One way to assess how important changing a behavior is to the client is to ask them using an Importance Ruler. This ruler invites the client to rate their level of perceived importance on a scale (Butler, Rollnick, Cohen, Russell, Bachmann, & Scott, 1999). The scale typically ranges from 0 to 10 and the wording looks something like this:
鈥淥n a scale from 0 to 10, where 0 means 鈥榥ot at all important鈥� and 10 means 鈥榯he most important thing for me right now,鈥� how important would you say it is for you to -________________?”
The client will likely answer with a number between 0 and 10. And it is not this question that offers a significant answer, but instead, the follow-up questions about the number chosen by the client.
鈥淎nd why are you a ______________and not (a lower number)?鈥�
Followed by:
鈥淲hat would it take for you to go from a (current number) to a (higher number)?鈥�
When the questions are asked this way, the client will talk about change and the reasons why this is important. The clinician may be interested in asking the question, 鈥淲hy are you a 6 and not a 10?鈥� However, the answer to this question is sustain talk, whereas the question above, 鈥淲hy are you a 6 and not a 2?鈥� is more likely to have the client talking about the reasons why change is important. And then asking, 鈥淲hat would it take for you to go from a 6 to a 9?鈥� asks to client to explore what could happen that would make the change more important. Again, the goal is to keep the client focused on the change talk and the facilitators that will support them. By asking these questions, in this order, the clinician will be able to learn more about the reasons this change is important and the facilitators for making this happen.
Again, there are many ways to understand how important changing a behavior may be for someone. And if numbers do not seem to be the best way to assess, try something more appropriate for your client. Perhaps your client would prefer something with visuals, with the pictures, words, or graphics getting bigger or the words 鈥淣ot at all important鈥� at one end and 鈥淓xtremely important鈥� on the other. The person would mark where they are and you could ask the follow-up questions.
The process of using the Importance Ruler can yield a great deal of information by asking just a few questions. And it is by asking these questions that more change talk can be expressed by the client, making the change more likely to occur. Next month, we will continue with additional strategies to increase change talk and in supporting the client discovering their own motivations for change. I hope you all have a great month and have opportunities to use and practice Motivational Interviewing!
For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.