Download - Counseling for Behavior Change
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www.humanikaconsulting.com
Counseling for Behavior Change
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Objectives
1. Background
2. Counseling Steps
1. Preparation
2. Determination to Action
3. Maintaining Change
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Background
Cycle of Change
Brief Intervention FRAMES
Reflective Listening
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Stages of Change Cycle
Precontemplation
Contemplation
Determination
Action
Maintenance
Relapse
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Implications of Change Cycle
Majority are NOT ready for action
Each cycle improves the chance of maintenance of long-term change
Counseling that is matched to stage enhances outcome
Relapse is common and is a learning stage
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Brief Intervention Features
F Personalized Feedback to patient
R Patient has Responsibility for change
A Clear Advice on behavior to change
M Menu of options for choice
E Express Empathy to mobilize change
S Evoke Self-efficacy to enhance confidence
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Counseling Step # 1 : Preparation
Delivering the Message
Precontemplation
Contemplation
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The Message Counseling
Give Personalized Feedback – Clear message, advice to change
– Shutdown
– Doctor babble
Determine Readiness to Change (Stage) – Ask - “What do you KNOW about this?”
– Ask - “How do you FEEL about this?”
– Ask - “What are you willing to DO about this?”
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Pre-Contemplation Clues
Surprise
Ignorance
Demoralization
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Pre-Contemplation Counseling
Give information
Patient education works
Logbooks, journals, self-assessment
Classes
Role-models
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Contemplation - Clues
Ambivalence
Emotional arousal
Defensiveness
Resistance
Self-re-evaluation
Values - behavior gap
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Contemplation - Counseling
Express Empathy
Develop Discrepancy
Avoid Argument
Roll with Resistance
Support Self-efficacy
Use Decision Balance
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Decision Balance Exercise
No Change Change
Old Behavior Like about? Worried about?
New Behavior Worried about? Like about?
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Counseling Step #2 : Determination to Action
Determination Stage
Self-Efficacy - Play Hard To Get
Action Plan
Action Plan Interview
Action Stage
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Determination
Ephemeral stage
Must do something about the problem
Build Self-efficacy
– Skills
– Confidence of success
– Conviction to act
Develop plan for action
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Determination Clues
“This is a serious problem”
“I must do something!” “I can make the change”
NOT “What do you recommend I do?”
NOT “Whatever you say I’ll do!”
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Determination Counseling
Play “hard to get” in telling what to do
– “Only you know what is best for you. This is what others have used”
– “I’m not sure you’re ready to act yet; convince me”
– “How convinced are you change will help?”
– “How confident are you you’re change will be successful?”
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Plan for Action
Realistic goal
Small steps
Short trial period (7 days)
Self-monitoring
Role-models
Go public
Plan for problems and lapses
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Building an Action Plan
Here is a MENU of options…
What are you willing to DO?
What or who might HELP?
What PROBLEMS might arise?
What will you DO until we next meet?
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Action
Patient makes changes alone
Withdrawal symptoms – physical withdrawal
– psychological withdrawal
New coping behaviors
Clues to act and avoid old habit
Clues and rewards for new behavior
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Action Counseling
Moral support
Log or journal
Role-model
Frequent contact
Treat withdrawal symptoms
Devise diversions
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Counseling Step #3 Maintaining Change
Maintenance
Behavior Modification
Social Support - Role-Models
Relapse Learning
Follow-up
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Maintenance Clues
Humility
Humor
Honesty
Experience
Success and failure
Respect for conditions of relapse
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Maintenance Counseling
Self-monitoring Attend to cues and
consequences of new and old behavior - act to form new habit
Address maladaptive thoughts
New coping strategies Use and become a role-model
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Relapse
Common, may be necessary
Reframe as a learning experience
Experience loss of control
Learn pre-relapse clues
Experience “relapse” thinking
Cope with guilt and shame
Cope with guilt and shame, “I blew it!”
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Relapse Counseling
Express empathy for guilt, shame, distress
Confront “stinking thinking”
Explore triggers to relapse
Plan for different coping strategies
Negotiate a new action plan Consider referral or increasing
intensity of support
Role-models
Close follow-up
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Summary
Deliver a clear message about change
Counsel by asking not telling
Determine patient’s stage or change
Use stage-specific counseling
Use brief intervention methods
Change involves more than knowledge
Relapse is a usual stage of change
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Source :
• 2000, F. Duffy, D., MD, MACP and Goldstein, M.G.,MD, Counseling for Behavior Change, ACP
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