Module 4 · Strengthening commitment · Activity 2 of 4

Reading: Importance and confidence rulers

Two quick scaling questions that evoke change talk and show where to focus.

Lesson · 4 min

ASSIGNED READING · START HERE

TIP 35, evoking change talk and the rulers

pp. 53–61 · 9 pages. Read it first, then use this lesson to study and practice.

Go to reading

What you’ll learn

Use the importance and confidence rulers.
Ask follow-up questions that evoke change talk rather than sustain talk.
Decide where to focus based on the answers.

Two parts of motivation strongly predict change: how important it feels and how confident the client is that they can do it. The importance and confidence rulers ask about each on a scale from 0 to 10. They take a minute, and the follow-up questions often produce some of the clearest change talk in a session.

Importance: “How important is it to you to make this change?”

Not importantExtremely important

Confidence: “How confident are you that you could, if you decided to?”

Not confidentExtremely confident

The importance and confidence rulers, redrawn. Adapted from TIP 35, Exhibits 3.9 and 3.10

The importance ruler

Ask: “On a scale of 0 to 10, how important is it for you to change your drinking, if you decided to?” Whatever number the client gives, the follow-up does the work.

First, ask why the number isn’t lower: “How are you at a 6 instead of a 3?” The answer is the client’s own reasons for change. Asking why it isn’t higher does the opposite and invites them to explain why they aren’t ready.

Example: asking about a lower number

Counselor

You said you’re at a 6 on how important it is to quit drinking. How are you at a 6 instead of a 3?

Client

I’m realizing drinking causes more problems in my life now than when I was younger.

Compare “Why not a 9?”, which tends to get “Well, I’m just not ready to quit right this second.” That’s still useful information, but it’s sustain talk.

Then ask what would move the number up a little: “What would help you get from a 6 to a 7?” Keep the step small. The question invites the client to think about what would make change matter more.

The confidence ruler

Ask: “On a scale of 0 to 10, how confident are you that you could stop drinking, if you decided to?” Follow up the same way. Asking about a lower number helps clients see how far they’ve already come. Asking about a slightly higher number invites ideas for building confidence. Don’t jump to a much higher number; it can overwhelm the client and lower their confidence.

Reading the answers

Where to focus

Low importance: What it suggestsThe client doesn’t yet see enough reason to change; Where to focusKeep exploring values, concerns and feedback

High importance, low confidence: What it suggestsThey want to change but doubt they can; Where to focusBuild confidence: past successes, strengths, small steps

Both high: What it suggestsThey’re likely ready to plan; Where to focusMove toward a change plan (Module 5)

Both low: What it suggestsChange feels neither important nor possible; Where to focusFocus on engagement; don’t push

Pattern	What it suggests	Where to focus
Low importance	The client doesn’t yet see enough reason to change	Keep exploring values, concerns and feedback
High importance, low confidence	They want to change but doubt they can	Build confidence: past successes, strengths, small steps
Both high	They’re likely ready to plan	Move toward a change plan (Module 5)
Both low	Change feels neither important nor possible	Focus on engagement; don’t push

Building confidence

Ask about past successes, including changes in other parts of their life.
Ask about strengths they could draw on.
With permission, share what has helped other people.
Break the change into small, achievable steps.
Affirm efforts as they happen.

TRY IT

Write a follow-up question that draws out confidence talk.

ClientMaybe a 3 on confidence. I’ve never been able to stick with anything.

Show a model answer

“A 3, and not a 0. What makes it a 3?” Then: “What would it take to get to a 4?” Asking about the lower number draws out what the client already has going for them.

Key takeaways

Ask why the number isn’t lower to evoke change talk; asking why it isn’t higher evokes sustain talk.
Low importance means keep exploring reasons. Low confidence means build self-efficacy.
Move up the scale in small steps.

Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapters 1, 3 and 5. Public domain. Open TIP 35, evoking change talk and the rulers