The confidence ruler is another MI tool. It is best used after the patient has expressed interest in making a change in a specific area, perhaps through a decisional balance exercise followed by the clinician's summary. The clinician then asks the patient to rate on a scale of 1-10 how important making the change is to the patient, with 1 being "not at all" and 10 being "very important." Whatever the patient response is, the clinician should commend the patient for his or her answer and then ask why the patient did not choose a lower number. This then results in the patient describing all of the positive reasons for choosing the particular number. Next, the clinician may ask what it would take to rate the change higher on the importance scale. The questions can then be repeated, using confidence as the metric. Some patients may prefer to place their finger on a visual ruler, marking their position.
Not at all 1 2 3 4 5 6 7 8 9 10 Very Important