Interviewing, with a focus on change talk. Please note that much of the information regarding change talk in this article was gleaned from an excellent Continuing Education Workshop I attended in January 2021. Hosted by Core Learning, Inc., this workshop, MI Skill Building: Moving Through the Stages of Change, was presented by Maureen Lyn Bernard, LMSW, ACSW, CADC, CCS, MIMIT.

But first let’s recap the basic definition of Motivational Interviewing

Motivational Interviewing is “a collaborative, goal-oriented style of communication with particular attention to the language of change, designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”

Miller, W.R. & Rollnick, S. Motivational Interviewing: Helping People Change (3rd Edition)

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What is change talk?

When making change, people are best persuaded by what they say themselves.

Motivational Interviewing is a therapeutic model that mental health professionals utilize to assist our clients in making change. Change talk is any talk from the client themselves that favors any movement in the direction of change. The clinician’s role is to help evoke change talk with our clients. The more a client can work through their own process of change, the better the outcome.

The opposite of change talk is sustain talk. Sustain talk is any talk that favors the status quo.

How do we recognize change talk in our clients?

There are certain phrases that our clients may say that can be recognized as change talk. These statements fall in several categories, that are identified with the acronym, DARN CATS. (Oh, those DARN CATS!)

Ten Strategies for Evoking Change Talk

It’s important how you ask your clients questions when they are considering making a change. Questions need to be open-ended and phrased in such a way as to elicit thoughts on the part of the client. Remember, Motivational Interviewing is “a collaborative, goal-oriented style of communication.” Motivationalinterviewing.org has developed Ten Strategies for Evoking Change Talk, which will be outlined below.

  1. Ask Evocative Questions: Ask open question, the answer to which is change talk.
  2. Explore Decisional Balance: Ask first for the good things about status quo, then ask for the not-so-good things. (Note: I’ve developed a Decisional Balance worksheet that may be helpful for your work with clients. To download this handout, click on Decisional Balance Worksheet.)
  3. Ask for Elaboration: When a change talk theme emerges, ask for more details. In what ways? Tell me more…? What does that look like?
  4. Ask for Examples: When a change talk theme emerges, ask for specific examples. When was the last time that happened? Give me an example. What else?
  5. Look Back: Ask about a time before the current concern emerged. How were things better, different?
  6. Look Forward: Ask what may happen if things continue as they are (status quo.) Try the miracle question: If you were 100% successful in making the changes you want, what would be different? How would you like your life to be five years from now?
  7. Query Extremes: What are the worst things that might happen if you don’t make this change? What are the best things that might happen if you do make this change?
  8. Use Change Rulers: Ask, “On a scale from zero to ten, how important is it to you to [target change] – where zero is not at all important, and ten is extremely important? Follow up: And why are you at __ and not __ [lower number than they stated]? What might happen that could move you from __ to [higher number]? Instead of “how important” (need), you could also ask how much you want (desire), or how confident you are that you could (ability), or how committed are you to (commitment). Asking “how ready are you?” tends to be confusing because it combines competing components of desire, ability, reasons and need.
  9. Explore Goals and Values: Ask what the person’s guiding values are. What do they want in life? Using a values card sort can be helpful here. If there is a “problem” behavior, ask how that behavior fits in with the person’s goals or values. Does it help to realize a goal or value, interfere with it, or is it irrelevant?
  10. Come Alongside: Explicitly side with the negative (status quo) side of ambivalence. Perhaps ______ is so important to you that you won’t give it up, no matter what the cost.

Change plan elements

To review, we’ve discussed the concept of change talk, learned ways to recognize our client’s change talk with the acronym DARN CATS, and outlined questions to evoke change talk. The last area that I would like to cover is assisting our clients to determine their change plan elements.

Change plan elements are questions that clients can consider when they decide they are ready for change. These questions help clients to formulate an actual plan for change. Here’s an example of these elements in written format:

If you think that the above Change Plan handout would be helpful for your clients, I’ve made a printable for you to use as you wish. To receive this handout, please click on Change Plan Handout.

Thank you for reading this article. Hopefully the information (plus two handouts) will be useful as you continue to do your good work with your clients. Your feedback is appreciated!!

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