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MI: Change talk

Recognizing and Reinforcing Change talk

Change talk and sustain talk reflect two sides of a person's ambivalence about changing. The skillful counsellor understands that difference and guides the client away from sustain talk and toward change talk, listening especially for statements that show commitment.

Change talk

Change talk in general refers to clients' statements about their desire, ability, reasons and need for change, whereas commitment language represents a more assertive declaration about commitment/actions to change.

Research shows that change talk is associated with enhanced motivation for change, and motivation is associated with increased likelihood of actual change. This supports the emphasis that MI places on listening for--and eliciting--change talk as key counselling skills (Miller & Rollnick, 2013; Moyers et al., 2009).

Sustain talk

Sustain talk is the opposite of change talk. Clients may use sustain talk to indicate: their desire to stay as they are, their worries about being able to change, reasons not to change; need to stay as they are.

Change talk Sustain talk
I really need to quit smoking because of the bad example I am setting for my kids But I love to smoke; it is so much a part of my life.

I have started an exercise program, and things are going well.

But I know I will go back to my old ways once the cold weather comes.
My gambling is totally out of control.  But betting is the only way I can de-stress and forget all my problems for a while.
I know I should take my medication every day. It's just that I hate the side-effects so much.

 

Reflecting change talk—and moving away from reflecting sustain talk—keeps the momentum of the conversation toward enhancing motivation for change.

Change talk and commitment language

The acronym DARN CAT summarizes different kinds of change talk and commitment language:

DARN:

Desire: "I want to be a good parent."

Ability: "I can quit any time I want."

Reasons: "I think I'm getting too old for this lifestyle."

Need: "They will take away my kids unless I go to this program."

CAT:

Commitment: "I am going to get help with my drug problem."

Activation: "I've erased the dealers' phone numbers from my contact list, and I am getting a new phone number so they can't call me anymore."

Taking steps: "I've started taking a fitness class at the community centre twice a week in the evenings."

DARN statements tend to predominate when people are still deciding to make a change. DARN statements on their own are insufficient or do not necessarily predict change. For example, two people exchanging wedding vows "ideally respond with commitment language (‘I do') rather than just change talk (‘I hope so,' ‘I could,' ‘I have good reason to' or ‘I need to')" (Miller and Moyers, 2006 p. 11).

CAT statements indicate that a client is ready to take action. Commitment language signals that a client is ready to actively plan for change or is already making some positive changes.

Evoking and Strengthening Change Talk

The strategies to elicit and strengthen change talk and commitment language build on the basic OARS skills. The following are effective ways to evoke change talk and help guide the conversation toward increased commitment:

Ask open-ended questions:

"What are some of the less good things about drug dealing?"

Listen empathically and selectively reflect back:

Client: "Don't get me wrong—I know my crack use is out of hand, but the dealers are everywhere in my neighbourhood."

Counsellor: "Things are really difficult, and you are worried about how much crack you are using."

Look forward, look back: "Where would you like to be five years from now? How does that fit with where you are now?" "Tell me about what things were like for you before all of these difficulties started."

Link behaviour with values and develop discrepancy:

"Your kids mean more to you than anything, and being a good parent is a high priority. Yet you also mentioned that they were scared when you left them alone in the house that time. How do those things fit together?"

When all else fails, the easiest way to elicit change talk is to listen carefully for any example of change talk (Desire, Ability, Reasons, Need), and then respond with "Tell me more about that." Asking for elaboration encourages more conversation about change.


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