Contrasting decisional balance to eliciting change talk: Considerations for therapist training

Decisional balance and evoking change talk are therapeutic strategies designed to increase the likelihood of individuals deciding to make changes, especially when they feel ambivalent. While these approaches overlap, decisional balance is traditionally associated with the Transtheoretical Model (TTM), or stages-of-change model, whereas evoking change talk is central to Motivational Interviewing (MI). There has been ongoing debate about which method is more effective or appropriate for resolving ambivalence and promoting change. Some evidence suggests that decisional balance might even hinder behavior change, raising questions about its clinical relevance. This article aims to address these issues conceptually and explore how aspects of decisional balance—such as its structure, stepwise facilitation, and guiding principles—can benefit the education, training, and supervision of psychotherapists. It emphasizes that learning decisional balance can positively impact psychotherapist training by encouraging engagement, exploration, and elaboration. Additionally, it helps new clinicians avoid rushing into prescriptive interventions prematurely, fostering a more thoughtful, client-centered approach to facilitating change.