Business models contain compelling indicators for building personal commitment to change and the applicability of these models to health behaviour change is very appropriate. Click here, for example, to see one graphic representation of a business model depicting the process of committing to change. In Motivational Interviewing, patients come to health care providers with low commitment to change (and/or they have not been able to change) and they exhibit a lot of what Miller and Rollnick call status talk or the way things are and where they are stuck. Through using MI, health care providers work with their clients to move status talk toward change talk or that ‘tipping point’ where clients begin to see their potential for change. Once the client has reached his or her behavioural tipping point and is ready to change (see our Readiness to Change Ruler in the Monarch Resource information, item # 10), the client is in the process of changing.
It is important to remember that MI is an emergent process not a prescriptive one – we cannot give clients their change formula as some form of panacea or cure-all. Thus, it takes time to move with clients from status quo and low commitment toward understanding and accepting change and higher commitment. If we can tease out a client’s ‘north star’ or vision for the change s/he wants through helping each person understand what is important about the change and then determine the client’s willingness to work to acquire the skills to change, we will reach the point of client buy-in. At this juncture, the client has a vision for change and is at the stage of owning that change vision in her or his unique way and of making that change their new normal. Nailing down the commitment is vital to the behavior change process. To do this, you can ask what would work or what would it take to make this change real. Perhaps the choice would be for the client to announce their new commitment as a pledge to a significant other.
Another possibility is to ask permission to suggest a demonstrable way to cement the commitment; if the client says yes, put a piece of tape on the floor and have the client stand on one side of the tape, that side representing what they are leaving behind. Then, invite your client to actively step over the line of commitment and once standing firmly on the other side, ask your client to state the specific change to which they are committing. As odd as it might sound, this is a very powerful way to reinforce client commitment to change and begin to work out the steps toward achieving the desired change.