Exam 3 Flashcards
“Yes, but…”, “I guess I could try” are examples of what?
Resistance
Too quick to agreement, not following through on plans, interrupting, appearing distracting, or getting defensive could indicate
Resistance
What is resistance?
Pushback when a client isn’t ready for change
What is internal resistance?
Ambivalence
What is ambivalence?
Conflict within a person
change talk vs. sustain talk
When does resistance occur?
No control
No choice
No understanding
Wanting to fix a crooked picture is an example of
The Righting Reflex
Knowledge of long-term health consequences, picking up client’s anxiety, desire to be successful, and pressure from others on the team are ways in which…
Counselor contributes to resistance
How can a counselor minimize the chances of resistance occurring?
Emphasize personal choice and control
What are some ways a counselor can emphasize personal choice and control?
Emphasize autonomy Ask permission before advice Let clients choose what to work on Check works carefully Open-ended questions Affirm and reflect
What is crucial to avoiding resistance?
Assessing readiness
What are the two parts of assessing and re-assessing readiness?
focus on what’s important to the client
how confident they are about changing
T/F Assessing readiness might include “how ready are you to change?”
False
WIC participants, bariatric surgery candidates, and teens are what type of clients?
Mandated
How to deal with resistance in mandated clients?
Acknowledge resistance Affirm something Offer list of options Open-ended questions Ask for elaboration Reflect and focus on one area Collaborate
How should a counselor react when encountering resistance?
Roll with it State what you know (immediacy) Back off Acknowledge resistance Collaborate Talk about issue in a different context
When is interrupting appropriate?
Client off topic
To summarize change talk if sustain talk comes up
When time is limited
When not to interrupt?
Progress
Strong feelings
What are some CONS with self-reference?
Helper self-absorbed
Chatty session
Loss of focus
What are some PROS with self-reference?
Builds trust and rapport
With self-reference, if a helper says, “I never thought I could give myself shots either when I first learned I had diabetes,” this is an example of…
Self-disclosing
Which form of self-reference is seen as less risky?
Self-involving
With self-reference, if a helper says, “I am delighted that you are doing so well” or “I’m concerned…,” (interjecting your feelings) this is an example of
Self-involving
Why do clients ask personal questions about their counselor?
To see if counselor can understand
Not about the counselor, it is about the client
How to answer personal questions?
Determine what to disclose What's behind the question Respond to what matters to the client Briefly self-disclose Redirect the topic back to your client
If a client is expressing desire, what stage of change are they exhibiting?
Pre-contemplation
What does DARNCAT stand for?
Desire Ability Reasons Need Commitment Activation Taking Steps
If a client is saying “I could”, “I can”, or “I can see myself”, what type of change talk are they exhibiting?
Ability
If a client is saying “I would feel better if” or “This keeps me from…”, what type of change talk are they exhibiting?
Reasons
If a client is saying “I ought to”, “I have to”, or “I really should”, what type of change talk are they exhibiting?
Needs
If a client is saying “I will” or “I am going to”, what type of change talk are they exhibiting?
Commitment
If a client is saying “I’m ready to” or “I’m willing to”… what type of change talk are they exhibiting?
Activation
What does change talk reveal about a client?
Motivations
Concerns
Readiness
What does EARS stand for
Elaborate
Affirm
Reflect
Summarize
When is EARS used?
when there is change talk
“Tell me more” might be something a counselor says to…
Elaborate
Evoke
If a counselor shows appreciation such as “thank you for coming in today”, notes steps or efforts the client has made, or says something like “you can do as much as you want for your health”, what are technique are they using
Affirmation
If a counselor restates what they hear and makes a guess about the meaning, they are exhibiting…
Reflection
T/F A counselor should include minimal sustain talk and reflect all change talk during summarizing
True
A long-term outcome that the client desires
Goal
Short-term strategies you help the client to develop in order to make progress towards their goal(s)
Plans
In what stages of change would goal-setting and planning be appropriate?
Contemplation
SMART goals
Specific Measurable Achievable Realistic Timely
What is a first order change?
Adjustment to current situation
Fixing
Addressing symptoms
What is a second order change?
Changing underlying system
Transforming
Addressing causes
What is the process for plan making with clients?
Ask client for ideas first
Offer options
Summarize and ask for next step
What questions might a counselor ask to inquire about a client’s ideas for goal setting/planning?
What appeal to you about your plan?
What concerns do you have?
The client feels like there is only one option or one right way to go about something
Convergent thinking
The client is aware of the potential for more options
Divergent thinking
What are some problems that might be encountered with goals setting/plan-making
Too big Too vague Counselor suggesting a plan Resistance Convergent thinking
What might be discussed with a client to help them consider problems they might encounter with their plan?
Time
Money
Effort
What is important with implementation of a client plan?
Identify obstacles
Higher quality of motivation (intrinsic)
Flexible tenacity (adaptability)
Contingency plans
What type of motivation is considered the strongest?
Intrinsic
What might a counselor address when the client is procrastinating with moving forward with a plan?
Readiness Restate goals Competing agendas Necessary skills Fear of failure
How would a counselor apply social cognitive theory in order to assist a client with sustaining behavior change?
Increase self-efficacy by providing missing skills
What are some things that happen in the present when interacting with clients?
Build rapport
Clarify key issues
Bias for action
How does a counselor respond to sustain talk?
Reflect
Amplify
Confrontation (on one hand…)
Which change talk is in the contemplation & preparation stage?
Desire
Ability
Reasons
Need
Which change talk is in the preparation stage?
Commitment
Activation
What are types of affirming with clients?
Appreciation
Steps/Efforts
Strengths/Process
What are some ideas for affirmation?
Ambitious Adaptable Bold Brave Capable Competent
If a client isn’t showing an change talk, what can a counselor do?
Focus on reasons to make change
T/F The best option for the nutrition problem is not always the best option for the client
True
When should you discuss goals with a client?
Early in the assessment
Characteristics of a high-goal-directed people
Outgoing
Involved
Resourceful
Persistent
Characteristics of low-goal-drected people
Self-critical
Dissatisfied
Sulky
Self-centered
T/F Eat healthier is a specific goal
False
What are must-haves with setting ACHIEVABLE goals?
Resources
Under client’s control
External circumstances
What is a specific goal to decrease blood pressure?
Eat two servings of vegetables for lunch and dinner
What is a specific goal to decrease cancer risk?
Take an apple with me to work each day to eat during a break
Comparing a client’s wants to their needs is involved in which part of smart goal setting?
Realistic
A client says “Well I have kept food records before and it did help me eat less carbs” - what could a counselor pick up on here?
Focus for change
A counselor says, “So you are able to keep track of your carbs and you know it helps,” what is occurring here?
Reflection of ability
A client says, “I have a new phone app and it can tell me carb portions. I could start putting my food in it,” what is occurring here?
Ability statement
A client says, “I don’t know about starting this week, its going to be crazy with travel,” and the counselor responds “I hear that this is not the ideal week to begin using that app. What do you see yourself doing this week?” What is occurring here
Rolling with resistance
If a client is committing to a plan that seems too big or vague, how could the counselor respond to encourage a more specific plan?
Tell me more about how this will look.
Run me through your week to see where it will fit in.
Give an example of an open-ended question related to evoking desire
Why would you want to make this change?
Give an example of an open-ended questions related to evoking ability
How might you go about it in order to succeed?
Give an example of an open-ended question related to evoking reasons
What are the three best reasons for you to do it?
Give an example of an open-ended question related to evoking need
How important is it for you to make this change?
Give an example of an open-ended questions related to evoking commitment
So what do you think you’ll do?
Give an example of evoking change talk by looking back
How have things been better in the past?
Give an example of evoking change talk by looking forward
How would you like your life to be in the future?
How to respond to a client that says “This is all just so hard” by elaboration?
Tell me what is hardest about…
How to respond to a client that says “I don’t buy regular soda anymore” by affirmation
You are a person who can make permanent change
How to respond to a client that says “I’m scared of ending up on dialysis like my mother” by reflecting
Your health is very important to you
How could a counselor acknowledge resistance and back off
You believe that idea won’t work for you.
How could a counselor shift into tracking readiness when there is resistance?
I can tell we’ve gotten off track here. Can you help me review what’s most important to you right now?
How could a counselor promote client control?
What would you like to work on next?
How could a counselor mirror ambivalence?
I’m hearing that you feel two ways about this.
How could a counselor work with experiments when there is a resistance?
No matter what happens, something about it will be useful
When you can’t tell if the client has chosen the appt, how could you feel this out?
Tell me your thoughts about coming here today
How to take a collaborative stance by asking the client for suggestions about how to proceed or asking permission to provide advice?
If you were to do one thing differently to make that go better, what might it be?
People learn by observation and are influenced by their beliefs, environment, and the behavior
Social Learning Theory
Learning occurs in a social context with dynamic and reciprocal interaction of the person, environment, and behavior
Social Cognitive Theory
Social Cognitive Theory constructs
Reciprocal Determinism Behavioral Capability Observational Learning Reinforcement Expectations Self-efficacy
Interaction between a person, his/her environment and the behavior
Reciprocal Determinism
Having the knowledge and skills for a certain behavior
Behavior compatibility
Modeling/imitation
Observational learning
Self-initiated or in the environment, positive or negative
Reinforcement
Anticipated outcomes
Expectations
Person’s confidence in her/her ability to succeed at change
Self-efficacy
Which construct differentiates SCT from SLT
Self-efficacy
What are the 3 times to apply social cognitive theory during counseling?
Antecedent
Behavior
Consequence
What is an example of an antecedent?
Hunger
Stress
What component of social cognitive theory does stimulus control deal with?
Antecedent
What component of SCT does countering deal with?
Behavior
What component of SCT does reinforcement deal with?
Consequences
What are some common examples in nutrition of altering the ABCs?
use a shopping list
serve foods attractively
calendar reminders
social support
Changing your frame of mind regarding eating - don’t eat to “get your money’s worth” at a buffet
Cognitive restructuring
Forming a plan of action, a response to a situation - identify eating challenges in the week ahead
Contingency management
Can reveal patterns that may explain problem habits, can raise client awareness, can keep client accountable, can give you clues about progress
Self-monitoring
Motivation includes what 3 behaviors/expressions by a client
Ready
Willing
Able
Energy that directs our behavior
Motivation
What are some external issues in the community that could negatively influence a person’s motivation?
Barriers to health care
Lack of sidewalks
Food deserts
People feel effective in the behavior
Competence
People feel they have personally chosen the behavior w/o pressure/control from others
Autonomy
People feel like they belong, and is connect to and understood by others
Relatedness
What are the 3 basic psychological needs to move a client from should to want to
Competence
Autonomy
Relatedness
How to encourage autonomy with clients?
Give choices
Avoid coercion
How to demonstrate relatedness to influence motivation quality?
Use affirmation
Empathetic responses
“I wouldn’t if I had a choice or someone didn’t make me” is an example of
Non-regulation
“To look good, win a contest, lose weight” is an example of
External regulation
“I think I should/I feel guilty if I don’t” is an example of
Introjected regulation
“It’s enjoyable and I feel great when I do it” is an example of
Intrinsic regulation
“I value the outcomes it produces” is an example of
Identified regulation
“I want it to be who I am…” is an example of
Integrated regulation
How to cultivate a client’s own lasting motivation?
Unpack meaning and importance
Open-ended questions
Affirm
Circle back to original motivators
Place the quality of motivation in order from the lowest to highest quality
Nonregulation External regulation Introjected regulation Identified regulation Integrated regulation Intrinsic regulation
