Decisional Balance: Weigh Changing and Staying the Same
An interactive motivational interviewing decisional balance. Add good and not-so-good things about changing and about staying the same, and watch them drop onto a watercolor scale. Weights are optional.
With an ambivalent client, asking for reasons to stay the same can strengthen sustain talk.
More
If you're hoping to support change, spend your time on the change side. The scale is a picture of the weights given, not a verdict.
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How to play- Write the change you're weighing.
- Add items to the four boxes, starting with the good things about changing.
- Each item drops a stone onto the scale. Tap an item if you want to say how much it matters.
- Write what stands out to you, then see your balance.
About the technique
About the techniqueA decisional balance lays out the benefits and costs of changing and of staying the same, usually in four cells. It grew out of Irving Janis and Leon Mann’s conflict model of decision making in the 1970s and was later adopted in addiction treatment and stage-of-change research (Miller & Rose, 2015). In motivational interviewing it has often been used as a way to explore ambivalence.
How it is used matters. Motivational interviewing works by drawing out and strengthening the client’s own arguments for change (Miller & Rollnick, 2023), and MI as an approach shows small but meaningful effects across many problem areas (Lundahl et al., 2010). A full balance, however, asks for reasons to stay the same as well as reasons to change. Reviewing the evidence, Miller and Rose (2015) concluded that with clients who are still ambivalent, eliciting the pros of the status quo can lower commitment to change. They suggest keeping a full balance for situations where the counselor deliberately wants to stay neutral and not influence the direction of the decision.
Use it with adults and teens facing a decision, in session or on video. If you are hoping to support a specific change, spend most of the time on the change side and reflect change talk as it appears. The scale shows how the client weighted each item that day. It is a conversation aid, not a verdict and not a measure of readiness.
For therapists: how to run it
For therapists: how to run itGoal
See both sides of a change in the client's own words, without pressure to decide.
In session
- Decide first whether you want to stay neutral. A full balance suits a choice that's the client's alone; if you hope to support change, focus on the change side (see the caution on the tool).
- Share your screen or send the client link, and let the client's own words go in the boxes.
- Weights are optional. Use them only if the client wants to show what matters most; unweighted items don't move the scale.
- Reflect what stands out and copy the clinical-notes text.
As homework
- Fill in the boxes when you have a quiet moment. There's no need to decide anything.
- Tap See my balance. Tap Copy on the result card, then paste it into your therapist's secure messaging (client portal) or bring it to your next session. Nothing is saved, so copy before closing.
Items aren't weighted unless the client chooses, and unweighted items never tip the scale. The boxes are ordered with the change side first. Pairs well with the readiness ruler.
Worksheets that pair with this tool
ACT Values Worksheet
Six life domains from relationships to community, with questions that end by testing your daily actions.
Stages of Change Worksheet
Identify your stage across the five Transtheoretical Model stages using the signs listed for each one.
Anger Coping Skills
Eight steps over two pages, from naming triggers and body signs to 4-4-4 breathing and a written coping plan.Sources & credibility
- Method
- Decisional balance (pros and cons of changing and of staying the same)
- Developed by
- Irving Janis and Leon Mann; used in motivational interviewing by William R. Miller and Stephen Rollnick
- First described
- 1977
- Approach
- Motivational interviewing
- Evidence
- Practice-based (limited trials)Motivational interviewing is well supported, but research on the decisional balance itself is mixed. Miller and Rose (2015) found that a full balance can lower commitment in people who are ambivalent, so it's best used when the counselor wants to stay neutral.
References
- Miller W. R. & Rose G. S. (2015). Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behavioural and Cognitive Psychotherapy, 43(2), 129–141. Source
- Miller W. R. & Rollnick S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.). Guilford Press.
- Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D. & Burke, B. L. (2010). A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137–160. Source
How it was made
Built by the Mentalyc team from the original method and the published sources listed here. Nothing you enter is stored.
Questions people ask
Questions people askWhat is a decisional balance in motivational interviewing?
It's a four-part look at a possible change: the good and not-so-good things about changing, and the good and not-so-good things about staying the same, in the person's own words.
When should you not use a decisional balance?
Miller and Rose (2015) found that asking an ambivalent person for reasons to stay the same can strengthen those reasons and lower commitment. It's best used when the counselor wants to stay neutral; if you hope to support change, focus on the reasons for change.
Do I have to weigh each item?
No. Weights are optional. Items you don't weigh still appear on the scale as hollow stones but don't tip it.
Is a decisional balance the same as a pros and cons list?
It's similar, but it separates the pros and cons of changing from the pros and cons of staying the same, which often brings out reasons a simple list misses. DBT uses a related pros and cons skill for urges.
How do you do a decisional balance exercise with a client?
Draw four boxes: benefits and costs of changing, and benefits and costs of staying the same, and fill them in the client's own words. Then reflect the change talk; Miller and Rollnick caution that an even-handed pros and cons list can deepen ambivalence in clients who are not yet ready.
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