Picture this: Sarah, a 28-year-old with cystic fibrosis, sits across from you looking frustrated. Despite your detailed explanations about the importance of her airway clearance routine, she’s been skipping sessions. Again.

Or consider David, recovering from knee surgery, who nods politely when you explain his exercise programme but returns each week having done little more than the bare minimum.

Sound familiar?

If you’re like most clinicians, your first instinct might be to explain harder—more evidence, clearer instructions, stronger warnings about consequences. But what if the problem isn’t that patients don’t understand what they should do? What if they’re simply not convinced they want to do it?

The Problem with Persuasion

Traditional approaches to non-adherence often involve trying to convince patients they should change. We present evidence, outline benefits, and sometimes even resort to gentle threats about what might happen if they don’t comply.

But here’s the thing: external persuasion has limited power. When we try to convince someone, we’re essentially asking them to adopt our reasons for change. And our reasons—no matter how medically sound—rarely carry the emotional weight of their own motivations.

Dr Michael Pantalon, in his groundbreaking book “Instant Influence,” offers a different path. Rather than trying to persuade patients, his method helps them persuade themselves.

The Core Insight: Motivation Already Exists

Pantalon’s approach rests on a powerful presupposition: people already have reasons to change. Our job isn’t to create motivation from scratch, but to help patients access the motivation that’s already there.

This shifts everything. Instead of being the expert who knows what’s best, you become the guide who helps people connect with what they already know matters to them.

This presupposition transforms how we view resistance. When a patient says “I don’t have time for exercises,” they’re not being difficult—they’re revealing that something else feels more important right now. The resistance isn’t a barrier to overcome; it’s a signal about competing priorities.

The 6 Instant Influence Questions

Pantalon’s method centres on six carefully crafted questions. Each one is designed to bypass resistance and tap into intrinsic motivation. Let me walk you through them with clinical examples.

Question 1: “Why might you want to [specific behaviour]?”

Notice the presupposition here: the question assumes there are reasons, even if the patient hasn’t voiced them yet.

With Sarah, instead of asking “Why aren’t you doing your airway clearance?” try “Why might you want to keep up with your airway clearance routine?”

This subtle shift invites her to generate her own reasons rather than defend her current behaviour. She might say, “Well, I suppose it helps me breathe better during netball training.”

Question 2: “How ready are you to [specific behaviour] on a scale of 1 to 10?”

This question assumes everyone has some level of readiness—even if it’s just a 2 or 3. The number itself isn’t what matters; it’s what comes next.

David might say his readiness to increase his exercise is a 4 out of 10. Perfect. That’s your starting point.

Question 3: “Why didn’t you pick a lower number?”

This is where the magic happens. This question assumes that even their modest rating represents real motivation. It asks them to articulate the reasons behind their number—essentially talking themselves into change.

David might respond: “Well, I do want to get back to playing cricket with my son. And I know the physio said these exercises are important for that.”

Notice how he’s now voicing his own reasons for action, not yours.

Question 4: “Imagine you decided to [specific behaviour]. What would the positive outcomes be?”

This question uses future projection to help patients visualise success. The presupposition is that change is possible and beneficial.

For a patient with Type 1 diabetes struggling with blood glucose monitoring, you might ask: “Imagine you decided to check your blood sugar more regularly. What would the positive outcomes be?”

Question 5: “Why are those outcomes important to you?”

This digs deeper into personal values. The presupposition is that meaningful outcomes connect to what people care about most.

If your diabetes patient says regular monitoring would help them “feel more in control,” you follow up with: “Why is feeling in control important to you?” They might reveal it’s about being present for their children or pursuing career goals without health interruptions.

Important note: Patients often find this question the most challenging to answer. If someone struggles, that’s completely normal. Give them time—perhaps suggest they think about it between sessions. Never lead them to an answer or force a response. The power lies in their own discovery.

Question 6: “What’s the next step, if any?”

The phrase “if any” is crucial. It removes pressure and maintains autonomy. The presupposition is that the patient will choose their own path forward, not have it imposed on them.

The Deeper Presuppositions

Understanding why these questions work requires grasping the psychological assumptions beneath them:

People are more motivated by their own reasons than by external ones. When Sarah talks herself into airway clearance because she wants to perform well at netball, that carries far more weight than your explanation about lung function.

Resistance often masks ambivalence, not defiance. When patients seem resistant, they’re usually wrestling with competing priorities—work demands versus exercise time, social activities versus dietary restrictions.

Everyone has some motivation, even if it’s small. A readiness level of 3 out of 10 isn’t failure; it’s 30% motivation to work with.

Self-persuasion creates cognitive dissonance. When patients voice their own reasons for change but acknowledge they’re not acting on them, it creates productive internal tension.

Change happens when people feel autonomous. The questions consistently put choice back in the patient’s hands, reducing reactance and increasing buy-in.

Making It Work in Practice

Start small. Choose one question and practice it until it feels natural. You don’t need to use all six in every consultation—understand the principles behind each question and adapt them to fit your style and your patient’s needs.

Remember, this isn’t about manipulation. It’s about helping people access their own wisdom about what matters to them. Some sessions, you might only get through questions 1 and 2. That’s perfectly fine.

Be patient, especially with question 5. If someone can’t immediately identify why their positive outcomes are important to them, resist the urge to supply answers. Sometimes the most powerful response is: “That’s a really good question to sit with. What comes up for you when you think about it?” Or “Take your time to think about the answer asI I’m really interested in your thoughts.”

Replace Frustration with Curiosity

The next time you encounter patient resistance, try shifting your internal narrative. Instead of thinking “Why won’t they listen?” try “What are they trying to tell me about their priorities?”

What if the resistance isn’t a barrier—but a signal? What if that patient who keeps missing appointments isn’t being difficult, but is showing you that something else feels more urgent in their life right now?

Pantalon’s questions help you become curious about what drives your patients, rather than frustrated by what seems to hold them back. And curiosity, as we know, is the backbone of exceptional communication.

When patients convince themselves to change, rather than being convinced by you, something powerful shifts. They’re no longer following your instructions—they’re pursuing their own goals. And that makes all the difference in long-term adherence.

The beauty of this approach is that it works whether you’re helping someone manage a lifelong condition like cystic fibrosis or supporting recovery from acute injury. The questions remain the same, but the answers—and the motivation they reveal—are uniquely theirs.

How might these questions change your next challenging conversation?

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