This document discusses strategies for eliciting and strengthening change talk during a session with a patient. It recommends finding where the patient is in their readiness for change using importance and confidence rulers. The session aims to develop discrepancy, amplify ambivalence, and elicit change talk using empathic reflection and exploring goals, values, strengths and solutions. While the clinician guides the intervention, the ultimate outcome is not their responsibility. Examples are provided to distinguish resistance from change talk. The goal is to meet patients where they are on the continuum of ambivalence and increase their importance and confidence in making positive changes.
4. Find Out Where the Patient is
Meet them where they are
Continuum of ambivalence
Explore importance and confidence
5. Readiness Ruler
Importance. How important is it for you right
now to prevent illness? On a scale of 1-10, how
important is it?
1-------------------------------10
How come you are a ___ and not a ___? What
would it take to go from __ to __?
6. Confidence Ruler
Confidence. How confident are you that you could
complete a colon cancer screening test?
How come you are a ___ and not a ___? What
would it take to go from __ to __?
7. Strategies to Increase
Importance and Confidence
ELicit & reflect change talk
Explore goals & values
Highlight personal strengths
& supports
Brainstorm solutions
Hypothetical change (“I
wonder if...”)
8. Resistance or Change
Talk?
“I want to lose weight.”
“I’d like to spend less money.”
“I could if I wanted to, but I don’t really want
to.”
9. Resistance or Change
Talk?
“I wish people understood me better.”
“I want to get along with my wife.”
“I wish my parents would stop nagging me.”
10. Resistance or Change
Talk?
“I don’t want the colonoscopy but I need to do
it for my family.”
“I don’t want to go looking for trouble with
those tests. I feel fine.”
“I’m scared. But if you tell me I need it, I will
do it.”
Complex Empathic Reflections..
amplify, double-sided, continuing paragraph, metaphor, affective...
Elicit, Provide Options, Elicit..
Importance,Confidence & Energy Rulers..
Elicit Commitment Language..
We are responsible for the intervention, not the outcome...
Its important to meet the patient where he/she is at in terms of thinking about CRC screening.
MI involves an approach to making this “diagnosis” or determination using a continuum of ambivalence that ranges from resistance to true ambivalence.
The MI approach involves exploring IMPORTANCE and CONFIDENCE.