Useful guidelines in asking questions that can instigate change talk, i.e. encourage commitment language is the DARN acronym (Rollnick et al., 2008). Questions such as these can activate the person towards change, eliciting his or her own motivations and creative ideas.
Desire: What do you want, like, wish, hope, etc…
Ability: What is possible? What can or could you do? What are you able to do? What have you done before?
Reasons: Why would you make this change? What would be some specific benefits? What risks would you like to decrease?
Need: How important is this change – on a scale of 1-10, 1 being unimportant and 10 very important. How much do you need to change?
Other questioning techniques include the following:
Leading questions Show More
- It can sometimes be tempting to ask leading questions that have the desired answer already embedded in them. Questions such as “don’t you think that…?”, “have you thought about..?” or “what about trying..?” leads the person to believe that it is you who has all the best answers and they will therefore be less likely to come up with their own solutions or to accept ownership of the decision that has been made.
Caution should also be taken in avoiding the ‘question-answer’ trap, whereby questions become routine, controlling and overused to the exclusion of listening (Rollnick et al., 2008). In this case, the carer’s agenda may predominate and the sufferer becomes a passive recipient. This approach tends to evoke resistance in the sufferer, for example, and frustration in the carer. Furthermore, the onus will be on the carer to come up with the next question. It can also evoke defensiveness in an effort to protect one’s self esteem. Advice or guidance will have a stronger effect if the recipient is stuck, particularly if permission is requested beforehand, e.g. “this may or may not work but what do you think about this idea…”
‘Why’ questions Show More
- Caution should be exercised when using ‘why’ questions. These can evoke a defensive response that implies criticism or disapproval. Questions such as, “Why did you respond in this way?” prompts a need to justify, analyse or excuse. There is also a significant risk of heightening ambivalence or coming up against sheer resistance. A more effective way would be to use a reflection, followed by an open question: “I found what you said about … interesting. Tell me more about that”.
Questions that clarify Show More
- These questions are important when there is uncertainty as to the context of the recipient’s meaning. They also give him/her the opportunity to clarify any misunderstandings or misinterpretations.
“So from what you’re telling me, J, you’re finding your increasing need to exercise a bit frightening and maybe even overwhelming. You have this incessant need to go to straight to the gym after work. Would that be a fair recap?”
Questions that challenge limiting beliefs Show More
- Comments and responses frequently suggest limiting beliefs, e.g. “I could never do that”, “I’ll never get better, I’m just not sure I have the confidence to make it happen”, “I’m at a loss as to where to go next”. Negative beliefs that people hold about themselves or their situation prevent them from moving forward. Careful questioning techniques can challenge and expose limiting beliefs. By combining reflections and affirmations with motivationally adherent and empathic responses, one can skillfully weave open questions into the dialogue before becoming more focused and specific on the belief that is preventing person from moving forwards.
A useful technique in dealing with limiting beliefs is to encourage the person to suspend this thought for a while, i.e. to become more creative in coming up with a possible solution, in other words, the “what if” scenario:
“What if this obstacle didn’t exist, what would you do?”
“What if a friend had the same problem – what would you advise her”
“What beliefs would you need to adopt in order for this to happen?”
Reframing negatives to positives
Intertwined with limiting beliefs, there may likely be a display of low self esteem. Individuals may, for example become critical of themselves and/or of others. They indulge in negative self-talk. Try and challenge this talk and motivate the person to get back on track. Ask them how they can reframe negative statements into positive ones. Offer suggestions, if they agree and/or get stuck.
Challenging questions Show More
- Individuals suffering from an eating disorder frequently become negative and use destructive language. Through a series of affirmations, reflections and questions, motivational interviewing techniques can challenge these negative generalizations and perceptions of a given situation. In this next brief dialogue, the sufferer is questioning her mother’s attitude to her. The mother gives lots of praise and uses open questions to explore the source of the emotions. The mother does not talk about her own emotions and needs and provides a firm accepting stance for her daughter to say things which could be unhelpfully construed as personally attacking and hurtful.
Sufferer: You make me feel very depressed. I feel that I’m an absolute crap person.
Carer: I’m sorry that you interpret it that way. It certainly isn’t my intention to make you feel like that. I see an extremely loving and sensitive person, a young woman who is very special to many people. You say that you feel you’re a crap person. What makes you feel this way?
Sufferer: Oh it’s nothing… I mean probably this therapy business make me think about things… I mean I haven’t fallen to pieces during any of this yet, even when I was at my lowest ebb, because I know if I do then … sometimes I think I hold my feelings back too much and this isn’t great.
Carer: Something tells me your future, and ultimately your health, is very important to you. This is a very challenging illness you’re working with, one that raises your stress and anxiety levels. It’s interesting to hear you say that, on the one hand, thinking about things feels tough, yet on the other hand, you realize it’s important to acknowledge your emotions and feelings. I’d be interested in hearing more about these thoughts.
Sufferer: I think it’s forced me to think about how I’m feeling and I don’t do that too often.
Carer: That’s not important to you.
Sufferer: My survival strategy is that I just don’t.
Carer: So in the past it’s been easier to blank out your feelings.
Sufferer: I guess … perhaps I should think about that a bit more .. it’s been a while!
There may be difficult issues to be dealt with that will result in either person shying away. In these situations, care must be taken to tread carefully. Questions need to be phrased cautiously and if in doubt, reflections and motivational affirmations should be used. It is useful in these circumstances to look for the ‘green shoots’. Even in the most apparently dismal situations, there will always be a few green shoots to highlight. These can be used to turn the ambiance back into a more motivational tone.
Agenda setting questions Show More
- When you ask questions that follow the recipient’s agenda, it demonstrates respect for them as well as acknowledging that they have the ability to make choices for themselves in their quest to find their own solutions to the challenges in their lives. There may be areas for concern and these can be conveyed through reflective listening, e.g. “my concern is …… what are your feelings on that?” It is usually wise to start with trying to understand the recipient’s own perspectives and concerns so that the individual knows that they are being listened to which will, in turn, encourage a more open, honest and trusting dialogue.