Change conversations with older adults Resolving Ambivalence in the Direction of Change

Change or sustain? As we listen to a person discuss a dilemma, we can think of many of the things they say as “change talk” or “sustain talk.”

Sustain Talk Sustain talk is any statement by the person that supports the status quo Sustain talk is a normal part of ambivalence, and is part of the change process

Sustain Talk When there is more change talk than sustain talk in a conversation, change is likely; when the reverse is the case, change is unlikely Certain responses to sustain talk can be helpful in promoting change talk

Change Talk Preparatory Mobilizing Desire statements Ability statements Reason statements Need statements Commitment statements Activation statements Taking steps

Preparatory Ability: I can… I am able to… I could… Desire: I want to… I wish… I would like… I hope to… Ability: I can… I am able to… I could… Reason: There are good reasons to… This is important… Need: I really need to… I have to… I must… Something has to change…

Commitment: I will… I intend to… I promise... Mobilizing Commitment: I will… I intend to… I promise... Activation: I’m willing to… I’m ready to… I’m prepared to… Taking Steps: I did…

Ambivalence Ambivalence is the normal condition regarding any decision A person in a state of ambivalence will tend to use both change talk and sustain talk if they do not feel that their autonomy is threatened If they do feel that their autonomy is threatened, they will tend to use more sustain talk

Change Talk Ambivalence Sustain Talk

MI Spirit Partnership Acceptance Compassion Evocation

Spirit: Partnership Motivational Interviewing is a collaboration between two experts: the person and the helper “Dancing, not wrestling” The helper avoids creating the impression that he or she has the answers The helper suppresses his or her righting reflex The helper is aware of, and honest about, their own values or agenda The helper is profoundly respectful of the person

Spirit: Partnership Partnership can be expressed by saying things like: “I’d like to work with you on this. You know yourself – and the problem – much better than I do, and I know things that have worked for others and some of the research that bears on this.” “How do you see this? What do you think is going on here?” “What ideas do you have about how to approach this?” “You’re the expert on what will work for you.”

Spirit: Acceptance Absolute worth: the helper regards the person with unconditional positive regard – no judgment Accurate empathy: the helper strives to see the person’s world through the person’s eyes Autonomy support: the helper acknowledges the person’s right to self-direction and choice Affirmation: the helper identifies and notes the person’s strengths and efforts

Spirit: Acceptance Acceptance can be expressed by saying things like: “What to do about this is really up to you.” “You’re right. No one can make you change if you don’t want to.” (don’t follow this with a “…but…”!) Or by using: Reflective statements Affirmations

Spirit: Compassion The helper seeks the best interests of the person, and works for the benefit of the person, not of the helper

Spirit: Evocation The helper does not operate from the deficit model that is implicit in much of the health and human services fields The helper works to draw out the person’s own wisdom, experience, and expertise in their own change process

Spirit: Evocation Evocation can be facilitated by saying things like: “If you decide to change this, how do you think you would go about it?” “You’ve really put a lot of thought into this.” (when the person expresses a reason for change) “Tell me more about that.” Or by: Using evocation strategies Reflecting change talk

MI Skills Open Questions Affirmations Reflective Listening Summaries Informing and Advising

References Miller, W.R. & Rollnick, S. (2012) Motivational Interviewing: Helpig People Change. Guilford, New York. Video Segment by The Change Companies