The Importance Ruler: Catalyst for Change Talk and Client Change
Posted on April 25, 2014
I want to spend the next couple of post looking at a tool from Motivational Interviewing (MI). Since my first MI presentation seven years ago to the one I did last week, my favorite MI tool has always been the Importance Ruler. Recently, I have gone deeper with my thinking about how this tool can be utilized to maximize talk about change (or change talk in MI parlance). Ultimately this can help our clients implement changes that improve their well-being and help them reach the goals they want in life.
For those who have not been introduced to the Importance Ruler, this post will give you all you need to know. Think about a change you are trying to make in your life…don’t overthink this, just pick a small behavioral change you are attempting to make. Got it? Let’s put it on the ruler!
On a scale from 1 to 10 with 1 being not at all important and 10 being extremely important: How important is it for you to make this change?
Again on a scale from 1 to 10 with 1 being not at all confident and 10 being extremely confident: How confident are you that could make this change?
That’s the scale. Now let’s look at the magic behind these questions and how to get the maximum impact out the Ruler. We know that talk about change, predicts actual change in behavior. MI calls this “change talk”. In contrast, “sustain talk” is verbalizing reasons to continue past behaviors. In the 3rd Edition on their MI books, Miller and Rollnick have us think about a committee inside the client’s head. Until there are more vote for change (change talk) than to stay the same (sustain talk) change will be unlikely to occur. In a past post we examined the neurobiology behind this vote which you can read at http://coldspringcenter.org/mattsmumblings/?p=51.
I love the Importance Ruler because it strategically elicits two key aspects of change talk, importance and confidence. We know from stress research that if something is important, it increases the amount of stress we feel. Change in behavior is a mix between negative stress or strain and good stress or eustress. Think about your change again. What are the negative consequences, strain, are you experiencing by sustaining the current behavior? Also what positive outcomes or better future, eustress, motivates you to make this change. Helping clients voice their desire, reason and need for change helps them hear why change is important. This increases the motivation needed for action.
Confidence is the next critical piece of change talk that the Ruler helps us elicit. Hope is believing that change is possible. Self-confidence, or self-efficacy, is the belief that change is possible and that the person can contribute to making it happen. If we do not think we can change we will not change. Many of our clients face difficult changes while dealing with severe depression and/or anxiety, this can make hope a hard light to find in the darkness of their current situation. The confidence question helps us understand their level of hope and ability to achieve a better future.
On one hand the Importance Ruler gives us the opportunity to assess where the client is on the key aspects needed to change. On the other hand it gives us the opportunity to elicit change talk on the four key indicators for change: Desire, Ability, Reason and Need (DARN in MI parlance). It isn’t so much the questions or the answers that make the Importance Ruler such a valuable tool, it is the follow up questions that elicit the change talk that predicts actual change.
Think back to your answers to the importance and confidence questions. Assuming that you did not answer 1, I would ask the following question: Why are you a (insert your number) and not a (lower number)? Think for a second about how you would answer this question for your change. It is a little hard not to talk about why you have some confidence or why you believe your change is important. Not only does this help the client feel better about their current situation but it gives you some positive change talk to work with and build upon.
After having the client talk about why they are not a lower number, you can use the follow up question: What would it take for you to go from a (insert your number) to, say, (a higher number)? Again, think about your change and how you would answer this question. I like to use a number only one or two up the scale because going from a 3 to a 10 can seem overwhelming while going from a 3 to a 5 might seem in reach (especially if you asked the question in the previous paragraph).
Again, remember that change talk predicts actual change. When working with clients trying to make difficult changes, our goal needs to be to increase the amount of change talk. By itself, the Importance Ruler can elicit a great deal of change talk. The next couple of post I will introduce some innovative ways to maximize importance and confidence through the concept of priming the brain. Stay tuned!!