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pyb159 - alcohol & drugs > Week 10 - Ethics and Facilitating Change > Flashcards

Week 10 - Ethics and Facilitating Change Flashcards

1
Q

Principles of effective treatment

A
  1. No single treatment is appropriate for all individuals
  2. Treatment needs to be readily available
  3. Effective treatment attends to multiple needs of the individual, not just his or her drug use
  4. An individuals treatment plan must be assessed continually & modified as necessary to ensure the plan meets the person’s changing needs
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2
Q

Principles of effective treatment 2

A
  1. Remaining in treatment for an adequate period of time is crucial for treatment effectiveness
  2. Counselling (individual or group) & other behavioural therapies are critical components of effective treatment for addiction
  3. Medications are an important element of treatment, especially when combined with counselling & other behavioural therapies
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3
Q

Principles of effective treatment 3

A
  1. Clients presenting with coexisting
    mental health & substance abuse
    should have both disorders treated in
    an integrated way.
  2. Medical detoxification is only the first
    stage of treatment & by itself does little
    to change long-term drug use
  3. Treatment does not need to be
    voluntary to be effective
  4. Possible drug use during treatment
    must be monitored continuously
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4
Q

Priniciples of effective treatment 4

A
  1. Treatment programs should provide
    assessment for blood borne viruses &
    other infectious diseases, & counselling
    to help modify or change behaviours
    that place the person or others at risk
    of infection.
  2. Recovery can be a long term process
    & frequently requires multiple episodes
    of treatment
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5
Q

Miller & Hester Informed Eclecticism

A

4 assumptions:
- There is no single superior approach to
Treatment (Rx) for all individuals
- Rx programs/systems should be
constructed with a variety of approaches
that have been shown to be effective
- Different individuals respond best to
different Rx approaches, and
- It is possible to match clients to optimal
Rx, therefore increasing Rx effectiveness and efficiency

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6
Q

Australia Treatment Outcomes Study (ATOS) overview

A
  • Heroin users
  • Replacement; withdrawal; residential rehabilitation; non-Treatment control
  • 3 and 12 month post entry follow-up
  • Treatment sample differed from general population
  • More PTSD, Depression, Borderline PD, and disability.
  • High suicide and overdose rate; criminality
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7
Q

ATOS Outcomes

A
  1. General functioning improved
  2. Majority of participants abstinent for the 1 month prior to 12 month follow-up
    - 65% Replacement
    - 63% residential rehabilitation
    - 52% withdrawal
    - 25% non-Treatment control
  3. Noticeable reduction in criminal behaviours, improved injection related health, decline in depression
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8
Q

Future directions

A
  • Improve understanding of dependence & withdrawal
  • Greater attention to the use of psychosocial interventions as primary
    & adjunct treatment
  • Consider significance of lifetime treatment history & how individual
    treatment episodes fit together to achieve recovery
  • Assess effectiveness & efficiency under typical circumstances
  • Assess effectiveness of treatment interventions with subgroups
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9
Q

Unique moral, ethical and legal issues

A
  • Unique risks to user and community balanced with therapeutic goals
  • Potential impact on the therapeutic relationship, clinician and client’s reactions, and services offered
  • Who should have access to treatment? (esp. public)
  • Consent (intoxication, third party pressures)
  • Illegal behaviours and confidentiality limits
  • Minors
  • Harm reduction vs No Tolerance/Abstinence approaches
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10
Q

Impact of ethics & values

A
  • Different beliefs associated with different drugs
  • Differences between personal beliefs
    and evidence of harm
  • Stigmatisation of drug use often means
    clients have often experienced judgemental approaches and rejection in the past
  • Stigma is a barrier to accessing
    treatment
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11
Q

what are the 3 general prinicipals the APS is built on?

A
  1. Respect
  2. Propriety
  3. Integrity
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12
Q

APS- Code of ethics

Psychologists

A

Psychologists only provide psychological services within the boundaries of their professional competence. This includes,
but is not restricted to:
A) working within the limits of their education, training, supervised experience & appropriate professional
experience
B) basing their service on established knowledge of the discipline and profession of psychology
C) adhering to the APS Code and Ethical Guidelines
D) complying with the law of the jurisdiction in which they provide psychological services; &
E) ensuring their emotional, mental, & physical state does not impair their ability to provide a competent psychological service

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13
Q

Clinical vs Ethical decisions

A

According to the APS:
- A&D treatment based on established
knowledge requires clinical decision making based on evidence in order to provide a competent service to the client. However,
- Ethical A&D treatment decision making
requires respect, propriety & integrity.
- Thus,
- Clinical decision making is based on
evidence & ethical decision making is
based on respect, propriety, & integrity

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14
Q

The 5 moral principals of a healthy therapeutic relationship

A
  • autonomy
  • justice
  • beneficence
  • non-maleficience
  • fidelity
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15
Q

Key points of autonomy

A
  • addresses respect for independence, and self-determination
  • allows individual freedom of choice and action
  • encourage clients when appropriate to make their own decisions based on their own values
  • help clients understand how their decisions may be perceived and may affect the rights of others
  • assess whether a client is able to make sound and rational decisions (minor, mental disabilities)
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16
Q

Key point of justice

A

treat each client with equity

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17
Q

Key point of beneficence

A
  • to do good, be proactive and to prevent harm when possible.
  • comes in form of prevention and early intervention actions that contribute to betterment of clients
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18
Q

key points of non-maleficence

A
  • not causing harm to others
  • weighing potential harm against potential benefits
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19
Q

key points of fidelity

A
  • loyalty, faithfulness, and honouring commitments
  • clients must be able to trust counsellor and have faith in therapeutic relationship
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20
Q

APS Guidelines on Confidentiality

A
  1. Understand he legal context and the organisational requirements associated with confidentiality and limitations
  2. Informed consent
  3. Only breach confidentiality when:
    - Consent exists to do so
    - There is a legal obligation to do so
    - There is an immediate and specified risk to an identified person that can be averted by the disclosure of confidential information
  4. When disclosing information, only disclose what is needed to achieve the purpose of thedisclosure and only to individuals who require the information
  5. Where safety permits, psychologists inform their clients if, what, why, and who their information is being disclosed
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21
Q

The old way of change facilitation

A
  • Confront “addictive personalities”/denial
  • Key Skill – Coercion (shame, guilt,
    threats, force)
  • Leads to - Resistance, argument,
    reduced change
22
Q

What is the problem with the old approach

A
  • demoralises and
    leads to higher rates of relapse
  • when therpaist takes stop using stance, clients responds with keep usin position and argue from this perspective
  • people are more likely to be persuaded by what they hear themselves than what other people tell them
23
Q

Five important assumptions of new way (motivational interviewing)

A
  1. Motivation is a state not a trait
  2. Resistance is not a force we must overcome
  3. Ambivalence is normal
  4. Person seeking help should be an ally rather than an adversary
  5. Recovery and change are innate, constant and intrinsic to the human experience
24
Q

Background centrality of ambivalence

A
  • central to addictive behaviours
  • awareness of risks, costs and harms
  • also attached and attracted to behaviour
  • confrontation about adverse consequences
  • often results in argument
  • reinforces reasons for continuing
25
Q

Stages of change

A
  1. precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
  6. termination
  7. relapse
26
Q

Precontemplation - Happy user

A
  • Not planning to change in foreseeable
    future
  • Uninformed or under informed
  • Families/friends etc… see the problem
  • Resistant to change
  • Sometimes demoralised following relapse
27
Q

Contemplation - on the fence/ambivalent

A
  • Aware of problem
  • Seriously thinking about/considering change
  • Not yet made commitment to
    change
  • Ambivalence (weighing up the pros and cons)
28
Q

Understanding Ambivalence

A
  • Normal, understandable, acceptable, and expected
  • Strong & sometimes long held attachment to problem behaviour
29
Q

Preparation - making a plan for change

A
  • Plan for action in next month
  • Open to information and support
  • May have made small changes
30
Q

Action - making changes

A

Putting plan into action
- Modification of behaviour, thoughts,
environment
Behavioural changes (1 day to 6 months)
- Considerable commitment of time and energy
High potential for relapse

31
Q

Maintenance - changes that last

A
  • Changes maintained for 6 months or longer
  • Focus is on preventing relapse
  • More confident, “living the change”
32
Q

Lapse vs Relapse

A
  • Rule rather than exception
  • Most people don’t make it on first
    attempt
  • Can go back to any stage
  • Can happen on multiple occasions
  • Does not mean that the person is
    unmotivated
  • A lapse is a short term “slip up” and
    a relapse is a return to past usage
    patterns
33
Q

Percentage of drug addicted patients that relapse

A

40-60%

34
Q

Prevalence of relapse

A
  • Relapse is a common occurrence - The
    rule rather than the exception
  • 90% of clients will experience a lapse
    within 12 months of completing treatment (brief return to use)
  • 60% of clients will experience a relapse
    (return to old patterns) within 12 months
35
Q

Stages of change spiral

A
  • Each time learning more about themselves and triggers for relapse
  • 85% of relapsers return to contemplation then eventually move on through the stages
  • 15% of relapsers return to pre-contemplation
  • Key difference: attributions to personal failure; embarrassed, ashamed and guilt

not linear and organised and cycle back and forth

36
Q

Matching interventions to the stage of change

precontemplation and contemplation

A

change processes traditionally
associated with the experiential, cognitive, and psychoanalytic approaches, e.g., education and feedback (consciousness raising) and motivational interviewing
(self-reevaluation and emotional arousal)

37
Q

Matching Interventions to the
Stage of Change

Action and maintenance

A

Existential (e.g., self-liberation and will power) and behavioural approaches (i.e., practical) most useful

38
Q

Matching Interventions to the
Stage of Change

Maintenance

A

Behavioural approaches e.g.,
relapse prevention plan

39
Q

What is Motivational Interviewing (MI)?

A

A directive, client-centred approach for initiating behaviour change by helping clients to explore and resolve ambivalence

40
Q

five assumptions of MI

A
  • 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 and intrinsic to the human experience
41
Q

The spirit of MI

A
  1. Partnership
  2. Acceptance
  3. Compassion
  4. Empowerment

PACE

42
Q

The four tasks of MI

A
  1. Engaging
  2. Focusing
  3. Evoking
  4. Planning

These four processes are NOT a linear sequence, rather the client can double back and repeat throughout the session

43
Q

Engaging

A
  • Use of client centred counselling skills to develop a therapeutic alliance
  • Relational foundation
  • Client-centred
  • Acceptance facilitates change
  • Skilful reflective listening is fundamental
  • Express empathy
  • Empathy through reflective listening
44
Q

Focusing

A
  1. Clarifying the goals and direction of
    counselling (i.e., being on the same page)
  2. Ask the client to identify a target area in which they are struggling to make change by:
    - Setting an agenda
    - Asking the client what is important to them
    - Be transparent about what the target is, once identified
45
Q

Evoking

A
  • Eliciting the client’s reasons for change.
  • Attention is paid to the clients “change talk” in order to explore, understand and summarise it.
  • Use client’s own motivators to highlight discrepancy between present behaviour and important personal
    goals or values- ‘psychological squirm’
  • Planning- When readiness for change seems apparent, proceed to determine what the next steps will be
  • NOT a linear sequence, rather these processes can double back and repeat throughout the session
46
Q

Planning

A

When readiness for change seems apparent, proceed to determine what the next steps will be
- The bridge to change – negotiating goals and plans and strengthening commitment.
- Development of a change plan.
- Client’s belief in possibility for change - important motivator
- Client responsible for change
- Counsellor’s belief in client also important
- Client is primary resource for solutions
- Review change plans to determine if more support is needed

47
Q

OARS - the engaging skills of MI

A

O- Open ended question to allow exploration
A- Affirming. Watch for and affirm client’s
strengths
R- Reflecting your understanding back to
the client
S- Summarise. Shows you’ve been
listening and value their words enough to remember them, also can link material together and can help emphasize certain points.

48
Q

MI Evoking skills

DARN

A

Desire
Ability
Reasons
Need

49
Q

MI Evoking skills

CAT

A

Commitment
Activation
Taking Steps

50
Q

giving advice in MI

A
  • Ask permission first
  • use autonomy supporting statements
  • offer small chunk of information in a sequence of elicit-provide-elicit
51
Q

Assessing Change

A

Importance - refers to how much change matters to you.
Confidence - means how strongly you believe you can change and how self assured you feel
Readiness - is how ready you feel right now to make the changes you desire. Consider if this is the right time.

52
Q

Decisional Balance

A
  • Perceived advantages (pros) and
    disadvantages (cons) of staying the
    same Vs making a change
  • Assumption - motivation for change
    affected by decisional balance
  • A useful tool to raise self-awareness and assist in assessment of stage of change

pyb159 - alcohol & drugs (6 decks)

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