By asking patients about reasons for changing and not changing we can tap into their ambivalence about changing their behaviour.
Think about changes that you have thought about making. Have you both wanted to change and not wanted to change?
This is what we call ‘ambivalence’ and is both a common and normal part of being human.
Has anyone ever said to you “yes, but…” when you have told them all the good reasons for change?
This is their ambivalence at work.
Better if you encourage them to tell you both the reasons not to change and the reasons for change. That way they can start to address their own ambivalence. It is through increasing clients’ awareness of their own ambivalence about change that we can help them to have a discussion in their own head about the pros and cons of change.
Change is difficult. By harnessing ambivalence we can help clients to create more energy for change.
Understanding what the client sees as the disadvantages of change will help you to support them better. It may also prompt them to start problem solving on how to overcome these disadvantages. The more active the client is in this dialogue, the better. Ask them for examples or for more specific details.
Remember: Don’t move too quickly on to the advantages of change area- this is probably your comfort zone. Remember the client is probably reciting the disadvantages in their own heads already so you are not encouraging them to think about anything that they haven’t thought about before. As a health professional you won’t create more ambivalence- instead you can work with the client to harness their ambivalence as energy for change.
This conversation about advantages and disadvantages of change is a two way interchange. You can do this informally or formally – you may want to write things down for the client, even better if you can encourage the client to take their own notes.
- Try this to start this dialogue with a patient thinking about making changes in their life
- You could also do this as a group activity using a whiteboard
- Remember to always start with the disadvantages or not so good things about change
AIM OF DIALOGUE
This dialogue is intended to help patients identify the advantages (benefits) and disadvantages (costs) of making and sustaining a specific behaviour change, and to ‘weigh up’ these advantages and disadvantages. Advantages and disadvantages can be different for each person, so the tool is designed so that patients identify advantages and disadvantages that are relevant to them.
The advantages/disadvantages tool has several benefits:
First, it helps patients to see clearly the personally-relevant advantages (benefits) that they are likely to experience as a result of making and/or sustaining the behaviour change. This encourages them to want to make the change.
Second, it helps patients to see clearly the personally-relevant disadvantages (costs) that they are likely to experience as a result of making and/or sustaining the behaviour change. This helps them see the barriers that they are likely to come up against as they make attempts to change. Being aware of and ready for barriers before they arise helps patients to be better prepared once the barriers do come up. More specifically, this gives patients an opportunity to have some contingency plans in place for how they might overcome the barriers, should they arise.
Third, the tool helps the patient to weigh up the advantages and disadvantages of making and/or sustaining the change. When used in practice, the tool generally has the effect that the patient sees that the advantages of making and/or sustaining the change clearly outweigh the disadvantages.
First ask patients first about disadvantages of change
Probe and be interested in what the patient says.
Be ready to explore more. Ask:
- Can you give me an example of that?
- Anything else you’d like to add?
- What worries you about that?
Only when this topic of disadvantages is completely exhausted, move onto the advantages of change.
After the dialogue is completed, summarise responses. Ask the patient “where does that leave you?”. Encourage the patient to take their notes with them to add to or discuss with others such as their partner, family member, friend or doctor if required, to assist with identifying advantages and disadvantages.