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Developing Discrepancy

May 1, 2018 Comments Off on Developing Discrepancy

Here we present two strategies for developing discrepancy between the client’s current behaviour, goals, and values.

Decisional balance

This strategy involves asking the client to evaluate to the good and the not so good things about their behaviour. The aim of this strategy is to help the client understand and express their ambivalence and help move them further along the readiness to change continuum. The health professional can reflect this back to the client with the aim of having them address their ambivalence about changing. For example:

  • ‘What are some of the good things about [insert behaviour]?’
  • ‘On the flipside, what are some of the less good things about [insert behaviour]’?’

You can find a decisional balance template here.


Columbo approach

The Columbo approach is a technique to help clients identify and resolve discrepancies in their thinking. It takes its name from the main character in the 1970s TV series Columbo. It is a way for you to address discrepancies between what clients say and their behavior without causing them to resist or react with defensiveness or resistance. Here is an example of the Columbo approach:

  • “Help me to understand, on the one hand you say you want to live to see your 12-year old grow up and go to college, and yet you won’t take the medication your doctor prescribed for your diabetes. How will that help you live to see your daughter grow up?” (From Sobell & Sobell (2008). Motivational interviewing strategies and techniques: rationales and examples. Available here).

When possible, as shown in the example above, try to end the reflection on the side of change. This means clients are more likely to elaborate on the last part of the statement.

More information on the Columbo approach can be found here.

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