Free Therapist Training›Motivational Interviewing Toolkit›Readiness Rulers
Last updated: November 11, 2026
A readiness ruler worksheet asks a client to rate a change on a scale from 0 to 10, usually twice: how important the change is and how confident the client feels about making it. This free readiness ruler worksheet, available as a PDF and a Google Doc, pairs each ruler with the two follow-up questions that turn a number into change talk and ends with a short clinician guide. It comes with Linda's completed rulers, steps for using them in motivational interviewing (MI), a guide to low and high scores and a summary of what studies of readiness rulers have found.
The template comes from Sentio's free motivational interviewing toolkit, and MI is one of the core therapy models taught in the Sentio MFT program. When both ratings are high and the client is ready to plan, the change plan worksheet is the natural next step.
This is an optional aid from Sentio's motivational interviewing toolkit, free to adapt to your setting.
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The change I am thinking about
| Name the change in a few words |
Importance ruler
How important is it to you right now to make this change? Circle a number.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|---|
| Not important | Extremely important | |||||||||
| Why did you choose this number and not a lower one? |
| What would help move it a point or two higher? |
Confidence ruler
If you decided to make this change, how confident are you that you could do it? Circle a number.
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|---|
| Not confident | Extremely confident | |||||||||
| Why did you choose this number and not a lower one? |
| What would help move it a point or two higher? |
Clinician guide: using the rulers
- Ask about the lower number. Asking why the client chose this number and not a lower one draws out the client's own reasons for change, which is change talk; asking why the number is not higher invites reasons against the change, which is sustain talk.
- If the answer is zero. Reflect it without arguing. Ask what would help the number rise even a point, or return to engaging and focusing to learn what does matter to the client.
- Low importance. Explore the client's values and reasons before any planning, for example with the values conversation TIP 35 describes, which explores what matters to the client and how the current situation fits with it (SAMHSA, 2019).
- High importance, low confidence. Explore past successes, strengths and options, break the change into small first steps, and reflect any confidence talk you hear (SAMHSA, 2019).
What Does a Completed Readiness Ruler Worksheet Look Like?
Linda, 61, who has type 2 diabetes, completed these rulers on November 12, 2026, at her second health coaching visit with K.T., the nurse health coach at her primary care clinic.
| Prompt | Linda's answer |
|---|---|
| The change I am thinking about | “Walking after dinner and taking my evening medication every night.” |
| Importance (0 to 10) | 8 |
| Why did you choose this number and not a lower one? | “My numbers keep creeping up, and I want to be around for my granddaughter.” |
| What would help move it a point or two higher? | “Picturing myself walking my granddaughter to school next fall. When I think about that, it's a 9.” |
| Confidence (0 to 10) | 4 |
| Why did you choose this number and not a lower one? | “I walked every day on vacation in September, and my knees are fine on flat ground.” |
| What would help move it a point or two higher? | “Keeping the pill box by the TV remote, and having my neighbor to walk with now that it's dark by six.” |
With importance at 8 and confidence at 4, K.T. spent the rest of the visit on confidence. K.T. reflected Linda's daily walks on vacation as a past success and asked what would make walking at home feel as doable, and Linda chose her own small steps: asking her neighbor whether she could join her dog walk after dinner on Monday, Wednesday and Friday, and setting an alarm for 8:30 with the pill box kept by the TV remote. Her confidence in that plan was 7.
How Do You Use a Readiness Ruler Worksheet?
Use the rulers once the client has named a change to talk about, and ask each question aloud, even if the client also marks the sheet. The steps are the same for both rulers:
- Name the change in the client's words and write it at the top.
- Ask for a number from 0 to 10, and accept whatever number the client gives.
- Ask why the client chose that number and not a lower one, then reflect the reasons you hear.
- Ask what would help move the number a point or two higher, and reflect those ideas too.
- Repeat the steps for confidence, then summarize the client's reasons and ideas in a sentence or two.
The follow-up questions do most of the work. Asking why the number is not lower draws out the client's own reasons for change, while asking why it is not higher invites the client to explain what holds the change back, which is sustain talk; TIP 35 pairs each of its rulers with a lower-number question and a question about moving higher (SAMHSA, 2019). The distinction matters because, in a meta-analysis of 36 studies, a higher proportion of change talk in sessions went with less risk behavior at follow-up, and sustain talk went with worse outcomes (Magill et al., 2018).
D.O., a counselor at a community clinic, used the question with Marcus, 46, who rated importance at 6 at his intake on November 3, 2026:
| Speaker | What was said |
|---|---|
| D.O. | “You picked a 6. Why a 6 and not a 2?” |
| Marcus | “Because it's more than I want. My wife is worried, and I'm sleeping badly. I've always been the steady one.” |
| D.O. | “Being the steady one matters to you, and you don't like what the drinking is doing to your sleep or to your wife's peace of mind.” |
| Marcus | “Yeah. She has enough to worry about since the layoff.” |
| D.O. | “You'd like to take some of that weight off her. What would help move it from a 6 to a 7 or 8?” |
| Marcus | “Getting a job interview, honestly. I'd want to be sharp for it.” |
What Is a Readiness Ruler, and What Have Studies Found?
A readiness ruler is a scale on which a person rates readiness to change a specific behavior, and the name now covers a small family of related tools. Stott et al. (1995) included a readiness-to-change ruler in a method for diabetes consultations, and Christopher Butler and Stephen Rollnick developed the importance and confidence questions in experimental consultations with smokers, as part of a brief intervention for general practice, and described the method in 1997 (Rollnick et al., 1997). Miller and Rollnick (2013) describe the importance and confidence rulers as scales, typically from 0 to 10, and TIP 35 treats the two together as an indication of how ready a client is to change (SAMHSA, 2019). For a single-item measure, CASAA at the University of New Mexico hosts a Readiness Ruler form that asks for a 1 to 10 rating of readiness to quit or cut down for each of 12 drug classes.
Studies of single readiness items are few and small, and they used different formats. LaBrie et al. (2005) gave change rulers to 96 male college students and found that ruler scores correlated strongly with longer readiness questionnaires for both drinking and safer sex (r = .77) and predicted intentions to change at least as well as the questionnaires. In a study of 87 people entering opioid agonist maintenance treatment in Copenhagen, 55 of whom were analyzed, those who rated themselves readier to cut down or quit at intake reported less drug use about 18 months later, after accounting for the severity of their drug problems (Hesse, 2006). In an English general practice, Heather et al. (2008) turned the LaBrie ruler into a five-statement item for 72 patients whom practice staff had identified as drinking excessively; its relationships with the 12-item Readiness to Change Questionnaire were significant but weaker than expected, grew stronger when the authors set aside people who chose the ruler's maintenance option, and led to a revised ruler without that option.
These studies tested single readiness items as measures, and their results varied with the format and the sample; none tested importance and confidence rulers like the two on this worksheet. Those two rulers are adapted from Exhibits 3.9 and 3.10 of TIP 35, which is in the public domain apart from material it reproduces from copyrighted sources, and neither exhibit credits an outside source (SAMHSA, 2019). They serve mainly to open a conversation that evokes change talk.
How Should You Respond to Low and High Ruler Scores?
Let the pattern of the two numbers guide the next part of the conversation, and listen closely to the reasons behind each number, which tell you more than the number alone.
| Pattern | What it suggests | What to try |
|---|---|---|
| Low importance, whatever the confidence | The change matters little to the client right now. | Explore the client's values and reasons, for example with the values conversation TIP 35 describes (SAMHSA, 2019), ask what concerns them about the current situation, and offer information only with permission. Hold off on planning. |
| High importance, low confidence, as with Linda | The client wants the change but doubts it can happen. | Explore past successes, strengths and options, break the change into small first steps (SAMHSA, 2019), and reflect any confidence talk. |
| Both high | The client may be ready to plan. | Summarize the client's reasons and ideas, and ask what the client would like to do next; the change plan worksheet can help. |
| A zero on either ruler | The client sees no reason for the change, or no way to make it, right now. | Reflect the answer without arguing, ask what would help the number rise even a point, or return to engaging and focusing. |
With a low importance score, resist the fixing reflex, the urge to argue for the change yourself (Miller and Rollnick's earlier term was the righting reflex), and keep evoking the client's own reasons (Miller & Rollnick, 2023). Engaging and focusing, the first two of MI's four tasks, may need more time before evoking begins. Use the rulers again in later sessions to see how the numbers and the reasons move, and record both in the progress note.
Practice the Skill Behind This Template
Practice evoking change talk next, because a ruler pays off only when the number is followed by a question that draws out the client's reasons and a reflection of what you hear. Rehearse it with the motivational interviewing practice scenarios, watch Episode 8 on Practice Time, and use the exercises in Deliberate Practice in Motivational Interviewing (Manuel et al., 2022).
Keep reading
Decisional Balance Worksheet, a free template and a guide to when weighing pros and cons fits.
Change Plan Worksheet, for the client whose importance and confidence are high enough to plan.
Motivational Interviewing Progress Note Template, with room for ruler ratings and the client's reasons.
Free Motivational Interviewing Toolkit, every template with a completed example.
Deliberate Practice in Motivational Interviewing, a free webinar with Robert Scholz, Tony Rousmaniere and Alexandre Vaz.
Frequently Asked Questions
What is a readiness ruler worksheet?
A readiness ruler worksheet is a short client sheet with 0 to 10 scales for how important a change is and how confident the client feels about making it, each followed by questions about the number. Together the two ratings give a picture of how ready the client is to change. The questions after each number matter most, because they invite the client to say why the change matters and what would help.
What should you ask after the client gives a number?
Ask why the client chose that number and not a lower one, and reflect the reasons you hear, which are usually change talk. Then ask what would help move the number a point or two higher. Avoid asking why the number is not higher, because the answer is likely to be reasons against the change.
What if the client rates importance as zero?
Reflect the answer without arguing, since a zero tells you the change is not important to the client right now. You can ask what would help the number rise even a point, or return to engaging and focusing to learn what does matter to the client. A different change may be a better place to start.
Has the readiness ruler been studied?
It has, in a few small studies of single readiness items. Change rulers correlated strongly with longer readiness questionnaires among college men (LaBrie et al., 2005), readiness ratings at intake predicted less drug use about 18 months later among people entering opioid agonist treatment (Hesse, 2006), and a ruler tested with primary care patients related to a longer questionnaire less strongly than expected and was then revised (Heather et al., 2008).
Can you use the rulers in telehealth sessions?
You can. Read the question and both end labels aloud, ask for a number, and follow with the same questions you would ask in person. On video you can also share the worksheet on screen or send it before the session, and by phone the client can simply say the number.
References
Heather, N., Smailes, D., & Cassidy, P. (2008). Development of a Readiness Ruler for use with alcohol brief interventions. Drug and Alcohol Dependence, 98(3), 235-240. https://doi.org/10.1016/j.drugalcdep.2008.06.005
Hesse, M. (2006). The Readiness Ruler as a measure of readiness to change poly-drug use in drug abusers. Harm Reduction Journal, 3, Article 3. https://doi.org/10.1186/1477-7517-3-3
LaBrie, J. W., Quinlan, T., Schiffman, J. E., & Earleywine, M. E. (2005). Performance of alcohol and safer sex change rulers compared with readiness to change questionnaires. Psychology of Addictive Behaviors, 19(1), 112-115. https://doi.org/10.1037/0893-164X.19.1.112
Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E. F., Tonigan, J. S., & Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change. Journal of Consulting and Clinical Psychology, 86(2), 140-157. https://doi.org/10.1037/ccp0000250
Manuel, J. K., Ernst, D., Vaz, A., & Rousmaniere, T. (2022). Deliberate practice in motivational interviewing. American Psychological Association. ISBN 978-1-4338-3618-3. https://www.apa.org/pubs/books/deliberate-practice-motivational-interviewing
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press. ISBN 978-1-60918-227-4. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781462552795/prior-editions
Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press. ISBN 978-1-4625-5279-5. https://www.guilford.com/books/Motivational-Interviewing/Miller-Rollnick/9781462552795
Rollnick, S., Butler, C. C., & Stott, N. (1997). Helping smokers make decisions: The enhancement of brief intervention for general medical practice. Patient Education and Counseling, 31(3), 191-203. https://doi.org/10.1016/S0738-3991(97)01004-5
Stott, N. C. H., Rollnick, S., Rees, M. R., & Pill, R. M. (1995). Innovation in clinical method: Diabetes care and negotiating skills. Family Practice, 12(4), 413-418. https://doi.org/10.1093/fampra/12.4.413
Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment (Treatment Improvement Protocol (TIP) Series No. 35, SAMHSA Publication No. PEP19-02-01-003). https://library.samhsa.gov/product/tip-35-enhancing-motivation-change-substance-use-disorder-treatment/pep19-02-01-003
