Clients tell us where they are in the process of change. In Tip #69 we looked at change talk, the specific client language we hear when a client is moving toward change. We support the change process by reflecting change talk and by skillfully eliciting more. Just as change talk can be usefully categorized, its opposite, sustain talk, can, too.
Desire: “I don’t want to eat vegetables.”
Ability: “I can’t walk more.”
Reasons: “Eating this won’t help with my constipation.”
Need: “I don’t need to lose weight.”
Commitment: “I’m not going to keep this food record.”
Taking Steps: “I haven’t done any exercise.”
Feeling powerless means
you are focused on
something you can’t control.
Drawing on my fine command
of the English language,
I said nothing.
When we encounter change talk, we reflect it in order to accentuate it. The best response to sustain talk is silence. An exception is when you are hearing only sustain talk. A brief reflection of sustain talk signals to the client that you are listening and accept what is true for him. This serves the important process of engagement. For example, you may notice you are arguing with the client. All the statements you hear are pointing to not changing. Very briefly reflecting some of what you hear can end the argument and regain rapport. Then switch to open-ended questions (Tip #60) that will elicit change talk.
Of course, it’s wise to avoid anything that will evoke sustain talk. Examples: “Why don’t you eat fruit?” “Could you walk after work?” “Why didn’t you write in your food record?” “Why don’t you want to lose weight?” This style of wording can be tricky to avoid. We ask these questions in an effort to move the change process along. Unfortunately, they are more likely to elicit sustain talk and stall the flow toward change. Review the questions that elicit change talk in Tip #69.
When using summaries to begin a transition or to end a session (Tip #72), mention just a bit of sustain talk and as carefully as possible include all the change talk you heard. Strike a balance between ignoring the sustain talk and acknowledging it. This may mean using minimizing language. For example: “You don’t particularly like vegetables.” “You haven’t yet begun to exercise.” “You are unsure about whether eating more fiber will help your constipation.”
For those who use the decisional balance concept to work with ambivalence to change, it is common to explore each of the four squares. (Pros and cons of changing, pros and cons of staying the same.) This way of looking at decision-making is very useful when it does not matter what the person chooses to do. For example, choosing which type of equally beneficial exercise the client will pursue. However, for a food behavior change such as eating more fruits and veggies, there is an assumed “right” choice. The client came to you with a goal and this change is tied to that goal. In these discussions, it is counterproductive to deliberately evoke sustain talk.
A final note: Resistance and sustain talk are not exactly the same thing. Sustain talk is about the behavior, and resistance is about the relationship between you and the client. For example, take the statement “I won’t drink skim milk and you can’t make me.” The first part is sustain talk. The second part is resistance. Understanding this distinction may help you decide which way to go when you encounter negative statements. If you are hearing resistance, roll with it. “Indeed, I can’t make you do anything. It is your choice.” In response to sustain talk, it will be more effective to ask questions likely to elicit change talk. “Tell me more about benefits you would get from eating lower fat foods.”