The document discusses readiness for change and the transtheoretical model of change. It defines readiness as a combination of previous experience, skills/knowledge, and attitude. It explores using the readiness ruler to assess motivation and lists questions to ask at different stages. People progress through stages using cognitive, affective and evaluative processes and later rely on commitments, conditioning and support. The goals of system change and 10 processes for moving through stages are outlined.

1. Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, NCC
Executive Director, AllCEUs.com

2.  Define Readiness
 Learn how to use the readiness ruler
 Identify the 4 types of precontemplators
 Identify processes people use to move through the
stages of change
 Explore the TransTheoretical Model of Change
 Discuss the 7 steps in the change process

3.  "Readiness" refers to the combination of factors
evident in participants: their previous experience
with such endeavors, the degree to which they have
the necessary skills and knowledge for the tasks
ahead and their attitude toward undertaking this
change

5.  Types of precontemplators
◦ Reluctant precontemplators
 Lack sufficient knowledge about the problem, or the
personal impact it can have, to think change is necessary.
 Sensitively provide feedback about how substance use is
actually affecting their lives
◦ Rebellious precontemplators
 Afraid of losing control over their lives and have a large
investment in their substance of choice
 Help them shift energy into making positive choices rather
than rebelling against what they perceive as coercion

6.  Types cont…
◦ Resigned precontemplators
 Feel hopeless about change
 Feel overwhelmed by the energy required
 Help them regain hope, optimism about capacity for change
 Explore specific barriers that impede new beginnings
◦ Rationalizing precontemplators
 Have all the answers. Substance use may be a problem for
others but not for them
 Double-sided reflection seems the most effective strategy
for this type of client

7.  If the person's mark is on the left of center:
 How will you know when it is time to think about
changing?
 What signals will tell you to think about making a
change?
 What qualities in yourself are important to you?
 What connection is there between those qualities and
not considering a change?

8.  Change Extrinsic to Intrinsic Motivation
 Intrinsic motivation often begins at the point when
clients recognize the discrepancies between "where they
are" and “where they want to be.”
 Start with the client's current situation and find a
natural link between existing external motivators and
intrinsic ones the client may not be aware of
 Understand what change means to clients and what
their expectations of treatment are

9.  If the person's mark is near the center:
 Why did you put your mark there and not closer to the left?
 What might make you put your mark further to the right?
 What are the good things about the way you are currently
trying to change?
 What are the things that are not so good?
 What would be a good result of changing?
 What are the barriers to changing?

10.  Signs of readiness
◦ Decreased resistance.
◦ Fewer questions about the problem.
◦ Resolve.
◦ Self-motivational statements reflecting willingness ("I
have to do something") and optimism ("I can beat it").
◦ More questions about change.
◦ Envisioning.
◦ Experimenting.

11.  If the person's mark is on the right of center:
◦ What is one barrier to change?
◦ What are some things that could help you overcome
this barrier?
◦ Pick one of those things that could help and decide to
do it by____________________(specific date).

12.  If the person has taken a serious step toward
change:
◦ What made you decide on that particular step?
◦ What has worked in taking this step?
◦ What helped it work?
◦ What could help it work even better?
◦ What else would help?
◦ Can you break that step down into smaller parts?
 Pick one of those parts and decide to do it by______(specific
date).

13.  If the person is changing and trying to maintain
that change:
◦ Congratulations! What's helping you?
◦ What else would help?
◦ What makes it hard to maintain the change?

14.  To progress through the early stages, people use
◦ Cognitive
◦ Affective
◦ Evaluative processes
 In action and maintenance, they rely on
◦ Commitments
◦ Conditioning
◦ Contingencies
◦ Controls (environmental)
◦ Support

15.  10 covert and overt activities used to progress
through the stages of readiness for change
◦ Consciousness-Raising—increasing awareness via
information, education, and personal feedback
◦ Dramatic Relief—Feeling inspiration and hope when they
hear about how people are able to change
◦ Environmental Reevaluation—realizing how their unhealthy
behavior affects others and how they could have more
positive effects by changing

16.  The 10 processes
◦ Social Liberation—realizing that society is more supportive
of the healthy behavior
◦ Self-Reevaluation—realizing that the healthy behavior is an
important part of who they are and want to be
◦ Stimulus Control—using reminders and cues that
encourage healthy behavior as substitutes for those that
encourage the unhealthy behavior.
◦ Helping Relationships—finding people who are supportive
of their change

17.  The 10 processes
◦ Counter-Conditioning—substituting healthy ways of acting
and thinking for unhealthy ways
◦ Reinforcement Management—increasing the rewards that
come from positive behavior and reducing those that come
from negative behavior
◦ Self-Liberation—believing in one’s ability to change and
making commitments to act on that belief

18.  Create coalition
 Develop vision
 Share vision
 Empower
 Short term wins
 Consolidate gains
 Anchor change

19.  Establish rapport
 Decisional balance exercises
 Roll with resistance

20.  Define the problem (observable, measurable)
 Define the resolution (observable, measurable)
 Questions
◦ What do you think you will do?
◦ What does this mean about your drinking?
◦ It must be uncomfortable for you now, seeing all this.
What's the next step?
◦ What do you think has to change?
◦ It sounds like things can't stay the way they are now. What
are you going to do?

21.  Questions
◦ Of the things I have mentioned here, which are the most
important reasons for a change?
◦ How are you going to do it?
◦ Where do we go from here?
◦ How would you like things to turn out now for you, ideally?
◦ What concerns you about changing your use of drugs?
◦ What would be some of the good things about making a
change?

22.  Develop a plan
◦ Offering a menu of change options
◦ Developing a behavior contract
◦ Lowering barriers to action
◦ Enlisting social support
◦ Educating your client about treatment
 Identify intensity and amount of help needed

23.  Identify available social support—
Who, Where, When
 Develop a sequence of subgoals or steps in the
plan
 Discuss how to address multiple concurrent
problems--for example, how to deal with
legal, financial, and health problems

24.  Assist patients in implementing plan
 Provide encouragement and support
 Reward small steps
 Troubleshoot
◦ Decreasing motivation
◦ Relapse warning signs

25.  Identify patient’s goals and rewards
◦ Daily
◦ Weekly
◦ Monthly
 Rewards that are sufficiently strong and frequent
◦ Prevent behavior strain
◦ Maintain forward progress

26.  Monthly treatment plan reviews
◦ Highlight successes
◦ Empower patient to troubleshoot unmet goals
◦ Normalize imperfection

27.  Relapse prevention planning
 Daily grounding/mindfulness activities
 Support group meetings

28.  Defining "Readiness“ as the combination of factors
◦ Their previous experience with such endeavors
◦ The degree to which they have the necessary skills and
knowledge for the tasks ahead
◦ Their attitude toward undertaking this change
 Explored the use of the Readiness Ruler and questions
to ask to propel people toward change.
 To progress through the early stages, people use
cognitive, affective, evaluative processes

29.  In action and maintenance, they rely on Commitments,
Conditioning, Contingencies, Controls, Support
 Goals for System Change
◦ Create coalition
◦ Develop vision
◦ Share vision
◦ Empower
◦ Short term wins
◦ Consolidate gains
◦ Anchor change

30.  10 activities used to progress through change
◦ Consciousness-Raising
◦ Dramatic Relief
◦ Environmental Reevaluation
◦ Social Liberation
◦ Self-Liberation
◦ Helping Relationships
◦ Stimulus Control
◦ Helping Relationship
◦ Counter-Conditioning
◦ Reinforcement Management