The words you are searching are inside this book. To get more targeted content, please make full-text search by clicking here.

Designing Interventions Using the Stages of Change: Precontemplation ... please email me [email protected] and I will email it to you directly in pdf format.

Discover the best professional documents and content resources in AnyFlip Document Base.
Search
Published by , 2016-10-01 08:10:02

Course: Designing Interventions using the Stages of Change

Designing Interventions Using the Stages of Change: Precontemplation ... please email me [email protected] and I will email it to you directly in pdf format.

Course: "Designing Interventions using the Stages of
Change"

Week 3: Designing Interventions for the Precontemplation
and Contemplation

Stages of Change

This week we will be exploring the issues associated with designing interventions using the
Stages of Change for people in the Precontemplation and Contemplation Stages of Change. As
we reviewed in the last lesson, designing stage-specific interventions is one of the primary
functions of the clinician. Meeting people “where they are” in their process of recovery is a
combination of several important elements such as assessing where they are in the process of
change and designing stage-specific interventions to assist them to complete their current
stage-specific task in order to promote movement to the next Stage of Change. However, one of
the most important components of meeting people “where they are” in their process of recovery
is utilizing a motivational enhancement approach to partnering with the person in recovery.
Unlike some treatment approaches of the past, the Stages of Change and the TTM have been
found to be most effective when service delivery is facilitated by a motivational enhancement
style of counseling. Motivational Enhancement Therapy and Motivational Interviewing are the
most common motivational enhancement approaches in the field.

Motivational Interviewing has been seen by many to be one of the most important treatment
intervention and clinical innovations in several decades. I can not underemphasize the value,
importance, versatility and impact that Motivational Interviewing has had upon the field. Ideally
we would be able to afford a significant amount of time to a thorough discussion and review of
the Motivational Interviewing literature. Unfortunately, we will not be able to spend much time on
the Motivational Interviewing (MI, as it has become know) literature. However, because it is so
closely related to the TTM and the Stages of Change and providing and designing interventions
is so dependent upon motivational enhancement techniques, we will briefly review some of the
central components and themes of MI from TIP 35.

Motivational Enhancement Approach to Working with People in Recovery

“Motivational interviewing is a way of being with a client, not just a set of techniques for doing counseling”.

Miller and Rollnick, 1991

“Motivational interviewing is a technique in which you become a helper in the change
process and express acceptance of your client. It is a way to interact with substance-using
clients, not merely as an adjunct to other therapeutic approaches, and a style of counseling that
can help resolve the ambivalence that prevents clients from realizing personal goals.
Motivational interviewing builds on Carl Rogers' optimistic and humanistic theories about
people's capabilities for exercising free choice and changing through a process of self-
actualization. The therapeutic relationship for both Rogerian and motivational interviewers is a
democratic partnership. Your role in motivational interviewing is directive, with a goal of eliciting
self-motivational statements and behavioral change from the client in addition to creating client
discrepancy to enhance motivation for positive change (Davidson, 1994; Miller and Rollnick,
1991). Essentially, motivational interviewing activates the capability for beneficial change that
everyone possesses (Rollnick and Miller, 1995). Although some people can continue change on
their own, others require more formal treatment and support over the long journey of recovery.
Even for clients with low readiness, motivational interviewing serves as a vital prelude to later
therapeutic work.”

Motivational interviewing is a counseling style based on the following assumptions:

 Ambivalence about substance use (and change) is normal and constitutes an important
motivational obstacle in recovery.

 Ambivalence can be resolved by working with your client's intrinsic motivations and
values.

 The alliance between you and your client is a collaborative partnership to which you
each bring important expertise.

 An empathic, supportive, yet directive, counseling style provides conditions under which
change can occur. (Direct argument and aggressive confrontation may tend to increase
client defensiveness and reduce the likelihood of behavioral change.)

From TIP 35 (p. 39)

FIVE PRINCIPLES OF MOTIVATIONAL INTERVIEWING

In their book, Motivational Interviewing: Preparing People To Change Addictive Behavior, Miller
and Rollnick wrote,

“[M]otivational interviewing has been practical in focus. The strategies of
motivational interviewing are more persuasive than coercive, more supportive than
argumentative. The motivational interviewer must proceed with a strong sense of
purpose, clear strategies and skills for pursuing that purpose, and a sense of timing to
intervene in particular ways at incisive moments” (Miller and Rollnick, 1991, pp. 51-52).

The clinician practices motivational interviewing with five general principles in mind:

1) Express empathy through reflective listening.

2) Develop discrepancy between clients' goals or values and their current behavior.

3) Avoid argument and direct confrontation.

4) Adjust to client resistance rather than opposing it directly.

5) Support self-efficacy and optimism.

From TIP 35 (p.40-41)

Because MI is so fundamental and helpful in designing and implementing interventions using
the Stages of Change, I strongly encourage you to read chapter 3 in TIP 35, titled Motivational
Interviewing as a Counseling Style. Even if you have read this material before, I strongly
encourage you to review this chapter. It is a rich and comprehensive overview that is a
wonderful review for a novice or expert level clinician.
http://www.health.org/govpubs/bkd342/35f.aspx

Designing Interventions Using the Stages of Change: Precontemplation

Over the next two lessons, we will be exploring the issues associated with designing
interventions for people in the various Stages of Change. However, instead of a discussion of
the issues associated with designing interventions in the format you may be familiar with (i.e.,
lesson discussion) we will be using a combination of reading material from TIP 35 and what I
will refer to as Stages of Change Worksheets. I have created these worksheets based on the
feedback from participants in the previous Stages of Change course that requested tools and
resources designed to assist them in utilizing and implementing the materials. Please keep in

mind that since this is not an introductory course, some of the material will be assumed. If you
need or are interested in additional material or resources, please consult the reading materials
or contact me directly and I will be happy to connect you with materials to meet your needs.

Before we begin, I want to encourage you to read helpful, insightful and comprehensive
overview of the TTM. Many of the issues and content that will be discussed in the Worksheets
are reviewed in this paper.

Cancer Prevention Research Center: Detailed Overview of the TTM
http://www.uri.edu/research/cprc/TTM/detailedoverview.htm

Designing Interventions Worksheets Overview

The worksheets that we will be using in the lesson were created to assist you in becoming
familiar with the material and to be used as a tool when you are implementing these techniques
with people in recovery or training others. Many of you have shared that you will be training
others or you supervise clinicians doing this work. The worksheets are ideal to train with and
perfect to use when designing interventions with people in recovery. They include several
important components of the model and each focus on one of the various Stages in the model:

1) The Process of Change model (M. Rosier, 2005) – This model represents that
Stages of Change a bit differently than other models. Some important differences
include the emphasis upon Recovery, reduced emphasis upon recurrence, large
emphasis upon precontemplation and maintenance – the stages that tend to be more
stable and contain the most people in recovery for most target behaviors. The
Process of Change model is only one of many; I encourage you to find the one that
best fits your clinical approach and philosophy.

2) Description of the Stage and the stage-specific task

3) Stage-specific characteristics of the stage including stability, commitment to change,
self-efficacy/confidence for change, temptation, help seeking, information seeking,
decisional balance and pros/cons of change towards the target behavior.

4) The requirement for Transition from the stage.

5) Stage-specific processes of change most relevant to the stage.

6) Stage-specific motivational strategies

7) Stage-specific interventions most relevant to the stage.

In addition to the Worksheets, you will be strongly encouraged to read the corresponding
chapter in the TIP 35 related to the Stage of Change. These chapters are invaluable resources
and highlight the central themes and issues related to stage-specific intervention development
and implementation.

PRECONTEMPLATION

The person is not considering change, does not see the need for change, does not feel
confident that they can change, is unwilling or unable to change and is not planning to change in
the next 6 months.

Stage-specific task: To raise doubts and increase concern and awareness around the target
behavior; develop hope and optimism in order to encourage consideration of change

Stage-Specific Motivational Strategies

• Establish rapport, ask permission, and build trust

• Raise doubts or concern in the client about target behavior patterns by:

 Exploring and weighing pros and cons of target behavior
 Eliciting perceptions and attitudes towards the target behavior
 Offering factual information about the risks related to the target behavior
 Providing personalized feedback about assessment findings
 Allow the person to explore the pros and cons of the target behavior
 Include significant others and stakeholders in the change process
 Examining discrepancies between the person’s perception of the target behavior and

other’s views
• Express concern about the target behavior

• Focus on the strengths and abilities of person & their past-successes around previous
attempts at change process

Stage-Specific Interventions

• Discussions of advantages/disadvantages of target behavior, role playing, prevention
materials, media portrayals, bibliotherapy, psycho-educational material and groups,

testimonials, (re)interpretations, observations

Precontemplation Worksheet – PLEASE NOTE: If you have any difficulty printing this worksheet
please email me [email protected] and I will email it to you directly in pdf format.

PRECONTEMPLATION WORKSHEET

Chapter 4 From Precontemplation to Contemplation: Building Readiness

http://www.health.org/govpubs/bkd342/35g.aspx

CONTEMPLATION

The person is considering the possibility of change, acknowledges concerns about target
behavior, but is ambivalent and uncertain about change. The person is planning to take action in
the next 6 months.

Stage-specific task: To examine the impact of the target behavior and to consider the
pros and cons in order to tip the decisional balance in favor of a commitment to change
the target behavior.

Stage-Specific Motivational Strategies

 Normalize and explore ambivalence associated with target behavior
 Assist the person to “tip the decisional balance” in favor of change by:

o Eliciting and weighing the pros and cons of the target behavior and change
o Changing focus from extrinsic motivation to intrinsic motivation
o Examining personal values in relation to change and target behavior
o Emphasizing free choice, self-determination, responsibility and self-efficacy for

change
 Elicit self-motivational statements of intent and commitment to change and ideas for

change
 Elicit beliefs, attitudes and expectations regarding the person’s self-efficacy/confidence

for change and treatment
 Summarize, reflect and emphasize self-motivational statements as the focus of

treatment
 Develop discrepancies between values/goals/hopes for the future and current situation

and behaviors

Stage-Specific Interventions
Decisional balance exercises, exploring pros and cons of target behavior, values and needs
clarification, imagery, corrective emotional experiences, challenging beliefs and attitudes,
cognitive restructuring and role clarification
Contemplation Worksheet – PLEASE NOTE: If you have any difficulty printing this worksheet
please email me [email protected] and I will email it to you directly in pdf format.

CONTEMPLATION WORKSHEET

Chapter 5 From Contemplation to Preparation: Increasing Commitment

http://www.health.org/govpubs/bkd342/35h.aspx

Module 3 Reading

1) TIP 35: Chapter 3 Motivational Interviewing as a Counseling Style
http://www.health.org/govpubs/bkd342/35f.aspx

2) TIP 35: Chapter 4 From Precontemplation to Contemplation: Building Readiness
http://www.health.org/govpubs/bkd342/35g.aspx

3) TIP 35: Chapter 5 From Contemplation to Preparation: Increasing Commitment
http://www.health.org/govpubs/bkd342/35h.aspx


Click to View FlipBook Version