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Listening for and appreciating the client’s ambivalence about change is a key element of motivational interviewing.We are all ambivalent when confronted with the need for and possibility of making changes in our lives. For example, perhaps you would like to get more sleep, but find it hard to go to bed earlier.

One key to listening for ambivalence is the “but” in the middle of the sentence.

“I’d like to make that change, but…” When you hear ambivalence, you are also hearing change talk.

In substance abuse treatment, as in many other areas of health behavior change, we are asking clients to give up something very important in their lives, often for things they don’t understand or don’t like.

Client: Oh, if you talked to my wife she’d tell you at least three! She says I’m not reliable and don’t come home when I say I will and that I don’t remember some conversations. Clinician: It seems that things might be more peaceful in your marriage if you were drinking less. Client: I have so many other worries about my health.

Clinician: How important would you say changing your drinking is right now? Clinician: It seems to you that your drinking is not the most important thing right now.

Change Talk refers to the client’s mention and discussion of his or her Desire, Ability, Reason, and Need to change behavior and Commitment to changing.

The point here is that when people talk about change themselves, they are more likely to change than if someone else (such as the clinician, a friend or relative) talks about it In this way, change talk is self advocacy.

Using these questions can help to elicit change talk: Here are some examples of how conversations might go: Clinician: If you were going to change your alcohol use, why would you do it?

Client: Well, my doctor’s been nagging me, and I’m beginning to think she’s right.

Sagrada Familia in Barcelona, Spain, which began construction in the early 1880s under the direction of the architect Antoni Gaudí.

Thanks in large part to Gaudí's death and the Spanish Civil War (and in large part to the incredible complexity of Gaudí's design), the construction for the cathedral has dragged on for decades.

What would have to happen to make it more important?