Module 8: Counselling Flashcards
Behavioural change that is integrated with counselling assists patients on what 5 main factors?
- Exercise/physical activity
- Diet/nutrition
- Medication use
- Smoking cessation
- Stress/depression
The main duties in counselling to prevent and manage CVD are (3)?
- Education
- On disease, how risk factors impact disease, how to manage risk factors/symptoms/lifestyle - Awareness
- Of disease status, risk of disease, risk factors, lifestyle behaviours - Behavioural change
- Facilitate change in attitudes and behaviours in order to reduce risks
Effective counselling is a skill that requires what 4 things
- Practice
- Experience
- Different methods of counselling needed based on patients’ personalities
- Counselling success is measured by client’s success
It is important to establish relationships with patients based on trust and rapport. Some of the effective counselling skills are (5)?
- Patience- empathy
- Listening
- Ask questions
- Giving feedback and getting feedback
- Explanation
What are the 6 theories for counselling/behavioural change?
- Social cognitive behavioural theory
- Motivational interviewing
- Transtheoretical model of change (stages of change)
- Feminist
- Humanistic
- Existential
How does Social Cognitive Theory view people?
Views people as proactive rather than reactive, who can self-regulate.
The Social Cognitive Theory recognizes the importance of what 3 factors?
Altering any or all of these factors can influence a person’s beliefs and behaviours
- Behavioural factors
- Environmental factors
- Personal factors
What is self-efficacy?
Essentially one’s confidence in themselves to perform a particular action
How does self-efficacy relate to the SCT?
- Intrinsic to social cognitive theory
Why is self-efficacy important?
- Provides foundation for human motivation, well-being and personal accomplishment
- Critical for self-regulation
- One’s self-efficacy is a powerful predictor in their personal attainment.
- Individuals tend to select tasks they feel competent in achieving, but need incentive (personal or outward).
- Increased self-efficacy will lead to greater effort, perseverance and resiliency.
- A person perception towards failures and successes depends on self-efficacy.
What influences self efficacy?
Knowledge, skills and previous experience with tasks influence self-efficacy
-> These will influence what people choose to and not to do
Is self efficacy objective?
based on what a person believes and not necessarily on what is true
Self-efficacy is built on what 4 sources?
- Mastery experience
- Vicarious experience
- Social persuasions
- Somatic and emotional states
Describe mastery experience and how self-efficacy relates to it? (3)
- Individuals engage in behaviours and activities based on prior experience
- Success improves self-efficacy while failures lower it
- Also takes into account effort required for task, even if successful
Describe vicarious experience and how self-efficacy relates to it? (4)
- Observing the actions and success/failures of other
- More important when individual has little experience with specific task
- Use others to ‘teach’ them how to do things
- Most powerful when those observed posses similar attributes to themselves
Describe social persuasions and how self-efficacy relates to it? (2)
- Encouragement, feedback, criticism from others
- Important in building one’s self-efficacy
Describe Somatic and emotional states and Emotional States experience and how self-efficacy relates to it? (3)
- Emotional state (anxiety, stress, mood, etc.) can impact self-efficacy
- Emotional reactions can provide cues to success/failure of task
- Improving physical and mental well-being will improve self-efficacy
What are the five principles of motivational interviewing?
- Express empathy
- Develop discrepancy
- Avoid argumentation
- Roll with resistance
- Supporting self-efficacy
Describe expressing empathy?
- Involves ‘active listening’
- Provides understanding of patient’s situation- builds trust
- Needs to be used throughout counselling process
- Relates past/personal experiences to situation
- Prevent the patient from feeling alone/unique/odd
Describe develop discrepancy?
- Identify any conflict or contrast between patient’s behaviour and beliefs/values (patient desires to inc fitness… but patient is too busy, leads sedentary life)
- Discuss pros and cons of change
Describe expressing empathy?
Do not increase patient’s resistance
Be ‘on their side’ working together as a team
Feelings or opinions are not arguable
Instead explore background of feelings/opinions- why do they feel this way
Describe rolling w/resistance?
- Patient may be resistant to suggestions:
- > Accept this and avoid increasing it
- > Discuss reasons for resistance
- May indicate change in strategy
- Use empathy
- Understand perceptions/perspectives
Describe supporting self-efficacy?
- Self-efficacy: belief in one’s own ability (confidence)
- Focus on positives and any previous successes
- Ensure realistic goals
How does the Stages of Change Model classify individuals?
Recognizes that individuals can be classified into discrete ‘categories’ of decisional change- stages
Can individuals be forced through stages if not ready
No
What was the Stages of Change Model based on?
- Based on pattern of change in individuals trying to quit smoking
- Now applied to numerous other behaviours
What are the 5 stages in the Stages of Change Model
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse (sometimes)
Describe the Pre-contemplation phase (Not Ready) and what phrases individuals would say during it
In this stage individuals are not aware they have a problem.
“I have no intention to start exercising”
“I don’t want to exercise”
No desire/thought of change
What can you do for the patient during the pre contemplation stage? (6)
- Provide info and education
- Discuss why patient is here- what do they value?
- Tie in what they value with area of focus
- Establish trust and rapport
- > Empathize and let patient know this is a long-term process
- Not many options at this stage- act as a resource
Describe the Contemplation phase and what phrases individuals would say during it
In this stage the thought may occur to an individual that they actually have a problem.
- Says things like “I’m thinking about starting to exercise”
- > Previous thought of change
- > Vague statement, no specific timeline
- Explore client’s previous thoughts on change
- Scale of reasons to change and stay the same
- > Identify reasons and what value client places on them
- Write out pros and cons
- > Starting exercise
Draw the Contemplation- decisional balance
2 teeter totters
Describe The ‘cons’ of change (3)
Cons can be misperceptions that require education or discussion or can be an identifiable barrier
Recognize that cons are something that can be overcome
When cons < pros- change can occur
Describe the Preparation phase and what phrases individuals would say during it
In this stage the individual acknowledges and accepts the fact that their behavior is problematic and are considering what to do.
Says things like:
- “How do I do it?”
- “I’m going to be starting to exercise ”
- > Pro-active statement from patient
- > Date specific- usually within next month
- > At this point pros»_space; con
- What prompted the change?
- > Better health, family, knowledge
- Does patient have a plan?
- > Patient may have some idea or started some actions regarding change
- > Your role is to provide guidance/help to develop patient’s plan
- Gather info on patient
- > Identify goal
- > Medical history (nutrition/exercise/smoking history)
- > Assess baseline levels
- > What are patient’s interests, likes/dislikes
- > Find out if patient has attempted change before and learn from experience
- Work with patient to develop plan
- > Set out specifics:
- > -> Timeline- when will change begin, actual date is sign of commitment
- > -> Goal- specifics, SMART
- > -> Possible barriers and identify strategies to overcome - use background info and knowledge to identify barriers
Describe the Action phase and what phrases individuals would say during it
- In this stage, the individual takes action.
Says things like:
- “I have been exercising for 2 months now”
- > Already involved in change/new behaviour
- > Recent change (<6 months)
- > -> Reflects evidence that a new change is more susceptible to relapse
- Still have work to do
- What things need to be considered:
- > How recent was change?
- > May not yet be routine
- > Any barriers not accounted for?
- > Focus on positive aspects of change- be a cheerleader
- > Recognize that this is just the beginning and need to guard against possible relapse
- Review and revise plan if needed
- Recognize work of patient
- How do they feel? Problems? Complications?
Describe the Maintenance phase and what phrases individuals would say during it
During this stage an individual has successfully changed their behavior and is reaping the rewards.
Says things like:
- “I have been exercising for 2 years now”
- > Still actively involved in behaviour
- > Behaviour change has been sustained for a longer duration- > 6 months
- Interaction may not need to be as intense
- Keep patient interested to maintain behaviour
- > Review motivation, revise goal
- Barriers still may arise
- > Continually need to ‘fine tune’ plan
- Have plans for ‘high-risk’ situations that can be a barrier to maintaining behaviour
Describe the Relapse phase
- ‘6th’ stage of change but in opposite direction.
- Cessation of behaviour/change or moving backwards on stages
- > May skip stages, ie: maintenance to preparation
- Can be small relapse (holidays) or large (re-event, injury, loss of job)
- Need to identify ‘trigger’ of relapse
- > May have nothing to do with desired behaviour change
What feelings does the patient experience during Relapse and what must be done?
- Guilty that they let themselves and you down
- Depressed/down
- Failed
- All of these may reduce patient’s self-esteem.
- The patient needs to get through these negative feelings and increase self-esteem.
How to deal with relapse?
- Relapse is a common process and part of change, not a sign of failure.
- > Smokers ‘quit’ and average of 3 times before become long-term quitters
- Identify trigger- can this be addressed, does it still exist?
- Focus on positives of initial success.
- Review previous plan and take elements of that plan
- > “You were successful once before, let’s review that success.”
- Review pros and cons: are they the same?
How to prevent relapse?
- Approach may be based on patient’s current stage.
- Work with patient to identify high-risk situations and barriers
- Set plan to overcome or avoid
- Review reason for change and emphasize pros/cons list
- Follow-up with patient to review/revise plan/goal- emphasize pros
What is Goal Setting? (5)
- Goals are needed to help plan direction and define success.
- Goals can be targets for risk factors, lifestyle behaviours or other things of value to patient.
- Can develop short and long-term goal.
- Devise a plan/contract with patient.
- Once goal is complete it loses its ability to motivate.
What does SMART Goal Setting stand for?
SMART stand for:
Specific Measurable Achievable Relevant Timely
What does it mean that a goal is Specific, provide an example
- Goal needs to be clearly laid out so that patients can identify if goal is met.
- The goal needs to include the specific task to be done and the time frame in which it will be completed.
- > E.g. “I will quit smoking by November 24.”
What does it mean that a goal is Measurable, provide an example
- The goal itself needs to have an outcome that can be measured or clearly identified as complete.
- > E.g. “I will lose 10 pounds.”
What does it mean that a goal is Achievable
- The goal has to be realistic but also challenging.
- A goal that is unachievable will result in discouragement, while a goal that is not challenging will not provide enough motivation.
What does it mean that a goal is Relevant, provide an example
The patient’s goal needs to be both relevant to improving the patient’s health and also one that the patient will value.
What does it mean that a goal is Timely, provide an example
The goal needs to be appropriate for the patient given his/her experiences and current situation.
