As a significant factor in the outcome from any treatment, alteration in attitudes towards change represents a key therapeutic target.19 An attitude in this context can be defined as “the dynamic element in human behaviour, the motive for activity” (p 409).20 This concept can be operationalized to encompass clients’ initial and dynamic appraisal of change, including positive, negative, or ambivalent reactions to change, interest, desire, and/or commitment to change, as well as acquisition of any related skill, proficiency, or belief involving self-efficacy and the consequences of change.