Integrating Motivational Interviewing, the Stages of Change .ppt
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1、Integrating Motivational Interviewing, the Stages of Change Model, and Treatment Planning Kevin Glavin Kent State University kglavinkent.edu Rachel Hoffman Kent State University rhoffmankent.edu All-Ohio Counselors Conference November 2-4, 2005,Agenda,Background & Introduction to the Stages of Chang
2、e Model (Transtheoretical Model) The Stages of Change: Key points Practical Applications Teaching treatment planning and case conceptualization. Educating clients about the stages of change Motivational Interviewing Techniques Moving through the stages: Techniques and Strategies The Processes of Beh
3、avior Change Determining a Clients Stage of Change using SOCRATES,Background Information,During his college years, psychologist James Prochaska, Ph.D., lost his father to alcoholism and depression. Prochaska reported his fathers mistrust in psychotherapy and his refusal to participate in counseling.
4、 This served to fuel Prochaskas research into substance abuse and the stages of change. Prochaska and DiClemente started their research by observing individuals who had over come an addiction to nicotine. They discovered change occurred on a continuum and identified common stages and processes indiv
5、iduals appear to progress through. The model is named the Transtheoretical Model spans so many different theories. This model provides practitioners with a way in which to understand how clients change, as well as what motivates them to change. It can be used to teach case conceptualization, and bui
6、ld appropriate stage related interventions into treatment plans.,The Stages of Change Model: Transtheoretical Model (Prochaska & DiClemente, 1982),The central organizing construct of the model is the Stages of Change The Transtheoretical Model views change as a process involving progress through a s
7、eries of five stages Precontemplation Contemplation Preparation Action Maintenance The goal is to determine which stage of change the client is in and assist the client in progressing through subsequent stages.,The Stages of Change,Source: http:/www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.
8、62561,No intention of changing behavior,Intends to change in the next 6 months, but may procrastinate,Intends to take action soon, for example next month,Has changed behavior for less than 6 months,Has changed behavior for more than 6 months,Change is Dynamic and Cyclical,It is important to note tha
9、t the change process is cyclical, and individuals typically move back and forth between the stages and cycle through the stages at different rates. In one individual, this movement through the stages can vary in relation to different behaviors or objectives. Individuals can move through stages quick
10、ly. Sometimes, they move so rapidly that it is difficult to pinpoint where they are because change is a dynamic process. It is not uncommon, however, for individuals to linger in the early stages.For most substance-using individuals, progress through the stages of change is circular or spiral in nat
11、ure, not linear. In this model, recurrence is a normal event because many clients cycle through the different stages several times before achieving stable change. The five stages and the issue of recurrence are described below.Source: http:/www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.61626
12、,Key Points,Prochaska and DiClemente argue that behavior change cannot be thought of as a specific event occurring at a specific point in time. Rather, change should be thought of as a process that may take months or even years. Many behavioral change programs are characterized as lasting for a pred
13、etermined number of weeks and consisting of structured content. Such programs do not take into account the uniqueness of each client, and the subtle changes that often go unnoticed. Some clients will respond very positively and make significant changes. However, for those who do not, they are said t
14、o lack motivation and/or willpower. We tend to acknowledge change has occurred when we see a change in behavior, e.g. a period of abstinence, leaving an unhealthy relationship. These are seen as successes.,Key Points,The stages of change model suggests that change occurs along a continuum and theref
15、ore cannot be measured by one criteria alone, i.e. a change in a specific problem behavior. If we view change as a process then we can report positive changes each time an individual progresses from one stage to the next. Small steps constitute changes and should therefore be recognized and supporte
16、d.Since clients differ in their readiness to make changes Prochaska and DiClemente suggest matching interventions to the appropriate stage (or readiness). “Success, moreover, is defined not just by changing the behavior but by any movement toward change, such as a shift from one stage of readiness t
17、o another.” There is an emphasis on the maintenance of change. Relapse is common and should not be seen as a sign of failure. Clients are encouraged to learn from their relapse.A great deal of importance is placed on the decision making capability of the individual,Practical Applications,Teaching ca
18、se conceptualization and treatment planning in counselor education and supervision Common concerns of student counselors in supervision: “I dont know what else to do with this client” “I feel like I do not know enough techniques” “I want to be prepared and have a diverse number of tools to draw upon
19、” “The client is stuck, I am stuck, I dont know where to go” “I am exhausted, she or he, wont budge.” Counselors need to become aware of when they are working harder than their clients Counselors may get into difficulties if they rely too heavily on theoretical techniques and attempt to draw from th
20、eir “bag of tricks”. Eventually someone will throw a spanner in the works. Student counselors will benefit from learning about the stages of change because it explains the process of change. More emphasis is placed on the client, which will help alleviate some of the pressure counselors feel. Counse
21、lors can use the model to teach clients about the stages of change, and thus set the tone for future counseling sessions. All of the above can then be used to create a collaborative treatment plan based on the clients current position,Integration of Major Therapy Systems within the Transtheoretical
22、Framework,Motivational Interviewing,A counseling style that is derived from the field of addictions counseling. Brief intervention format. Six critical elements necessary for successful brief interventions (the acronym FRAMES) Feedback emphasizing the clients Responsibility for change offering Advic
23、e provide a Menu of alternative treatment options demonstrate Empathy reinforce clients optimism; Self-Efficacy.,Miller & Sanchez, 1994,Motivational Interviewing,Motivational interviewing is guided by several principles: Avoiding argumentation Rolling with resistance Expressing empathy Developing di
24、screpancies Supporting self-efficacy Counselors avoid harsh confrontations MI counselors emphasize the need for change and increase confidence and hope that change can occur.,Lewis & Osborn, 2004,Stage 1: Precontemplation,Adapted from: The National Center for Biotechnology Information: TIP 35: Enhan
25、cing Motivation for Change in Substance Abuse Treatment: http:/www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.61302,Precontemplation: Strategies,Use self motivational statements with questions such as: “How does this concern you?” “What do you think will happen to you if you do not make any c
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