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Enhancing Motivation for Change

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Enhancing Motivation for Change

  1. 1. Enhancing Motivation for Change in Substance Abuse Treatment Part 2 Instructor: Dr. Dawn-Elise Snipes, PhD Executive Director: AllCEUs.com, Counselor Education and Training Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 1
  2. 2. Objectives  Learn about the nature of change  Explore the different stages of readiness for change  Learn about goals and interventions for each stage for readiness for change  Identify ways to identify a clients change in readiness for change  Explore ways to identify barriers to recovery  Learn how to explore expectations regarding recovery and how to use that to enhance motivation  Briefly review how to develop a relapse prevention plan AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 2
  3. 3. Change  Is Constant  Occurs all the time  In the natural environment  Among people  In relation to behaviors  Occurs without professional intervention  The change process is cyclical, and people typically move back and forth between the stages and cycle through the stages at different rates.  It is not uncommon for people to linger in the early stages.  Recurrence of at least some symptoms or old behaviors is a normal event, and many clients cycle through the different stages several times before achieving stable recovery. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 3
  4. 4. Nature of Change  6 basic stages in the process of change:  Precontemplation  Contemplation  Preparation  Action  Maintenance  Recurrence  People typically vacillate between the stages and cycle through the stages at different rates. (Pool) AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 4
  5. 5. Precontemplation  The client is unaware, unable, or unwilling to change.  Establish rapport  Raise doubts about patterns of use  Give info on risks, pros and cons of use  Explore reasons for unwillingness to change (.i.e fear of failure)  The client is likely to be wary of the counselor and of treatment.  Should not rub the client the wrong way  Should try to keep the interview informal. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 5
  6. 6. Ambivalence  Many clients are ambivalent about change.  Change is hard  Ambivalence is expressed in several ways.  Argue: Challenge or discount statements  Interrupt: Take over or cut off conversation  Deny: Blame, disagree, excuse, minimize  Ignore: Not responding, not paying attention AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 6
  7. 7. Goals/Actions  Explore the meaning of events that brought the client to treatment or the results of previous treatments.  Elicit the client's perceptions of the problem.  Offer factual information about the risks  Provide personalized feedback about assessment  Explore the pros and cons of substance use.  Help a significant other intervene.  Examine discrepancies between the client's and others’ perceptions of the problem behavior.  Express concern and keep the door open. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 7
  8. 8. Contemplation  The client is ambivalent or uncertain, considering the possibility of change. ◦ Counselor can  Discuss and weigh pros/cons of change (Decisional Balance)  Emphasize client's free choice and responsibility  Elicit self-motivational statements  Reassure the client that no one can force him to change and he is in charge.  Ask questions that prompt motivation. ◦ For example, "When you want to keep up your motivation for doing something, what are some of the things you say to yourself?" AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 8
  9. 9. Goals/Actions  Help the client recognize the problem(s) contributing to the current situation  Help the client acknowledge concern  Help the client generate intention to change  Help the client develop optimism  Convey feedback  Help clients see a difference  Show curiosity about client strengths. Explore how those skills and competencies may be negated by their current state  Reframe negative statements. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 9
  10. 10. Highlight Reasons for Change  Summarize concerns  Explore specific pros and cons  Allow client to explain benefits  Assure client conflicting feelings are normal  Review feedback from assessment  Find out what client expects from treatment  Provide info  Help client connect core values to committing to treatment AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 10
  11. 11. Strengthen the Client's Personal Choices  Nudge the client to make positive choices.  "No one can decide this for you. You can choose."  Help the client set goals and take steps.  Provide feedback.  Remind client of "triggers," including negative emotions (anger), social pressures (peers), physical concerns (headache) and extended withdrawal symptoms (craving). AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 11
  12. 12. Reinforce the Client's Commitment  What do you think has to change?  What are you going to do?  How are you going to do it?  What are some benefits of making a change?  How would you like things to turn out, ideally? For more detailed information, see TIP 35, pp. 54–92. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 12
  13. 13. Preparation  The client asks questions, indicates willingness and considers options to make specific changes.  Explore treatment expectancies and the client's role.  Elicit from the client what has worked in the past either for him or others whom he knows.  At this stage, the client shifts from "thinking about it" to "planning first steps."  Counselor guides the steps by offering help but not yanking the client forward. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 13
  14. 14. Help The Client Get Ready  Negotiate a plan  Offer a menu of options  Develop a behavior contract  Identify and lower barriers  Enlist social support  With permission offer advice  Assist the client in negotiating finances, child care, work, transportation, or other potential barriers.  Have the client publicly announce plans AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 14
  15. 15. Client Indicates Readiness  Stops arguing, interrupting, denying  No longer asks questions about the problem, but more about how to change  Appears calm, peaceful  States openness to change ("I have to do something")  Expresses optimism ("I can beat this")  Talks about how life will be after the change  Experiments between sessions AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 15
  16. 16. Barriers  Ask what has gone wrong in the past  Find out if clients anticipate problems  Provide all necessary information  Sources of barriers may include  Family relations  Health problems  Depression or other negative feelings  Bureaucracy: Waiting lists, paperwork, legal  Finances AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 16
  17. 17. Action  The client takes steps toward change, but is still unstable.  Negotiate an action plan  Acknowledge difficulties and support attempts  Identify risky situations and coping strategies  Help client find new reinforcers  Support perseverance ("Sticking to the plan")  In this stage, clients are receptive to the full range of counselor techniques, but motivation can wax and wane  If relapse occurs, "back up" and apply techniques from an earlier stage. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 17
  18. 18. Goals/Actions  Engage the client in treatment and reinforce the importance of remaining in recovery.  Support a view of change through small steps.  Acknowledge difficulties for the client in early stages of change.  Help the client identify high-risk situations and develop appropriate coping strategies  Assist the client in finding reinforcers  Help the client assess levels of social support. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 18
  19. 19. Explore Expectations  Explore past experiences, hopes, and fears regarding  Confrontation, judgment  Costs in money or changed behavior Can’t stay out late anymore because it triggers depression Have to give up certain activities (at least temporarily) like cross posting  Family involvement, shame, guilt  Medications the client will have to withdraw from or take  Perception of rules too strict, no "wiggle room."  Understanding  Immunize against difficulties  Resolve barriers to treatment AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 19
  20. 20. Increase Motivations  Help the client to see the value of both internal and external motivating factors  Suggest to the client that external coercions are compatible with the client's best interests  Support signs of internal motivation AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 20
  21. 21. Examine & Interpret Noncompliant Behavior  Noncompliant behavior is a thinly veiled expression of dissatisfaction with treatment or the therapeutic process.  It may be you  You may be missing something  What are the benefits to the behavior AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 21
  22. 22. Maintenance  Client has met initial goals, made changes in lifestyle and now practices coping strategies.  Support and affirm changes  Rehearse new coping strategies  Review goals  Keep in contact (aftercare, support groups)  In this stage, clients "keep on keeping on." AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 22
  23. 23. Cont…  Remind the client about new tools to maintain and reinforce recovery, such as  Action plan  Awareness of risky situations  Coping strategies for each situation  Participation in 12-Step programs or support groups  Pursuit of hobbies and cultural activities  Volunteer opportunities AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 23
  24. 24. Goals/Actions  Help the client identify and sample drug-free sources of pleasure (i.e., new reinforcers).  Support lifestyle changes.  Affirm the client's resolve and self-efficacy.  Help the client practice/use coping strategies  Maintain supportive contact  Develop a "fire escape" plan if the client feels symptoms returning or notices a return to old ways of thinking  Review long-term goals with the client. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 24
  25. 25. Form a Plan.  Identify triggers  Identify effect/benefits of the old way of responding to the trigger  Identify alternate, helpful coping responses AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 25
  26. 26. Developing Reinforcers  Competing  Sleeping  Crying  Self-Harm  Contingent (If/Then)  If you respond effectively then you can…  If you get out of bed by 9am each day then…  Community (natural consequences) AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 26
  27. 27. Recurrence  Help the client reenter the change cycle and commend any willingness to reconsider positive change.  Explore the meaning and reality of the recurrence as a learning opportunity.  Assist the client in finding alternative coping strategies.  Maintain supportive contact. AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 27
  28. 28. Applications of Motivational Approaches  A means of rapid engagement in the general medical setting to facilitate referral to treatment  A first session to increase the likelihood that a client will return and to deliver a useful service if the client does not return  An empowering brief consultation when a client is placed on a waiting list, rather than telling a client just to wait for treatment  A preparation for treatment to increase retention and participation AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 28
  29. 29. Applications cont…  A help to clients coerced into treatment to move beyond initial feelings of anger and resentment  A means to overcome client defensiveness and resistance  A stand-alone intervention in settings where there is only brief contact  A counseling style used through the process of change AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 29
  30. 30. Other Things to Remember  Often there is a relatively short period of time to make a beneficial impact on the client  The average length of stay in substance abuse treatment is very short  If clinicians do not make an impact in the first session or two with clients, they may not be able to make an impact at all  Make the best use of the first contact  It is usually a mistake to start a session with filling out forms AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 30
  31. 31. Summary  Even one session can make a positive impact on a client  Lasting change takes time and effort  All clients have the ability to make positive choices and changes  Clients will be at different stages of readiness for change for different issues and symptoms and may vacillate between conflicting goals  Clients with low motivation begin arguing, ignoring or becoming apathetic  Sometimes enhancing motivation means focusing first on barriers to recovery instead of the problem itself.  Explore expectations regarding recovery to enhance motivation  Develop a relapse prevention plan that helps clients identify triggers and vulnerabilities and ways to prevent and address them AllCEUs Unlimited CEUs $59 | Webinars $3 | Addiction Counselor Certification Training $149 31

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