Facilitating change Flashcards
what does this thought process display
“drugs are bad… but i like being high”
ambivalence.
understanding ambivalence
normal, understandable, acceptable and expected in facilitating change
strong and sometimes long held attatchment to problematic behavour
- e.g. physical dependence, social association, conditioned association, help with coping etc.)
what is the stages of change model?
process of change rater than change as an event
process of changing addictive behaviours happens via a series of stages from pre-contemplation to maintainance
what are the stages of change according to
Prochaska and DiClemente’s model
pre-contemplation
contemplation
preparation
action
maintenance
REPEAT - learning from each relapse
what does pre-contemplation stage look like
“i dont have a problem”
happy user
not planning to change in foreseeable future
uninformed or under informed
- not that there isn’t a solution but they cant see the problem
family/friends see the problem
resistant to change
sometimes demoralised following relapse
what does contemplation stage look like
on the fence
aware of the problem
seriously thinkng about/considering change
not yet made a commitment for change
ambivalence - weighing up the pros and cons
what does preparation stage look like
making a plan for change
plan for action in next month
open to information and support
may have made small changes
- reduced smoking slightly
what does the action stage look like
making changes
putting plan into action
- modifying behaviour, thoughts, environment
behaviour changes (1 day - 6 months) - considerable commitment of time and energy
high potential for relapse
what does the maintenance stage look like
changes tht last
changes maintained for 6 months+
focus on preventing relapse
more confident
what does lapse stage look like
lapse = a slip up, using foe a brief time and getting back on track
common after long periods of maintenance
rule rather than exception - most people dont make it on the first attempt
can go back to any stage
can happen on multiple occasions
does nto mean the person is not motivatied
what does relapse stage look like
going back to old patterns or use
go back to contemplation/preparation stages
prevalence of lapse/relapse
common occurance
90% of clients will experience a lapse within 12 months of competing treatment
(breif return to use)
60% of clients will relapse within 12 months
(return to old patterns)
what is motivational interviewing?
a collaborative person centred form of guiding to elicit and strengthen motivaition to change
what are the assumptions of Motivational interviewing ?
5 important assumptions
- motivation is a state not a trait
- resistance is not a force we must overcome
- ambivalence is normal
- person seeking help should be an ally rather than an adversary
- recovery and change are innate, constant an dintrinsic to the human experience
what are the three deviations of the motivational interviewing “spirit”
collaboraiton - client centred, partnership nto expert/recipient
evocation - designed to elicit clients own motivations, “change talk”
autonomy - client is responsible for change, freedom to choose the direction
what are the four processes of MI
engaging
focusing
evoking
planning
what are the key concepts of the engaging process of MI
relational foundation
client centred
acceptance facilitates change
skilful reflective listening is fundimental
express empathy
what are the key concepts of the focusing process of MI
assist clients to identity the target area in which they are struggling to make change by:
- setting an agenda
- askign the client whats important to them
- once identified, be transparent about what the target is
what are the key concepts of the evoking process of MI
evoking change talk
use clients own motivators to highlight discrepancies between present behaviour and improtant personal goals or values
ambivalence is normal
recognise and respond
“psychological squirm”
in the evoking process of MI what do the acronyms
DARN
and
CAT
stand for?
D- desire to change
A- ability to change
R- reason to change
N- need to change
C- Commitment
A- Activation
T- taking steps
what is change talk
speech that favours a movement towards change and motivation
how do you evoke change talk
OARS skills
open ended question s
affirmations
reflective listening
sumarising
what are the key goals of the planning process of MI
the bridge to change - negotiating goals and plans and strengthening commitment
development of a change plan
review change plans to determine if more support is needed
in the planning process of MI, what are the important things to consider when developing a plan?
clients belief in possibility for change - important motivator
client responsible for change
counsellor’s belief in client is also important
client is primary resource of solutions
where does motivational interviewing fit in to the stages of change model?
during the contemplation stage
assessing change
how do you assess when a client is prepared for change ?
assess importance, confidence and readiness to assess how ambivalent or how prepared a client is for change
in assessing change what does assessing importance confidence and readiness tell us
importance - how much change matters
confidence - how strongly you believe you can change and how self assured you feel
readiness - how ready you feel right now to make the changes you desire, is this the right tiem
what is decisional balance,
perceived advantaged and disadvantages of problem vs. change
what is the assumption of decisional balance
motivation for change affected by decisional balance
what can a clients decisional balance tell us
can assist in assessment of what stage of change the client is in
what differs between the traditional view and alternate view of change
trditional -
use pressure and force»_space; short lived changes
alternate -
develop personal desire»_space; long lasting change
what are the steps in completing a moticational interview ?
- gain rapport
- assess readiness to change
- cost benefit analysis
- explore concerns,
- build confidence
- summaries and assist decision making
what is sustain talk?
speech favouring staying the same
what is the desired relationship between sustain talk and change talk
elicit change talk to reduce sustain talk
