Counseling Strategies to Promote Behavior Change Flashcards
4 key elements in effective counseling
- change needs to come from patient: not imposed from outside
- see a compelling need for change
- confidence that they can do the new behavior
- be empathic and demonstrate it
2 requirements to change a behavior
- see a compelling need for change
2. feel capable o making change suggested
7 stages in trans theoretical model
- Pre-contemplative
- contemplative
- planning
- action
- maintenance
- relapse
- identification
pre contemplative
Patient:
-not considered possibility that diet is affecting their health
You:
-suggest to them that health problem is related to their diet
contemplative
patient:
- sees compelling need for change but doesn’t feel capable of changing
You:
- reinforce that you agree that there is a compelling need to change behavior
- help them if they pick a small achievable goal
planning
Patient:
- compelling need to change
- some confidence that they can make the change
You:
- troubleshoot the plan
- increase level of confidence that they can succeed in achieving their chosen goal
action
Patient:
- identified problem behavior
- made behavior change
You:
- should be supported in behavior change
- help them look toward the future
maintenance
Patient:
-tries to incorporate new diet into long-term lifestyle
Two outcomes of maintenance
- relapse
- patient feels hopeless
- you should encourage review of previous experience; relapse is common - identification
- incorporate long term changes into lifestyle
- you should help patients achieve long term success
problems with trans-theoretical model
-very few patients in action or maintenance phase
- different stages for different lifestyle change
- move through stages quickly and non-sequentially
role of counselor in motivational interview
- direct persuasion does not resolve ambivalence
- counseling style is quiet and eliciting, not directing/ advice giving
- counselor focuses on ambivalence as opposed to teaching specific skills
- readiness to change/ resistance provides feedback to counselor’s demands
- therapeutic relationship is a partnership more than an expert/recipient role
patient in motivational interviewing
- patient responsible for their progress
- goal: build self-efficacy and competence so they can solve problem themselves
- motivation is from the person and cannot be imposed from outside
- people don’t change because they are ambivalent; so goal: patient clearly articulate and work toward resolving ambivalence
It is unlikely that a person will make a lifestyle change if they don’t rate their behaviors as a problem at what level?
7 out of 10
confidence
- dramatic lifestyle changes undermine a person’s ability to make any change at all
- encourage the patient to make very small lifestyle changes and increase their confidence that the change can actually be made
- assist patient in coming up with strategy that works for them
patient rating level of confidence
7 or greater to increase likelihood that behavior change will actually occur
5 strategies that are part of MI
- reflection
- role with resistance: not ready for change
- highlighting discrepancies
- alternative futures
- Pro’s and Con’s to current and future behaviors
role of good reflexion statement
- shows patients that you are hearing what they said
- sincerely puts you in patient’s shoes to allow you to see them more clearly and a way forward
- person can hear their own words coming back at them
advantage of using alternative futures
- consequences of current behavior vs alternative behavior
- helps perceive adverse consequences that are distant
Health Belief Model
provides checklist for why patients are not taking your advice
Health Belief Model 5 factors
- perception of risk to self
- risk is serious
- treatments are effective and lack substantial SE
- exposed to compelling cues to health action
- confidence to perform behaviors that are proposed
values based counseling
–do not produce behavior change if they do not see it as a high priority
-relate core value to health behavior
cognitive behavior therapy
- have individual work backwards in time to see how even occurred to gain insight into how they might break chain of events
- identify specific idea that lead to undesired behavior and come up with specific strategies to counteract it so behavior change will be more effective
CBT uses
techniques directed at changing behaviors instead of focusing on values, motivation or ambivalence
overall approach
ask a question --> listen --> reflect --> Empathize --> Work w/ person to decide what they want to do
