Agenda setting and importance/confidence rulers are just two of the simple tools used by practitioners to support patients to better self manage their conditions. Here Mavis Dwaah, a Psychological Wellbeing Practitioner from Wandsworth Psychological Therapies and Wellbeing Service tells us about these techniques and talks us through how to use them.

About the tools

Agenda setting and importance/confidence rulers are core aspects of the self management approach. They are widely used to help people find ways to better manage their physical and mental health when experiencing a range of long-term conditions - from depression to diabetes, back pain to COPD.

Agenda setting

This approach supports patients to set their own agenda for each session of treatment, with help and encouragement from their clinician. This puts the patient in the driving seat and empowers both parties to work together towards more meaningful goals and outcomes. Importantly it recognises the expertise that both people bring to the room, combining the knowledge of the clinician (‘expert by profession’) with the knowledge of the patient (‘expert by experience’).

Importance/confidence rulers

The importance/confidence ruler is a rating scale used together by a patient and their clinician to help quantify the patient’s readiness to improve their condition. Patients indicate, on a scale of 0-10, how important change is to them and how confident they are they can achieve it. This highlights their motivation, a significant factor in the effectiveness of treatment, and looking at confidence prompts discussion about possible barriers to progress. The clinician can then use this information to help the patient set goals for treatment which are realistic, engaging and achievable. It can also help to highlight issues that the patient might want to include in the agenda for future sessions.

How I use these tools in my practice

My job involves providing psychological support for people with mental health problems such as depression and anxiety. I use CBT techniques to help patients self manage their symptoms and improve their coping strategies. Agenda setting and importance/confidence rulers are core techniques for this and I use them before and during each course of treatment.

Prior to their first session with me, I ask patients to complete a pre-consultation form which guides them to articulate their main presenting problem and the impact it has on their everyday life. Patients are asked to identify three things they’d like to focus on during their first consultation, and to rate how important and confident they are about achieving those targets.

This introduces the patient to the self management approach from the outset, providing the context for the work we do together. It encourages self-reflection and thought, helping them focus on what’s important to them when it comes to the face-to-face sessions.

At the end of the first session, they set an overall goal for treatment and I ask the patient to rate their level of importance and confidence in achieving this within the timeframe we have.

Patients usually rate higher for importance, yet lower for confidence. In these cases we might agree to focus in future sessions on building their confidence to achieve goals through understanding symptoms and learning how to use CBT techniques. We can revisit the rulers throughout treatment to assess how things are progressing.

The benefits of these approaches

These tools are an essential part of my practitioner toolkit. They have helped me develop a coaching style that enables an empowering therapeutic relationship between me and my patients, helping them make sustainable improvements in managing their mental health and overall wellbeing.

Traditionally, clinicians are seen as experts who impart advice because they ‘know what’s best’. However, experience and studies have shown that treatment is most effective when the clinician-patient relationship is two-way, based on a co-created, shared therapeutic alliance. These tools help achieve this by guiding the patient to discover their own motivation to change, helping to identify barriers and explore options available to them.

I have found that this approach truly increases the likelihood of sustained change after treatment. It also benefits other professionals as patients are empowered to interact with clinicians about future difficulties more proactively, and be more engaged in their treatment.

Find out more about these tools

Examples of agenda setting forms and confidence rulers can be found in our person-centred care resource centre.

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