“People are the undisputed experts on themselves. No one has been with them longer, or knows them better than they do themselves. In MI, the helper is a companion who typically does less than half of the talking.”
―William R Miller, Motivational Interviewing: Helping People Change
Step 1: Find your what!
What is your purpose? What are your goals? What are you trying to change? What is your motivation?
Listen for your own evidence of “change talk”. What have you recently told yourself or others? Have you recently thought that you needed to “lose weight”, “quit smoking”, “to start exercising”, or “to find a new job or change careers”?
Step 2: Find your why!
Why do you need to change? Why do you need to meet your goals?
On a sheet of paper, divide the paper into two columns. In the left column, write down the disadvantages of what would happen if you were to “meet your goals”, and then in the right column, list the advantages of what would happen if you were to “meet your goals”. I can almost guarantee that working towards meeting your goals will always feel like you are moving in the right direction. At the same time, it’s always a good idea to consider why. Why do you need to change? Why do you need to meet your goal? What does this mean for you?
Step 3: Find your how!
How are you going to reach your goals? How are you going to change? How are you going to make a difference? How are you going to do it!?
This step is probably the most difficult step that everyone has ever had to consider. How do you start? How do you put your plan into action? What is your plan in the first place? You find your how by planning SMARTER goals. Smarter goals are small steps or small changes that can help produce big results. These are small steps towards the journey of goal achievement. If we step too large, we may set ourselves up for failure, disappointments or other consequences. If we make these small steps, it helps to give us a sense of accomplishment, thus contributing to making us feel more motivated and self-confident to continue to make other goals for success.
Step 4: Find your when!
When do you need to meet your goals?
This step actually requires two parts. In order to set a deadline to meet your goals, you must be somewhat ready now to start making those changes. How do you know when you are now ready to make those changes?
Have you ever heard of the “readiness ruler” ? If not, it can be beneficial to use as an evaluation tool when determining if you are ready to make that initial step towards a positive behavior change. For healthcare professionals, it can also be beneficial when determining if your clients are truly ready for behavior change; and if not, then it can help determine what barriers there are that need to be removed before the individual can be ready to proceed with their changes. Such barriers could be economic, lack of social support, an underlying mental/emotional factor, or the need to prioritize other outstanding tasks that need to be completed first. Keep in mind, everyone is not going to be ready for change, and that’s OK. This needs to be evaluated before we shock our patients with multiple behaviors that we expect for them to change. We must strive to reach the path of the least resistance. Do not force change on anyone regardless if they are ready or not because they will be unlikely to be successful in reaching their goal as well as to maintain those behavior changes. Yes, there is such a thing as a patient striving to make changes too soon if they are not fully ready to commit to them. As health professionals we must strive to guide, support and let clients steer themselves into the right direction, but only when they are ready.
So, how do you know if you are ready to make these changes? Here is how you or health professionals can implement the “readiness ruler” into practice.
Ask yourselves or your client, on a scale of 1-10, how important is it for you to meet your goal? Those who rate their goal a 7 out of 10 usually tend to be more successful in achieving their goal because for them it is very important for them to do so. Continue asking more open-ended questions, and follow-up with, “why is it important for you to make these changes”. If the goal is very important to them, they are usually also very motivated to reach it. This can be beneficial, because this information is something that you can refer back when every you find yourself struggling to stay motivated. Then you can tell yourself, “remember why you started”.
If the readiness for change is rated less than 7, ask yourself why? Ask yourself, what else needs to change before you can feel like you are truly ready to change. Keep in mind, it is completely OK to not be ready. Do not let others and yourself make you feel guilty for not being ready. You are ready when you are ready to make that commitment.
If you do rate your readiness for change equal to or greater than 7, ask yourself, why didn’t you rate it a 2 or a 5? Assess your own willingness and reasons to change. Why is it important for you to make those changes? Write these reasons down. Put these reasons into a journal, a post it note or on your vision board where you can refer back to them whenever you are feeling unmotivated.
Step 5: Find your plan!
We know our what and our why, but the most difficult is not knowing our how and our when. How are you going to meet your purpose, or your goals? When are you going to achieve your purpose or your goals? Knowing your how and when can be achieved by planning SMARTER goals. If you are a nurse or a health care professional you may already be implementing SMART goals into practice or in a care management setting. SMARTER refers to the following:
Specific
Measurable
Achievable
Relevant
Time-bound
Evaluated
Re-adjusted
So, using the acronym SMARTER, we are going to use weight loss as an example for developing a SMARTER goal:
Lets say Jane Doe was recently informed by her Primary Care Provider that she was at an increased risk for obesity related complications due to her excess weight, especially the excess weight that she carried around her abdominal region. Jane was informed that excess abdominal weight increases her risk for diabetes, cardiovascular diseases and fatty liver diseases. Jane is also on multiple medications for her high cholesterol and high blood pressure. Jane also suffers from chronic knee and back pain and was also informed that losing weight and engaging in some moderate exercise would be helpful for these conditions as well. Jane is also a smoker who smokes 1 pack per day, eats a Standard American Diet and is sedentary.
If you are reading this as a health care professional immediately we start brainstorming all of the changes that Jane needs to make for her optimal health, for example Jane needs to quit smoking, needs to eat an anti-inflammatory diet and probably needs to increase her water intake and needs to engage in some physical activity. This is what WE want our clients to do, but what actually works best for the client? Upon hearing this, Jane has become extremely motivated to start exercising to lose weight because she sees a lot of her co-workers walking around the building throughout the day and wants to be able to walk with them too. Jane is not yet ready to quit smoking or make significant changes to her diet just yet because she feels overwhelmed with other changes going on in her life at the moment. So Jane has decided that she wants to set a goal to work on increasing her physical activity.
Solution: Jane is going to start with brisk walking 15-30 minutes 3 times a week in the afternoon during her work break.
At the end of the 4th week, Janes goal will be re-evaluated to see how this new change has been working for her and whether or not her goal needs to be changed or re-adjusted. If Jane is successful with her goal, then there is also a good chance that this will also give her the confidence and motivation that she needs to consider in terms of other behavior changes that she could make for her health, such as to reduce her cigarette intake and or to make some dietary changes as well.
Keep these in mind when you are planning your SMARTER goals or if you are a health professional and you are helping your clients make behavior changes. Regardless if it’s to quit smoking, lose weight, or to change how you feel about your current career, motivate yourself by remembering your what, why, how and your when.
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