Decisional Balance

This tool can be used to help patients explore their ambivalence regarding a change. The patient is asked to list the good and the not-so-good things regarding a given behavior. The patient then lists the good and the not-so-good things about changing the behavior. Using the adjective “not so good” is an important subtlety. In the spirit of MI, we discuss the good and the not-so-good, rather than the good and the bad. Describing things as bad or as negative can lead to blame or shame regarding an activity, and these are two feelings that can be counterproductive to the MI session. After the good and the not-so-good have been listed, the clinician can summarize the not-so-good things about the status quo and then summarize the good things about making the change. This summary ends on a positive note, supporting a change, and can lead to more conversation, as the patient contemplates his or her interest, confidence, and commitment to making a change.