18 - Developing Discrepancy

Question 1

What does it mean to Develop Discrepancy? (Video)

Answer 1

Developing a growing GAP between where they are and where they want to be

Question 2

How might you describe the motivation that comes from comparing the present situation vs the desired situation?

Why is that important?

Answer 2

The GAP between where they are and where they want to be.

Goal–status discrepancy is one of the most fundamental drivers of motivation for change (Ford, 1992)

Question 3

Why doesn’t all discrepancy lead to change? (3)

Answer 3

There are 3 potential reasons:

1) the discrepancy either seems too large to overcome, or too small to worry about
2) although the discrepancy may be clearly seen, the client may not feel they have the ability to close the gap
3) it is too painful to think about the discrepancy so they choose to ignore it altogether

Question 4

How should you handle the client who seems to be perfectly fine with their current situation?

Answer 4

Even when you meet someone who genuinely seems to be in precontemplation, a good starting point is to assume that some discrepancy is already there and search for it.

Question 5

What does it mean to instill discrepancy?

Answer 5

Instilling discrepancy is a process of sitting together and considering reasons why the person MIGHT consider change.

Question 6

What are the 4 elements of acceptance?

Answer 6

Remember that acceptance is not the same as approval or agreement.

The four elements of acceptance are:

• accurate empathy (accurately understanding the person’s own experience)
• autonomy (honoring the person’s choice and self-determination)
• absolute worth as a human being
• and affirmation.

Question 7

Why is acceptance important in developing discrepancy?

Answer 7

Ironically, it is when people experience acceptance of themselves as they are that change becomes possible. Causing people to feel bad and unacceptable usually entrenches the status quo.

Question 8

How might affirmations affect the client’s openness to discussing change?

Answer 8

Affirming someone’s strengths and good qualities, even ones unrelated to the task at hand, tends to decrease defensiveness and help people attend to potentially threatening information

Question 9

How might you start a process of instilling discrepancy with information?

Practice 1 example.

Answer 9

One approach that we find useful in this situation is to ask clients what they already know about the topic of concern.

“What do you know about (alcohol and pregnancy)?”

Question 10

What is the problem with trying to educate someone into action?

Answer 10

Addiction isn’t usually a knowledge deficit.

…we find, with people who smoke or who drink too much. Asked what they know, they can reel off a litany of the negative effects of what they are doing.

Question 11

You’ve just asked someone what they know about their problem and they’ve listed off several negative consequences of continuing. What’s one trap to look out for? Why?

Answer 11

Be careful, then, not to give in to the righting reflex here by thinking or asking, “Well then why haven’t you . . .?”

That will shut them down like an alligator’s jaws, and if you get any answer at all it is likely to be sustain talk.

Question 12

How generic should the information be that you provide to the client? Why?

Answer 12

Not at all. Ideally the information should be as specific to their situation as possible.

what consequences might this person be most concerned about based on age, gender, peer group, and stage of life?

The more tailored your response is, the less “canned” it sounds. Thus they are more receptive to what you have to say

Question 13

What is the purpose of the 2nd elicit section of the elicit - provide - elicit sequence?

Answer 13

Get the client’s reaction to what you have said:

“What do you think?”
“Does that make any sense to you?”
“Could I explain that better?”

Question 14

Based on the study with heavy drinkers, what form of feedback had the most impact?

Answer 14

The therapist offered one piece of assessment feedback at a time, then asked for the client’s reaction.

The result was often change talk in people who were initially not at all sure that they had any problem with drinking.

Question 15

When change talk is hard to find, what is a good starting point for the conversation?

Answer 15

When change talk is not forthcoming, a good starting point for engaging is to understand what your client DOES want.

Take your time in exploring the person’s own goals and hopes for the future.

Question 16

What is the biggest driver of clients changing their behavior?

Answer 16

Change tends to occur when a person perceives a significant discrepancy (GAP) between important goals/values and the status quo.

Question 17

What are the two forms of value/goal-status discrepancies?

Answer 17

1) Fear of loss
2) Desire for gain

It can be experienced as discontent with the status quo (Baumeister, 1994) or as an opportunity for betterment (or both).

Question 18

When developing discrepancies, it means discrepancy with what?

Answer 18

The client’s own goals and values

Question 19

What sort of atmosphere is best for helping develop discrepancy? Why?

Answer 19

A safe, accepting one.

In that environment, people are less defensive and more willing to honestly assess where they stand

Question 20

Your co-worker says to ask about values and then confront the client with the gaps you see: “don’t you see how this is holding you back?”

What might you do differently?

Answer 20

Let your client connect the dots

You usually don’t need to point out inconsistencies between the client’s behavior and values; usually these naturally become apparent to the client. Resist the righting reflex

Question 21

Is developing discrepancy only about moving away from the bad behavior?

Answer 21

It’s as much going TOWARDS something as away from something.

Bringing to life the thing the person wants to move towards, and then putting that together with their current behavior and saying “how does that fit?”

Question 22

How do you know when the discrepancy is widening?

Answer 22

The more the client describes the difficulties and what the behavior is costing them

and the more they describe where they would rather be instead

the more that discrepancy opens up