Motivating people to make changes (v)


Working with importance and confidence

Two words that are so incredibly powerful – and we so rarely use them!

One thing struck me some years ago when I started asking people about what was stopping them returning to work when they had pain: once you boiled it down, they were scared. Scared of not being reliable, not performing up to expectation, not being able to remain working, not earning as much as before, of being put off work again, of being unable to find work.

Not many said that work wasn’t important – although some were a bit shy of working again after so many years on compensation!

When something is incredibly important – but we think we can’t achieve it – we tend to not even attempt it. This is why it’s a useful strategy to ‘assess’, even informally, both how important an activity is, and how confident the person is that they can achieve it.

There are a number of ways to work out how important or confident a person is – just asking is great! But you can also use some more specific ways – 0 – 10 scales, a ruler, or a coloured scale can all be used.

Each of these provides a way to work out where the person is now, and some relatively easy ways to see what might help the person to move towards change.

Remember that when we are challenged to move beyond where we are ready, we are all great at giving reasons for NOT making a change, and in doing this, argue ourselves into a corner. (Think of those New Year’s Resolutions? Why haven’t you done them yet? What’s stopping you? – can you hear yourself saying ‘yes, but…’?)

Any time you hear a ‘yes but…’ you can bet you are going to get a reason to avoid changing. If we reinforce this kind of talking, by attending to it or arguing against it, we won’t help the person make change. In fact, we’ll probably help them back themselves into a corner and then help keep them there! If we can, however, get the person to start talking about what’s wrong with the current situation, or good reasons for making changes, they generate the momentum for moving forward – and we reinforce this by attending to what they’re saying, and giving encouragement and problem-solving when it’s asked for.

So… what can you say?

Ask the person ‘what made you rate yourself [x] and not a lower number?’

This helps them justify in a positive way, the reasons they have FOR change.

You can also ask ‘What would it take for you to move up a number?’

Or ‘why have you given yourself such a high number?’

When working with importance (and it’s good to work with this first if it’s lower than confidence, or when both importance and confidence are low), you can also ask these questions:

‘What concerns do you have if things don’t change?’

‘If you were to change, what would it be like?’

When working with confidence, these questions might be useful:

‘How can I help you succeed?’

‘Is there anything you’ve learned from past experiences that would help you now?’

‘If you were to change, what might your options be?’

And one of my all-time favourites ‘Where does this leave you? What is your next best step now?’

In the spirit of motivation, we can decide to trust the person to make a choice that is good for them, while pointing out any specific and real consequences that we are aware of. We just need to leave the door open for the person to feel OK to come back to us. So we may not do anything more than point out that they have the choice. Or we could work with importance by asking the person to ‘take a look over the fence’. What I mean by this is, ask them ‘let’s imagine for a minute what it would be like if you …. what would you feel?’ In doing this the person often identifies a negative aspect of change, but one that could well be present already, which you can pick up on (this develops the inconsistency between values and behaviour, which helps propel change).

If it’s confidence that is low, then apart from the suggestions above, you can acknowledge that there is no one single way to reach a goal, and that all you can offer (if they are OK with it) are some things ‘that have worked for other people’. Add to this comments like ‘you’ll be the best judge of what might work for you’, and ‘let’s go through the options together’, and you will encourage a sense of collaboration – which increases confidence.

You can also review challenging situations from the past – if they’ve succeeded, reinforce this by letting them know what an achievement this way. If they’ve struggled, acknowledge that it really must have been a triumph to not let go of the thought that things may be different – ‘you must be really impressed with how you managed such a difficult situation’.

 

For more in-depth resources on the decisional balance and working with motivation and confidence, the Motivational Interviewing website is a great place to start, as is Botelho’s website. I’ve drawn on those and the ‘Health Behaviour Change’ book by for this post.

Motivational Interviewing: Preparing People for Change (2nd edition) (Miller/Rollnick) (April 2002)
Health Behavior Change: A Guide for Practitioners Stephen Rollnick, Pip Mason, and Chris Butler

Motivate Healthy Habits (Rick Botelho)

Date last modified: 1 March 2008

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