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BPK 458 > Module 8: Counselling > Flashcards

Module 8: Counselling Flashcards

1
Q

Behavioural change that is integrated with counselling assists patients on what 5 main factors?

A
  1. Exercise/physical activity
  2. Diet/nutrition
  3. Medication use
  4. Smoking cessation
  5. Stress/depression
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2
Q

The main duties in counselling to prevent and manage CVD are (3)?

A
  1. Education
    - On disease, how risk factors impact disease, how to manage risk factors/symptoms/lifestyle
  2. Awareness
    - Of disease status, risk of disease, risk factors, lifestyle behaviours
  3. Behavioural change
    - Facilitate change in attitudes and behaviours in order to reduce risks
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3
Q

Effective counselling is a skill that requires what 4 things

A
  1. Practice
  2. Experience
  3. Different methods of counselling needed based on patients’ personalities
  4. Counselling success is measured by client’s success
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4
Q

It is important to establish relationships with patients based on trust and rapport. Some of the effective counselling skills are (5)?

A
  1. Patience- empathy
  2. Listening
  3. Ask questions
  4. Giving feedback and getting feedback
  5. Explanation
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5
Q

What are the 6 theories for counselling/behavioural change?

A
  1. Social cognitive behavioural theory
  2. Motivational interviewing
  3. Transtheoretical model of change (stages of change)
  4. Feminist
  5. Humanistic
  6. Existential
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6
Q

How does Social Cognitive Theory view people?

A

Views people as proactive rather than reactive, who can self-regulate.

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7
Q

The Social Cognitive Theory recognizes the importance of what 3 factors?

A

Altering any or all of these factors can influence a person’s beliefs and behaviours

  1. Behavioural factors
  2. Environmental factors
  3. Personal factors
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8
Q

What is self-efficacy?

A

Essentially one’s confidence in themselves to perform a particular action

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9
Q

How does self-efficacy relate to the SCT?

A
  • Intrinsic to social cognitive theory
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10
Q

Why is self-efficacy important?

A
  • 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.
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11
Q

What influences self efficacy?

A

Knowledge, skills and previous experience with tasks influence self-efficacy
-> These will influence what people choose to and not to do

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12
Q

Is self efficacy objective?

A

based on what a person believes and not necessarily on what is true

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13
Q

Self-efficacy is built on what 4 sources?

A
  1. Mastery experience
  2. Vicarious experience
  3. Social persuasions
  4. Somatic and emotional states
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14
Q

Describe mastery experience and how self-efficacy relates to it? (3)

A
  • 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
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15
Q

Describe vicarious experience and how self-efficacy relates to it? (4)

A
  • 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
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16
Q

Describe social persuasions and how self-efficacy relates to it? (2)

A
  • Encouragement, feedback, criticism from others

- Important in building one’s self-efficacy

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17
Q

Describe Somatic and emotional states and Emotional States experience and how self-efficacy relates to it? (3)

A
  • 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
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18
Q

What are the five principles of motivational interviewing?

A
  1. Express empathy
  2. Develop discrepancy
  3. Avoid argumentation
  4. Roll with resistance
  5. Supporting self-efficacy
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19
Q

Describe expressing empathy?

A
  • 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
20
Q

Describe develop discrepancy?

A
  • 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
21
Q

Describe expressing empathy?

A

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

22
Q

Describe rolling w/resistance?

A
  • 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
23
Q

Describe supporting self-efficacy?

A
  • Self-efficacy: belief in one’s own ability (confidence)
  • Focus on positives and any previous successes
  • Ensure realistic goals
24
Q

How does the Stages of Change Model classify individuals?

A

Recognizes that individuals can be classified into discrete ‘categories’ of decisional change- stages

25
Q

Can individuals be forced through stages if not ready

A

No

26
Q

What was the Stages of Change Model based on?

A
  • Based on pattern of change in individuals trying to quit smoking
  • Now applied to numerous other behaviours
27
Q

What are the 5 stages in the Stages of Change Model

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse (sometimes)
28
Q

Describe the Pre-contemplation phase (Not Ready) and what phrases individuals would say during it

A

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

29
Q

What can you do for the patient during the pre contemplation stage? (6)

A
  • 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
30
Q

Describe the Contemplation phase and what phrases individuals would say during it

A

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
31
Q

Draw the Contemplation- decisional balance

A

2 teeter totters

32
Q

Describe The ‘cons’ of change (3)

A

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

33
Q

Describe the Preparation phase and what phrases individuals would say during it

A

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&raquo_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
34
Q

Describe the Action phase and what phrases individuals would say during it

A
  • 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?
35
Q

Describe the Maintenance phase and what phrases individuals would say during it

A

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
36
Q

Describe the Relapse phase

A
  • ‘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
37
Q

What feelings does the patient experience during Relapse and what must be done?

A
  • 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.
38
Q

How to deal with relapse?

A
  • 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?
39
Q

How to prevent relapse?

A
  • 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
40
Q

What is Goal Setting? (5)

A
  • 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.
41
Q

What does SMART Goal Setting stand for?

A

SMART stand for:

Specific
Measurable
Achievable
Relevant
Timely
42
Q

What does it mean that a goal is Specific, provide an example

A
  • 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.”
43
Q

What does it mean that a goal is Measurable, provide an example

A
  • The goal itself needs to have an outcome that can be measured or clearly identified as complete.
  • > E.g. “I will lose 10 pounds.”
44
Q

What does it mean that a goal is Achievable

A
  • 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.
45
Q

What does it mean that a goal is Relevant, provide an example

A

The patient’s goal needs to be both relevant to improving the patient’s health and also one that the patient will value.

46
Q

What does it mean that a goal is Timely, provide an example

A

The goal needs to be appropriate for the patient given his/her experiences and current situation.

BPK 458 (29 decks)

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