1

Relational

Open-ended questions

The coach asks a question that does not have a limited response

'What have you tried before to make a change?’ and ‘How can I help with xxx?'

2

Relational

Affirmation

The coach provides a statement of affirmation that acknowledges the person’s difficulties, efforts and self-worth.

“I’ve enjoyed talking with you today”

“I enjoy reading your updates and hearing from you”

3

Relational

Reflective statement

The coach paraphrases user comments by repeating back what the user has said.

“It sounds like you …” or “The message I’m getting is that …”

4

Relational

Summary statement

The coach pulls everything together that the user has said and offers a summary

‘So on the one hand, you feel that xxx and on the other xxx’

5

Relational

Agenda mapping

The coach prompts the user to consider the way ahead and which behaviour they are motivated to discuss.

“I usually talk to people in a situation like yours about diet, exercise, sleep, stress or hydration. Which of these do you feel you would like to talk about?”

6

Relational

Review a typical day

A prompt from the coach to build rapport while collecting information.

“Can we spend the next 5 minutes going through a typical day for you from beginning to end, and where (behaviour) fits in?”

7

Relational

Permission to provide information and advice

The coach obtains the permission of the user before providing information or advice.

“Would it be helpful if I tell you what has worked for other people or what they have found useful?”

8

Relational

Elicit-provide-elicit

The coach first elicits the user’s understanding and need for information, then neutrally provides information, followed by eliciting what this information might mean for the user.

“You mention feeling confused by xxx topic, would it be useful for me to share more about this?” and then “How does this information fit with what you know? What are the next steps for you now?”

9

Content

Running head-start

A strategy for eliciting user motivational talk in which the coach asks open questions to first explore the perceived ‘good things’ about the status quo, in order to then query the ‘not so good things ‘about the status quo.

“What are the good things about (the status quo)?” / “What are the not-so-good things about (the status quo)?” / “What are the not-so-good things about changing (behaviour)?”

10

Content

Importance ruler

The coach asks open questions, using an importance ruler to explore the user’s motivation in terms of how important it is to make a behaviour change. A scale (typically 0–10) is often used to ask users to rate the importance of making a particular change.

“How important would you say it is for you to xxx?” / “On a scale of 0– 10, where 0 means not at all important and 10 means ‘the most important thing for me right now’, how important would you say it is for you to xxx?”

11

Content

Confidence ruler

The coach asks open questions, using a confidence ruler to explore the user’s motivation in terms of how confident they are to make a behaviour change. A scale (typically 0–10) is often used to ask users to rate their confidence in making a particular change.

“Again if 0 stands for not at all confident and 10 stands for very confident, what number would you give yourself and why?”

12

Content

DARN questions

The coach uses DARN questions (open-ended questions) that seek to elicit four subtypes of user motivational talk. These four subtypes are: Desire, Ability, Reason and Need.

“What do you hope you will accomplish by choosing that behaviour?” (D) “How could you do it differently, if you decided to?” (A) “What is the reason/need behind this change?” (R/N)

13

Content

Looking forward

The user is prompted to envision two possible futures. The first ‘future’ is if they continue on the same path without any changes where they might be five or ten years from now. The second future is if they decide to make a change, what their future might look like.

“If you were to make that change, how would things be different? What would it be like? How would you feel?”

14

Content

Looking back

The user is prompted by the coach to talk about what life was like ‘before’. The goal is for the user to observe how they have changed over time which may enhance motivation to return to a previous way of being.

A user may say: “I wasn’t always this way” and the coach may say: “It sounds like things have changed over time. Tell me about your eating habits back then”.

15

Content

Hypothetical thinking

The coach prompts the user to adopt hypothetical thinking to elicit ideas about behaviour change.

“Suppose that you did decide to change (behaviour) how would you go about it?”

16

Content

Query extremes

A technique used to evoke change talk by asking users to imagine best consequences of change or worst consequences of status quo.

“Suppose you did not change, what is the WORST thing that might happen?”

17

Content

Identify past successes

The coach prompts the user to think about previous successes at behavioural changes to build confidence for change.

“What have you learnt from previous attempts to change?”

18

Content

Identify strengths

The coach prompts the user to draw out their strengths and the relevance of these strengths to making successful behavioural changes.

“What are your key strengths?”

19

Content

Brainstorming

The coach prompts the user to generate a menu of options.

“What are your ideas about how you could change (behaviour)?”

20

Content

Troubleshooting

The coach prompts the user to think about potential barriers and identify ways of overcoming them to strengthen motivation.

“Suppose that this one big obstacle wasn’t there. If that obstacle was removed, then how might you go about making this change?”

21

Content

Values exploration (open or structured)

The coach prompts the user to explore his or her values and how the behaviour fits in with these values. The coach may ask the user to describe their main goals and values in life.

“What things are most important to you?” or “What do you most want in life?” and “How do your eating practices fit in with your goals and values?”

22

Content

Reframing

A coach’s reflective statement invites the user to consider a more positive and motivational interpretation of what has been said.

From “I can’t do it” to “So you find it difficult to ...”

23

Relational

Double-sided reflection

The coach provides a double-sided reflection to capture user ambivalence and communicate to the user that the coach heard their reasons both for and against change.

“On the one hand, you would like to change XX, but on the other hand, changing XX would mean giving up XX” or “you are torn about changing XX”

24

Relational

Emphasise autonomy

The coach provides a statement that directly expresses motivational support, acknowledging the user’s ability for choice and self-determination.

“Do you have any ideas about how we might resolve this dilemma?”

25

Relational

Overshooting

Overshooting is a motivational technique provided by the coach to argue against change by exaggerating the benefits of or minimising the harm associated with risky behaviour.

“So you see no benefit in changing XX” or “XX is all positive for you”. The coach, by arguing against change can exhaust the user’s negativity.

26

Relational

Undershooting

A reflective statement, provided by the coach that understates what the user has offered. By slightly understating the expressed intensity of emotion, the user is more likely to continue exploring and telling the coach about it.

The user says “I’m out of breath even walking up the stairs” and the coach responds with: “You’re beginning to notice that everyday activities are more difficult”

27

Relational

Coming alongside

A coach response to persistent resistance talk or discord in which the coach accepts and reflects the user’s resistance.

“Perhaps now is not the right time to be thinking about this change?”

28

Relational

Shifting focus

A coach responds to discord and low level of motivation by redirecting attention and discussion to a less contentious topic or perspective.

“Since you’ve been forced to come here, what would you like to do with the time we have left together today”

29

Relational

Agreement with a twist

A reflection whereby the coach reframes a negative comment by the user into a more positive response.

“I have no will power” to “So you’re saying that you have little confidence”

30

Content

Normalising

The coach communicates to users that having difficulties while changing is not uncommon.

“Many people report feeling like you do. They want to lose weight, but find it difficult”

31

Content

Explore change expectations

The coach prompts the user to identify the outcomes that the user expects to achieve based on the changes that they are motivated to make.

“Thinking about the benefits of (behaviour) that you’ve just been describing, what kinds of changes to your current level of (behaviour) are you prepared to make?”

32

Content

Consider change options

The coach prompts the user to consider change options in a neutral and supportive manner.

“How might you go about xxx?”

33

Content

Develop a change plan (CATs): Commitment, Activation, Taking Steps

The coach prompts the user to develop a specific change plan that the user is motivationally ready to accept.

“What do you intend to do specifically?” (C) “What would be a good first step?” (A) “When and how will that step be taken?” (T)

34

Content

Goal attainment scaling

A way to specify degrees of change towards the goal and focus motivation using a −3 to +3 scale where 0 is the status quo at the outset. The coach prompts the user to rate their goals on a scale ranging from the best possible outcome to the worst possible outcome.

Rate a weight loss goal on a scale ranging from −3 (most unfavourable outcome): gain 5 kg in one month to +3 (most favourable outcome): lose 5kg in one month where 0 is the status quo (remain at current weight)

35

Relational

Support change / persistence

The coach functions as a partner or companion, collaborating with the user’s own expertise.

“How can I best support you?”

36

Relational

Offer emotional support

The coach offers reassurance, to the user.

“I appreciate how difficult this is”

37

Content

Review outcome goal

The coach asks the user how they are progressing with their goals.

“How are you progressing with your goal?”

38

Content

Summarise the plan

The coach summarises the change plan including the specific behavioural goals, the reasons for making the change, the specific steps to be taken, the outcome goals and coping planning for relapse prevention.

“So you’ve decided you are going to ... This is because ... “ / “Specifically, you are going to ... You will know if the plan is

working if ...