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Increasing Readiness for Change
Objectives
Define ambivalence and its relationship to the change process
Define the righting reflex
Show the connection between ambivalence and the righting reflex
Identify ways to increase readiness to change
AmbivalenceFeeling two ways about change at the same time. It is
normal.The part that wants to stay the same may be equal to or
slightly greater than the part that wants to change. Ambivalence feels comfortable and may become
chronic.Ambivalence can be resolved if she or he feels
understood (empathy!).
Wants to Stay the Same
Wants to Change
Righting Reflex
Comes from concern and caring
Helpers, healers, and teachers want to “set things right” or “make it better”
Counselor is a fixer: There’s a problem? Let’s fix it!
Fails to consider ambivalence in the change process
Righting Reflex Meets Ambivalence
Increasing need to protect this part of herself leads to decreasingmotivation to change
Your righting reflex puts pressure here
Your urge to set things right feels like pressure she must resist!
Wants to stay the same
Wants to change
Recognizing Ambivalence
By showing her that you understand her as she is now . . .
. . . she will feel free to explore her own arguments for change!
This may increase her motivation to change.
Wants to stay the same Wants to
change
Stages of Change
Model of health behavior change
Useful in tailoring an individualized intervention to meet your client’s stage of readiness to change
Stages of Change (cont.) Precontemplation
No intention to change behavior
Contemplation Aware of the situation, but no concrete plans to change
Preparation Decides to change and plans to take action
Action Made the behavior change
Maintenance Works to sustain the change and prevent relapse/recycle
Relapse/Recycle
Stages of Change ExamplesStage ExamplePrecontemplation I don’t see a reason for change.
I can’t change, so I’m not going to think about it.
Contemplation I’m thinking about changing.
Preparation I’m preparing to change.
Action I’ve made the change
Maintenance I’m working to maintain change.
Relapse/Recycle I made the change, but I slipped.
Stages of Change Model
PreparationAction
RelapseContemplation
Stable Behavior
Maintenance
Precontemplation
Summary: Stages of Change
Readiness is not static
Change is nonlinear
It is important to match counseling strategies to client level of readiness
Ambivalence persists across stages
Change planning “script”
• What would you like to be different?• What could you do to get started?• Who could you ask for support or
assistance?• What would be signs that things are going
well?
Evoking Change Talk• Desire• Ability• Reasons• Need• Commitment• Activating language• Taking steps
Evoking change Elaboration: Why would the change be good?
Evocative questions: Why is change important? What happens if it doesn’t happen?
Scaling rulers: On a scale of 1 to 10…
Reflect: You think; You feel; You are
Ask key questions: Where does this leave you? What are your next steps?
Readiness Ruler
Not ready at all Extremely ready
On a scale of 1–10, how ready are you at the present time to change [insert behavior] ?
Readiness Ruler
Not ready at all Extremely ready
On a scale of 1–10, how important is it for you at the present time to change [insert behavior] ?
Readiness Ruler
Not ready at all Extremely ready
On a scale of 1–10, how sure are you at the present time that you can change [insert behavior] ?
Decisional Balance
Helps your client think about:
Benefits and costs of changing the behavior
What is involved in her decision to change
Scale needs to tip so the benefits outweigh the costs
Start with client’s ideas about the good things about the behavior
Then ask about the less good things about the behavior
Avoid arguing for change/persuading
Reflect her reasons for change
Summary
Ambivalence can be resolved if your client feels understood.
Suppress the righting reflex so that you can stay client-centered and avoid building resistance.
Change is not static and ambivalence exists across the stages of change.
Use rulers to assess and increase your client’s readiness to change.
Decisional balance can be used to explore your client’s ambivalence about drinking or contraception.
Contact information:Jessica D. Hanson, PhD
Sanford Research2301 E. 60th Street NorthSioux Falls, SD 57104Phone: 605-312-6209
Email: [email protected]: www.sanfordresearch.org
