Decisional Balance
Weigh up the pros and cons of continuing to use substances versus making a change. A core motivational interviewing technique.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Decisional Balance
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Continuing to Use
Making a Change
Reflection
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When to use ‘Decisional Balance’
‘Decisional Balance’ is an interactive motivational interviewing (MI) worksheet, for work with substance misuse. Consider this resource when a client feels ambivalent about change and wants space to explore their own reasons, the importance of change and their confidence in it.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 10 minutes. It moves through three short steps:
- Continuing to Use
- Making a Change
- Reflection
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The MI approach behind it
‘Decisional Balance’ draws on motivational interviewing (MI). MI is a collaborative conversation about ambivalence, including reasons to change and reasons to keep things as they are. The therapist listens for the client’s own reasons and respects their choice about what happens next. Exploring importance and confidence can distinguish wanting change from feeling able to attempt it, without turning the conversation into persuasion.
It is intended as one part of a wider course of therapy rather than as advice or a diagnosis. The therapist can help decide how it fits the work and discuss what emerges.
Evidence & sources
This worksheet draws on motivational interviewing. Key sources include:
- Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing (3rd ed.). New York: Guilford Press.
- Marlatt, G.A. & Donovan, D.M. (2005). Relapse Prevention (2nd ed.). New York: Guilford Press.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- Samaritans: 116 123 — free, day or night, 365 days a year
- SANEline: 0800 689 5555 — 4:30pm–10:30pm, every day
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