Motivational Interviewing assumes that almost all clients are ambivalent about changing. The desire to change is present, but so is the desire to stay with the status quo.
Five main Stages of Change have been described in the MI literature:
- No intention to change
- Possibility of change
- Commitment to change
However ambivalence may arise at any point in the change process.
Focusing only on the negatives of the current behaviour, and the positives of changing can quickly lead to resistance, especially from clients at an earlier stage in their readiness to change (Miller & Rollnick, 2009).
Asking first about the good things associated with (drinking for example) then affords some leverage and naturalness to ask about the not-so-good side as well.
Miller and Rollnick (2009; p133) advocate a thorough and structured exploration of ambivalence only when initial attempts to elicit change-talk have met with little success.
Exploring and exploring ambivalence means thoroughly exploring both the positives and negatives of change; exploring all the reasons for not changing before moving on to explore the reasons for changing; surveying all the benefits of staying the same, and the disadvantages of changing and weighing these up against the benefits of changing.
The ‘double-sided reflection’ is an active listening technique that reflects both sides of a person’s mixed feelings about change (e.g. ‘So it sounds like smoking marijuana is a way for you to relax with friends, and on the other hand you’ve said that it upsets your mother’) (Naar-King & Suarez, 2011; p102). This type of reflection expresses empathy around the difficulty of ambivalence and invites exploration.
The ‘Decisional Balance Technique’ is a highly structured technique for eliciting and exploring ambivalence. It is generally presented in the form of a 2x2 table within which the client can note down: (a) the benefits of the status quo; (b) the costs of the status quo; (c) the potential benefits of change, and (d) the potential costs of change.
Note that because the Decisional Balance Technique actually elicits ‘sustain-talk’ it should NOT be used routinely with all clients. It should only be used for clients with very low motivation for change and after other efforts at eliciting change-talk have failed. The Decisional Balance Technique can sometimes deflate a person who is actively considering the possibility of change. The Decisional Balance Technique should only be used with clients who currently have no intention to change or who are very ambivalent (Stages 1 and 2). It should be avoided at the later stages.