What is Decisional Balance?
What is Decisional Balance?
The Heart’s Way for Creative Clinicians
What is decisional balance? Decisional Balance is a therapeutic tool used in Motivational Interviewing. When our clients are contemplating making a change in their lives, Decisional Balance is a process by which they can consider the pros and cons of the situation or problem they are facing. Before diving into Decisional Balance, let’s set the foundation by discussing Motivational Interviewing (MI) and Stages of Change (SOC).
What is 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)
It is an approach that is respectful of the client’s own autonomy. It is considered a guiding form of communication that empowers people to make changes by allowing them to come to their own decisions rather than being directed.
According to MINT: Motivational Interviewing Network of Trainers, “MI is particularly useful to help people examine their situation and options when any of the following are present:
- Ambivalence is high and people are stuck in mixed feelings about change
- Confidence is low and people doubt their abilities to change
- Desire is low and people are uncertain about whether they want to make a change
- Importance is low and the benefits of change and disadvantages of the current situation are unclear.”
As seen above, making positive changes can sometimes be a daunting task. When clients present with problems or situations in counseling, some are ready to make those changes, some are uncertain about changing, and others are completely adamant against change. Making changes in our lives is not always a cut and dry matter. It is helpful to recognize and understand the various Stages of Change.
What are the Stages of Change?
One model of The Stages of Change:
- “Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed)
- Contemplation (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)
- Preparation/Determination (Getting ready to change)
- Action/Willpower (Changing behavior)
- Maintenance (Maintaining the behavior change) and
- Relapse (Returning to older behaviors and abandoning the new changes)”
Decisional Balance can be used within the Precontemplative or Contemplative SOC where ambivalence is strongest. It may also be used at any SOC if the person seems to be “stuck.” But, it is typically within the Contemplative stage that we find the Decisional Balance therapeutic tool as being most useful. Clients have an awareness that a problem exists and they have begun to consider the possibility of making a change, although they may still have some ambivalence. The goal in therapy during this SOC is for the client to examine the pros and cons to making change. If you are utilizing MI in your counseling…enter Decisional Balance. (For additional concepts regarding decision making, please see my post Decision-Making – Coloring the Pages of Your Life.)
What is Decisional Balance?
Decisional Balance “is a tabular method for representing the pros and cons of different choices and for helping someone decide what to do in a certain circumstance. It is often used in working with ambivalence in people who are engaged in behaviours that are harmful to their health (for example, problematic substance use or excessive eating.”)
From Wikipedia
The Decisional Balance matrix can be used when one wants to make decisions about changing habits or behaviors. As mentioned above, examples of such changes in behavior include substance use/abuse issues or excessive eating. Other examples may include smoking cessation, increasing physical activity, medication compliance, improving time management, issues regarding illegal activities, improving self-care, improving relationships with others, etc.
There are various Decisional Balance worksheets available for use. The basic worksheet is a four-square tool. The quadrants explore the pros and cons of either changing or maintaining a certain behavior (see diagram above).
How do I use the Decisional Balance Matrix?
When using a Decisional Balance worksheet it is important to ask questions in a certain order. This order varies from expert to expert. But I have found an example of an order that makes good sense to me…in terms of helping a client move towards positive change (see diagram above). This order may or may not align with your therapeutic concepts. If it does not, the order can be easily changed to suit your preferences and/or your client’s needs.
The Decisional Balance worksheet and process that I prefer is detailed by Bill Matulich, Ph.D. in his video, The Decisional Balance Technique (see below.)
Question #1: What are the advantages of the status quo? What are the advantages of continuing with the same behavior, i.e. drug use, non-compliance with your Diabetic medications, etc.? Most professionals don’t ask clients this question. But, when you do, this offers the opportunity for your client to talk about his/her problem in a non-defensive way. It “short-circuits resistance.”
Question #2: What are the downsides of the status quo? What are the downsides of not changing the behavior, i.e. continuing to consume large amounts of caffeine when anxious? This is where “change talk” begins.
Question #3: What are the downsides of changing the behavior? For example, what are the downsides to exercising regularly for my arthritis? Resistance continues to be short-circuited with this question. Clients may also begin to talk about their fears of change.
Question #4: What are the advantages of changing the behavior? What are the good things that would happen if I start a gratitude journal and voicing affirmations for my depression? The majority of “change talk” is in this area. It’s important to note that clients are now developing their own arguments for change. As a professional, you could have advised your client to make these changes from the very beginning…but you may have met with resistance. There is no resistance when “change talk” comes from the client.
What’s the Takeaway?
Decisional Balance can be a key technique to add to your clinical intervention repertoire. Change, when initiated by our clients and nurtured by us, can be a positively powerful thing. To help in this process, I’m including a Decisional Balance worksheet that you can download for you or your client’s use. Just click on this link:
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