Decisional Balance: Thinking About Change
A motivational interviewing worksheet with a four-quadrant decisional balance, importance and confidence rulers, and a prompt to identify what would increase readiness.
2-page fillable PDF · US Letter (prints on A4) · Motivational interviewing
- Approach / concern
- Recovery & Addiction
- Technique
- Motivational interviewing
- Format
- Fillable PDF, 2 pages (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the Decisional Balance: Thinking About Change?
Decisional balance is a tool for exploring ambivalence by considering the benefits and costs of both continuing a behaviour and changing it. Importance and confidence rulers are classic motivational interviewing (MI) techniques for evoking change talk.
Why it works
Ambivalence is a normal part of change. MI is an evidence-based approach that helps people resolve ambivalence and strengthen their own motivation (Miller & Rollnick, 2023). Decisional balance also links to the stages of change model (Prochaska & DiClemente, 1983).
When to use it
- Substance use and addictive behaviours
- Health behaviour change (smoking, exercise, diet)
- Clients in precontemplation or contemplation
- Mandated or ambivalent clients
How to use it in session
- Explore all four boxes, starting with the benefits of staying the same.
- Reflect and summarize rather than argue.
- Use the rulers to rate importance and confidence.
- Ask why the score isn’t lower, then what would raise it.
- Respect the client’s autonomy about next steps.
Clinician tips
- Avoid the ‘righting reflex’, the urge to persuade.
- Listen for and reflect change talk.
- Use MI spirit: partnership, acceptance, compassion and evocation.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Why ask about the good things about not changing?
Acknowledging the benefits of the current behaviour reduces defensiveness and helps people feel understood.
What if the person decides not to change?
That’s their choice. MI respects autonomy; the conversation may plant seeds for later.
References
Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
