Prochaska Process of Change Model Flashcards
The counselor-client relationship is a _____.
Collaborative process
- Bilateral, not unilateral
- Adopting a collaborative stance can help discover new patterns, insights, behaviors, and experience
- 2 person psychology
The therapist does not change people, but _____ change.
Facilitates
What are the common methods introduced by Prochaska?
- Consciousness-raising
- Social liberation
- Emotional arousal
- Self-Reevaluation
- Commitment
- Countering (counter conditioning)
- Environmental control
- Rewards
- Helping relationships
Describe Consciousness-raising:
facilitate conversation, be curious, awareness increases on its own in the client
Describe social liberation:
what’s the external environment for the client, and does it support change?
Describe emotional arousal:
Usually directly related to the issue; usually has to deal with loss; connect client to the issue and get them to see how it effects them
Describe self-reevaluation:
Conversation that facilitates the client thinking about themselves in a different way; the client talking about the pros and cons instead of the counselor telling them
Describe commitment:
Can you get client to make a decision and accept responsibility to change?
Describe countering:
AKA counterconditioning. Help the client replace negative behavior with positive
Describe environmental control:
Changing parts of the environment that are controllable
Describe rewards:
Internal and external, find what’s meaningful to the client and allow them to create rewards for themselves
Describe helping relationships
Who can you get involved to help the client? AA sponsors, family, friends…
When the therapists approach doesn’t match the client’s stage of readiness for change, the client may feel forced into change, that he/she doesn’t want to make and as a result:
- May feel the therapist doesn’t care/understand their need or struggle
- May resist change and withdrawal
- May resist change and leave therapy
- May comply to please therapist (especially if this is similar to their past experience)
A therapist’s ability to match the client’s stage of readiness for change helps the client through it with _____.
Less trial and error and less distress
- This collaborative awareness leads to a or many “a-ha” moments for clients
- Ex: Discovery = longer lasting change
List the phases in Prochaska’s Changes of Phase Model
Phase 1: Pre-contemplation Phase 2: Contemplation Phase 3: Preparation Phase 4: Action Phase 5: Maintenance/Relapse Phase 6: Relapse/Termination
Describe Phase 1 of Prochaska’s Changes of Phase Model:
Clients usually don’t believe they have an issue; aren’t interested in help
Client Language in Phase 1 of Prochaska’s Changes of Phase Model:
- I don’t have a problem.
- They made me come.
- I’ve tried this before and it didn’t work.
Client Characteristics in Phase 1 of Prochaska’s Changes of Phase Model:
- Defensive, resistant, lack awareness, pressured, uncommitted
- Denial, minimization
Therapist’s Strategy in Phase 1 of Prochaska’s Changes of Phase Model:
- Demonstrate great attending skills
- Engage in nonthreatening open discussion
- U-turn, raise ambivalence
Therapist’s Questions in Phase 1 of Prochaska’s Changes of Phase Model:
- Do you believe there is a problem?
- Why do you think others believe there is a problem?
- What would happen for you to know that there may be a problem?
- Have you tried to change in the past? What happened?
Describe Phase 2 of Prochaska’s Changes of Phase Model:
- Client is aware of a problem and has spent a lot of time thinking about it
- Often present here and often stay here; at this point in the journey, they see the cost of change as being too high (AKA Chronic Contemplation-needs all the answers, to know exactly what will happen)
- They’re so used to the problem, that to change is more problematic (in their mind) than the problem itself
- Secondary Gains: the client may not want to give up certain things
Client Language in Phase 2 of Prochaska’s Changes of Phase Model:
- I would like to change but…
- I feel like I’m stuck
- I’m just not sure I want to do that right now
Client Characteristics in Phase 2 of Prochaska’s Changes of Phase Model:
- Seeking understanding
- Distressed
- Previous attempts with failure
Therapist’s Strategy in Phase 2 of Prochaska’s Changes of Phase Model:
- Empathy is key here - validate their struggles and offer hope
- Get them thinking about the possibility of change and increase confidence
Therapist’s Questions in Phase 2 of Prochaska’s Changes of Phase Model:
- Why do you want to change at this time?
- What keeps you from not changing?
- What might help you overcome these barriers?
- How have you overcome difficult things in the past?
Describe Phase 3 of Prochaska’s Changes of Phase Model:
- Clients making plans to take specific actions to chance
- What resources does the client have available? Family, support groups…
- Therapist should make plans for potential relapse with client
Client Language in Phase 3 of Prochaska’s Changes of Phase Model:
- It really has gotten out of control
- I need to do something about it
Client Characteristics in Phase 3 of Prochaska’s Changes of Phase Model:
- Intentionality/readiness
- Engaged in the process
- On the verge
Therapist’s Strategy in Phase 3 of Prochaska’s Changes of Phase Model:
- Help client gather info about what they need to change their behavior
- Help client assess what it would take to change
- Help devise a specific workable plan of action
Therapist’s Questions in Phase 3 of Prochaska’s Changes of Phase Model:
- What resources are available for you to change?
- What support system do you have available?
- What do you think you could do to begin to bring about change?
Describe Phase 4 of Prochaska’s Changes of Phase Model:
- Talked about it, thought about it, prepared for it
- Started abstaining, maybe gone to detox
Client Language in Phase 4 of Prochaska’s Changes of Phase Model:
- I think I’m ready to work on this now
- So what can I do to get started?
Client Characteristics in Phase 4 of Prochaska’s Changes of Phase Model:
- Solid decision
- Motivated (internal/external)
- Open to feedback
Therapist’s Strategy in Phase 4 of Prochaska’s Changes of Phase Model:
Help client set realistic goals and develop practical methods
Therapist’s Questions in Phase 4 of Prochaska’s Changes of Phase Model:
- When things begin to change, how will you know?
- How can you avoid a slip/relapse?
- If you do slip, how can you get refocused again?
What are some of the issues seen during the first 4 stages of Prochaska’s Changes of Phase Model?
- Get through denial
- Simplifying, minimizing, rationalizing, intellectualizing, diversion, hostility
- Resistance - anything that prevents the client from tapping into unconscious
- Roll with resistance, be aware of counter-transference
What are clinical strategies during the first 4 stages of Prochaska’s Changes of Phase Model?
- Maintain rapport
- Support/present a realistic view of change through small, successive steps
- Acknowledge the difficulty of change (especially early in process)
- Help client identify triggers and high risk situations, then develop alternatives and explore coping strategies
- Assess client support system
- Offering insight
- Empathic validation leads to therapeutic bond (especially necessary for challenge/discrepancy)
- Removing barriers/decreasing desirability
- Offering new perspective and providing choice
- Clarify goals/active helping
- Offer support and HOPE
Describe Phase 5 of Prochaska’s Changes of Phase Model:
- Clients are doing what they have prepared for and their new goal needs to shift toward maintaining the gains they’ve experienced thus far
Client Language in Phase 5 of Prochaska’s Changes of Phase Model:
- I can’t believe how far I’ve come.
- Why did it take me so long to do this?
- I’m still working, but I’m beginning to feel so much better
Client Characteristics in Phase 5 of Prochaska’s Changes of Phase Model:
- Actively working to sustain change
- Some fear/anxiety of failure
Therapist’s Strategy in Phase 5 of Prochaska’s Changes of Phase Model:
- Encourage, support
- Remind them of the progress they’ve made
- Be aware of relapse potential and help client navigate them
Therapist’s Questions in Phase 5 of Prochaska’s Changes of Phase Model:
- What could potentially throw you off track right now? How can you avoid that?
Describe Phase 6 of Prochaska’s Changes of Phase Model:
- Clients who’ve overcome their issue(s) also maintain their desired behavior on their own.
- They have a clear direction and can distinguish between old and new life
- Confidence/self-efficacy is usually evident and high
Client Language in Phase 6 of Prochaska’s Changes of Phase Model:
- I never want to go back there again.
- I can’t see myself doing that anymore.
- I feel so much better now.
Client Characteristics in Phase 6 of Prochaska’s Changes of Phase Model:
- Celebrate change with your clients
- Remind them how far they’ve come and of progress made.
- Re-discuss relapse
- Begin termination discussion
- Leave relationship open for future needs
Therapist’s remarks in Phase 6 of Prochaska’s Changes of Phase Model:
- I’m so proud of you!
- So, let’s reflect on what this experience has been like for you.
- I really think you’re doing well on your own and it’s time to discuss ending therapy for right now.
Therapist’s input regarding relapse in Phase 6 of Prochaska’s Changes of Phase Model:
- When clients relapse, they often feel a sense of failure, which undermines their confidence regarding overcoming the problem.
- Remind them that relapse is not a final destination but an opportunity to examine why and how the slip occurred and a chance to reflect and learn new skills
- The potential for relapse is high - they should prepare for it and expect it
Describe loss of control:
- Rotter - describes the degree to which individuals believe that reinforcements are contigent upon their behavior
- Internal - what we do affects outcomes in our lives (easies to change)
- External - believe that other evens and people control outcome (weakest determination of change)
Learned helplessness & Learned Optimism are directly related to _____.
Locus of control
People with learned helplessness believe that bad events are:
- Global: it affects everything I do
- Stable: happens all the time
- Internal: It’s my fault, I’m flawed, defected, there’s no hope for me
People with learned optimism believe that bad events are:
- Specific: He/she didn’t like that comment I made
- Temporary: only a problem right now
- External: my parents are fighting because of their inability to get along, not because of me
Define Secondary Gains:
All the elements for change are in place, but there is no change.
- Means they are gaining something from the addiction
Define Unconscious Motivations:
Strong internal beliefs that affect outcome
Define Tertiary Gains:
A desire to please the therapist; therapist becomes image of parent/role model they never had, client does not want to let you down
Define Codependency:
Can only recover as long as a specific person is in their life
