It’s probably easy to think of a friend or family member who is always talking about a change they want to make - giving up smoking, losing weight, quitting a job they’re unhappy in - but never seems to be able to take the step. Discussions about change can strike noticeably varying tones depending on the speaker’s motivation and readiness.
The developers of motivational interviewing (MI) paid close attention to these variations in their early research, and noticed important patterns in the relationship between language and change. In this video, MI founder Dr. William Miller details how the language a client uses can predict the likelihood of them making the desired changes. He also explores how motivational interviewing utilises this discovery to support clients to shift more wholeheartedly towards healthy change.
As Dr. Miller describes, MI researchers began listening very carefully to the quality of how patients spoke about change, and eventually delineated two categories of speech: what they now call change talk and sustain talk.
Recognizing Change Talk
Change talk refers to any statement the client makes that moves them toward changing a behavior: expressions of desire, ability, reasons, or need for change, as well as more concrete commitments, intentions, or descriptions of steps already taken.
In MI, the clinical framework for identifying change talk is organized through the prompt DARN-CATs. DARN captures preparatory change talk:
Desire (e.g."I want to cut back")
Ability ("I think I could manage it")
Reasons ("My kids will be better off if I’m healthier")
Need ("Something has to change").
CATs captures mobilizing change talk, which reflects movement into action:
Commitment ("I’m going to make an appointment this week")
Activation ("I’ve been looking into options")
Taking Steps ("I actually signed up for the class yesterday").
Preparatory language signals that a client is weighing change, while mobilizing language signals they are moving toward it. Psychwire’s Motivational Interviewing Foundational course breaks down this model in more detail.
Recognising Sustain Talk
Sustain talk is the counterpart: statements that move the client toward maintaining the status quo, that defend the behavior in question, or that highlight the difficulties of change or reasons to stay the same. The DARN and CAT statements can be found within sustain talk in the reverse. For example, “I want to keep smoking” (Desire), “I can continue to drink and be okay” (Ability), “Drinking helps me sleep” (Reasons), or “I don’t need to quit smoking” (Need). In MI, sustain talk is recognized as an expected part of the clinical encounter, a reflection of the ambivalence most clients (and people) experience in the face of making significant behavioral changes.
Talk Ratios Predict Behavior Change
As Dr Miller mentions in the video, identifying change and sustain talk provides not only a useful descriptive framework, but can also be used to predict behavior change in clients struggling with addiction. Large scale meta-analyses have found that higher ratio of change talk to sustain talk (rather than the raw frequency of each) has been associated with better behavioral outcomes (Magill et al., 2018). Patients who use a dominance of sustain talk have also been found to demonstrate consistently worse outcomes (Pace et al., 2017). This research has informed much of the technique of motivational interviewing, with the goal of the intervention focussed on attending to the patient’s language carefully in a hope of increasing the ratio of change to sustain talk.
The Therapist’s Role in Shifting the Balance
Motivational interviewing techniques offer a range of empirically supported strategies therapists can use to support and encourage a patient’s change talk. Seminal research by Psychwire instructor Teresa Moyers and her colleagues (2009) with outpatient clients struggling with alcoholism has demonstrated that when a clinician reflects change talk, the client is more likely to use more change talk themselves in their next utterance. Conversely, when a clinician reflects sustain talk, or responds in MI-inconsistent ways such as confronting, warning, advising without permission, or arguing for change, the patient’s sustain talk tends to increase. This research highlights the extent to which the therapist can shape the linguistic climate of the session.
While it might be easy to think that the tone of the session will simply reflect the client’s state of ambivalence on that particular day, in practice, being met by a therapist who listens deeply, and reflects the client’s genuine desire and motivation for change with precision and care, can leave the client in a meaningfully stronger state of readiness for change.
Evoking Change Talk in Practice
For clinicians, the practical challenge is learning to recognize change talk and sustain talk as they occur in real time, and to respond in ways that selectively amplify the former and reduce the latter. Importantly, the goal is not to manufacture motivation from the outside. One of the defining features of MI is respect for client autonomy and an insistence that lasting change is more likely when the reasons for it are identified and articulated by the client themselves from within. The clinician’s task is to guide the conversation in a way that makes that exploration possible by creating the conditions in which a client’s own arguments for change can surface, be heard, and be taken seriously.
For clinicians interested in deepening their understanding of how to work with motivation, ambivalence, and the language of change, Psychwire’s Motivational Interviewing Foundational course, led by William Miller, Theresa Moyers, and Stephen Rollnick, offers structured clinical training that grounds these concepts in practice.
