36. DECISIONAL BALANCE Benefits of Changing Benefits of Not Changing Consequences of Changing Consequences of Not Changing Change Costs Status-quo Benefits
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Editor's Notes
As you review each stage – ask them for client examples – have them explain why they think the client is at that stage.
So, its most important to recognize where the client is at in their stage of change because that determines what your intervention should be. Use the AA example – what do you think would happen if you sent someone in precontemplation to an AA meeting? What do you have to do at an AA meeting? (acknowledge that you are an alcoholic) Is someone in precontemplation going to do that? How do you think they would feel at the meeting? How do you think they would feel about ever going to another one?
Client is strong willed. She lives on her own, and works hard to look after her children, two very active boys. She’s fearful outdoors, gets panic attacks and uses alcohol like medicine. Have them read the conversation and then ask the following questions: What is the attitude or style of the counselor? Who talks about change? What progress does the client make?
Have them review this conversation and ask the same questions: What is the counselor’s attitude or style this time? Who talks about change? What progress is the client making?
SPIRIT –Everything else is the skills and competencies!
Exercise: Provide Handout for closed and open ended questions. Give a couple minutes to complete and then review as a group.
Questions to staff : Why are affirmations important? Why should we express positive regard and caring? Why do they help strengthen the relationship? Exercise: Each staff think of a challenging client – pick 4 affirmations from the Characteristics of Successful Changers list
If the client believes that you understand them, they will be more likely to share things with you and more likely to work with you By using reflective listening instead of questioning you encourage the client to continue talking and expressing his or her view and feelings.
Client: I feel so full of shakes that I take a drink before I leave the house. Counselor: It helps to settle your nerves. – amplified – use metaphor or feelings Client: And I can go get the kids from school, shop and then feed them. Counselor: and you get quite a lot done. - simple Client: yes, those kids keep me going for hours after that, you know the food, playing, going to bed and they are not easy, shouting all the time. Counselor: you’ve told me about those panic attacks, how you work so hard to look after the kids and how you sometimes need a drink before you leave the house. – simple paraphrase Client: yes, that’s exactly right. Counselor: May I ask you, could we spend a few minutes talking about alcohol, how it helps and what else you’ve noticed about it? Client: well as I said, it calms my nerves, but it can’t go on like this forever. Counselor: although it helps, you’re concerned about it. – amplified – double sided Client: well, I’m not an alcoholic you know but I can’t be drinking while I am with the kids. Counselor: you don’t want your life to revolve about drinking. - amplified – metaphor or feeling added. Client: exactly you know I must watch it.
What do you think will happen if you do these? How would you feel?
7:00 – 11:00 class 14:40 - end
Why is it ambivalence in the contemplation stage? What is happening with the client then? * These are the two most important statements – expect it – be patient – roll with it!
It might mean you were judgemental. It might mean you came across as offering advice. So what could you do to change your approach?
After each example have them think of clients who fit.
Q/A = people don’t feel heard Expert = people like to be the expert of their own lives Taking sides Labeling Premature focus – first thing the client talks about may not be the real problem Blaming Righting reflex – watch for our urge to fix things
Review the conversation and identify change talk Client: I feel so full of shakes that I take a drink before I leave the house. Counselor: It helps to settle your nerves. Client: And I can go get the kids from school, shop and then feed them. Counselor: and you get quite a lot done. Client: yes, those kids keep me going for hours after that, you know the food, playing, going to bed and they are not easy, shouting all the time. Counselor: you’ve told me about those panic attacks, how you work so hard to look after the kids and how you sometimes need a drink before you leave the house. Client: yes, that’s exactly right. Counselor: May I ask you, could we spend a few minutes talking about alcohol, how it helps and what else you’ve noticed about it? Client: well as I said, it calms my nerves, but it can’t go on like this forever. Counselor: although it helps, you’re concerned about it. Client: well, I’m not an alcoholic you know but I can’t be drinking while I am with the kids. Counselor: you don’t want your life to revolve about drinking. Client: exactly you know I must watch it.
Evoke change talk – these questions will do it!
Pay off matrix that you have seen before – this can also help with querying the extremes – what is the worst that could happen what is the best, etc.
