Course Overview

This Lesson will go into depth on the importance of change talk and how it can predict actual behavior change. We use a combination of Evoking strategies and EARS to evoke deeper change talk. We provide several opportunities for you to test your knowledge on the information that is presented within this lesson.

  • Duration: 1 hour
  • Credit Hours: MCBAP-R (0.0) MCBAP-S (1.0) Mi-CEC (1.0) Nursing (0.0)
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Topics Covered

Motivational Interviewing and The Chain of Thought for Ambivalence

Most people who are ambivalent about change follow a common chain of thought. Typically the internal voice for change ends once a sustain thought becomes present. In Motivational Interviewing the goal is to keep the thought process going once a sustain thought comes into awareness. We explain three things that can be provided to the client to continue their thoughts for change and we also provide examples of a possible client chain of thought.

Recognizing Change Talk

Deep change talk predicts actual behavior change that is evoked during the interview. DARN talk alone predicts commitment which then predicts actual behavior change. We provide an exercise in which you are given a client statement that contains change talk and sustain talk and then you are asked to pick out the change talk. In a second exercise you are asked to come up with elaboration questions in response to the clients change talk and compare your answers with the ones given.

Strategic EARS

Once we recognize the change talk, we want to respond to change talk using EARS (Complex Reflection, Elaboration Question, occasional Affirmation, and Summary). To evoke more change talk, it is usually best to respond to the clients change talk and ignore their sustain talk. To deepen change talk using EARS you can guess at what the client is feeling and their reasons for change talk. In Motivational Interviewing it is recommended that most EARS be complex reflections, but Elaboration Questions can also be used to respond to change talk. Elaboration Questions consist of responses such as “tell me more” or “what does that mean to you?”


MI recommends mostly Reflections. This is because it conveys understanding, conveys empathy, Allows an internal dialogue for the client, and encourages awareness of reasons to change. We explain each of these in detail and revisit the differences between Simple and Complex Reflections. We provide an exercise in which you are given a client statement and are then asked to pick out the change talk and come up with an appropriate reflection, the complex evoking reflection should respond to the change talk and leave the client thinking about change.

Additional Considerations

The more change talk, the more likely the client is to change. The more sustain talk, the less likely the client is to change. The reasons already within the client are not enough for them to change, they require a deepening of those reasons to be able to change.

Course Objectives

  1. You will complete a review of ambivalence and strategies that evoke change talk.
  2. You will be able to identify a typical chain of thought when someone contemplates a behavior change and be able to discuss how Motivational Interviewing changes that thought process to aid the process change.
  3. You will be able to recognize change talk, even when it's seemingly overshadowed and embedded in problem talk.
  4. You will be able to identify the MI acronym of EARS and be able to discuss how Elaboration, Affirmations, Reflections, and Summaries are strategies for deepening change talk.
  5. You will be able to practice using reflections, elaborations, and affirmations to deepen change talk from actual client statements, matching your own answers to those of the module's content.

What People Are Saying

The module experience was a learning tool to further good practice in my work environment.

- Tanya B.