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Helping Ambivalent Clients Using Motivational Interviewing

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What is decisional balance in motivational interviewing?

Techniques for Helping Ambivalent Clients Reach Their Goals

When coaches have to guide a client through making changes, it can be a daunting task.  It can be even more challenging when the client has ambivalence.  Maybe the client is pre-contemplative and has not even considered making a change.  Or, the client may know they need to make a change but they are unsure.  This client is contemplative. 

The steps used to usher a client from one stage of the Transtheoretical Model (Prochaska and DiClemente) is tricky; it has to be done right, so that the decision to change is owned solely by the client.  It can not come from the direction of the coach. How can we do this if the client is not sure, or is not committed to stepping into the change arena?  We can start by using a process called decisional balance. 

What is Decisional Balance?

Decisional Balance is a method of assessing the positive and negative consequences, for oneself and others, of selecting a new behavior. This is a deeper way of thinking about a decision, moving beyond the traditional two-dimensional model people consider in such situations.  It is more than just “should I or should I not”.  The decisional balance exercise gives clients four key points to consider.  

Using a Decisional Balance Sheet

It begins by making a simple four-square chart, showing the advantages and disadvantages of making a change (such as making food intake changes a priority) as well as the advantages and disadvantages of not making the change (continuing to eat poorly).

Among the advantages of making the change might be: reducing your long-term risks of obesity-related chronic illnesses, heart disease, atherosclerosis, certain cancers, and other serious diseases; saving money on fast food; and gaining confidence (which is monumental in coaching). Among the disadvantages of making the change might be: no longer being able to enjoy a meal out with friends or while socializing; it might mean a shift is required with friends at work who have less-than-ideal nutrition.

Among the advantages of not making the change might be: not feeling deprived of what is wanted and holding on to a habit that you enjoy. Among the disadvantages of continuing to eat poorly might be: setting a bad example for your children and spending money on extra, unneeded food items. (It’s okay if there’s some overlap because that’s natural.)

Coaches can try using an importance ruler to assign a level of importance to each item listed with a numerical weight, based on which things matter most among the things you listed.  The main objective of this exercise is to allow the client to get a meta-view or a big picture.

Motivational Interviewing Questions

Motivational Interviewing (MI) is another great technique that can be used to help your client explore their motives for making a change while allowing your client to pick their own reasons for a change and thus, allowing them to be freed of any ambivalence.  Although motivational interviewing is used in the context of working in-session with a therapist, coaches can practice this on their own or even with a friend to perfect delivery with a client. 

Consider asking your client to answer the following questions:

  • Why do I want to achieve this?
  • Am I doing this to please myself or other people?
  • If I decide to do this, how would I go about it in a way that would help me succeed? What are my three best reasons for doing this?
  • What am I willing to do to make this change? What have I already done to take steps in this direction? 

When a client pursues a vision or goal of something they want to change, the desired outcome is more likely if it is one that they’ve freely chosen on their own.

Change Talk

Help your client hone their change talk vocabulary.  This means our ability to recognize and revisit stated reasons for moving forward with a change can help our client to have more successful outcomes.  This is nothing more than the coach redirecting clients toward their goals when they veer off-course.  When coaching, pay attention to your client’s change talk, and think about their desire, ability, reasons, and need for making the change. Listen for statements like “I might” or “I have wondered if”…these are all forms of change talk, as well.  They are simply rooted in pre-contemplation and the coach never wants to miss an opportunity to expand into this mindset with the client.

If your client is lacking energy or wants to start an exercise program, for example, they might use statements such as: “I want to be fit and active to play with my new grandchild,” “I enjoy racquetball and could exercise by joining a league,” or, “If I exercise with more intent or direction, I may be able to ditch my blood pressure medication. 

Newer research has found that “change talk” significantly increases during motivational interviewing, especially among people who have high-risk habits, like drinking and smoking. 

Try switching things up with your clients – if it is safe, try some experimentation.  Getting a client to act as if they are already in the midst of change will let them see how it might feel.  This is a twist on the fake-it-till-you-make-it mantra.  Don’t hesitate to have your client step into the action as if they have made a decision and they are now going to live with how it feels to make a change.  When clients have the power of seeing themselves doing new behaviors can move them in the right direction; it also can strengthen their resolve to change because they begin to see that it is plausible, maybe even enjoyable. 

When clients show us their ambivalence, we can use this to dig deeper into their story.  We need to do this in order to be able to truly serve them while keeping their best interests as a priority.  There is no better way to assess where a client has mental barriers than those opportunities to explore their ambivalence.  It will most often have a root cause that we need to understand.  Many times, it is connected to another issue or challenge they are struggling with.  

Our goal is to get our clients on a path of automated responses that are healthy and supportive of their health and wellness goals. 

When a client feels ambivalent about a health change they believe they should make, encourage them to simply try it for a couple of weeks, then reevaluate how they feel. Ideally, the small efforts made are enough to reward them and motivate them to keep going.

Where Can You Learn More?

Spencer Institute and NESTA are here to guide each step of the process. Be sure you take advantage of our course, programs, CEUs, and career training opportunities.

Be on the lookout for future articles about more ways to get an endless stream of clients for your training or coaching business. You will also want to search through the archives of our blog because there are many other articles that go into great depth about dozens of other ways to get clients. Here are a few for you to checkout now:

Believe in yourself.

We are here to be your partner in custom designing your highly successful coaching career.

NESTA and Spencer Institute coaching programs are open to anyone with a desire to learn and help others. There are no prerequisites.

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