This learner guide has been designed for students who are engaging in the units: CHCCM503-DEVELOP FACILITATE & MONITOR ALL ASPECTS OF CASE MANAGEMENT. Elements: 1.1, 2.1, 2.2, 2.3, 3.1, 3.2, 3.3, 3.7, CHCCS500A- CONDUCT COMPLEX ASSESSMENT AND REFFERAL Elements: 1.1, 1.3, 1.4, 1.5, 2.2, 2.3, 2.5, 2.6, 2.7, 3.1, 3.3, 3.4, 3.5, 4.1, 4.2, 4.4, 4.5, and 4.6. This guide would be useful for students to improve their questioning skills prior to a role-play assessment. This guide also focuses strongly on working with clients with a substance use/abuse issue. It is expected that students have already acquired knowledge of active listening and other verbal and non-verbal communications. This learner guide also includes a range of learning activities for which the answers can be found on page 34. This guide also includes an assessment that is divided into three parts: ASSESSMENT ACTIVITY 1 CREATE YOUR OWN CASE STUDY. Write a fictional story of around 500 words that begins with the words: ‘My name is..” The story must include the issue of substance abuse and at least two other issues of your choosing. This story must also contain two strengths (positives). Include the person’s original motivation for using. Is the motivation the same today? How did they feel when they used? How do they feel now when they use? How has it affected their lives with regard to relationships and employment? What does a normal day look like for them? What sorts of emotions do they experience? What would they like to achieve in the future? Try to be creative and put yourself into the shoes of someone who is in a situation that your future clients may find themselves in. However keep a reasonable amount of realism, as you will need this case study in other sections of the assessment. Do not finish the story with a ‘happy ending’ as the issues should be on-going. ASSESSMENT ACTIVITY 2 Create your own holistic assessment form that poses all of the required questions as briefly and unobtrusively as possible. Remember to include all personal details and an explanation and acceptance of confidentiality to begin with. Then try to pose the questions in a logical and polite manner. You probably would not begin with Mental Health, for example.
Once each pair has completed their holistic assessment questionnaire, using the case studies you created in ‘Assessment Activity 1’ conduct an informal role-play. One student will assume the role of the character they created, and the other will take on the role of a case manager, who will utilise their verbal and nonverbal communication skills to conduct a holistic assessment using the assessment questionnaire. Make sure that you fill in the answers. Once completed swap over and repeat the task. ASSESSMENT ACTIVITY 3 Formal Role-Play. Now that you have fulfilled the ‘case management stages’ of: ENTRY/SCREENING, and ASSESSMENT, It is time to meet up with the client again and to begin the PLANNING process. For this task you will be required to use your ‘questioning techniques toolbox’ as previously discussed. You are not required to adhere to one particular theory of technique. Rather, try to use strategies and questions from each as you fell would be most useful to achieve a positive outcome. For example you might begin with “Egan’s first stage of: What’s going on?” Your client maybe stuck in a stage of ambivalence, or has a lack of direction or motivation because they cannot see change as a realistic possibility. In this situation perhaps Egan’s second stage of brainstorming (What do I want?), Could be appropriate. Or perhaps a more solution focused approach of asking the miracle question. Motivational interviewing would also be useful in this situation. Maybe you might look at the positive aspects received by the client for the use of a substance or the continuation of behaviour, and then the less positive aspects. You may ask them what someone close to them might say are their best personal qualities. And then ask them how a stranger in the street may see them. You might ask them: What did they imagine they would be doing today when they were 15? (Adjust age appropriately) Then have they achieved any goals towards that? What do they think has held them back from achieving those goals? You could ask them how badly they want to achieve change on a scale from 10-to10. And then ask them: What would it take to achieve a higher grade. Feel free to create your own variations of these techniques and try to pose them in a logical order. At the same time do not forget to apply your verbal and non-verbal communication micro-skills.
By the end of the role-play, hopefully you have identified both areas of immediate need as well as some goals to work towards into the future. Once you have concluded the role-play you can begin to write up your case notes. Now you are ready to research appropriate agencies and programs to put a case-plan together for presentation to your client. Remember that the best case plans not only address issues of immediate need but also include activities directed at social, future vocational and emotional needs. Try to make it as enjoyable as possible. Before attempting these assessment tasks work through this learner guide and ask your trainer for assistance and clarification. Students are encouraged to read further on the subject. Many good references are given at the end of this guide.
4.' (Egan G. However. p7-8). which they choose. write down five personal or professional goals that you would like to achieve in the future. We must remember that it is the client’s life and that only they can choose to make changes in their life. Egan’s 3 stages theory. 2. 5. However this may not be the case for the client. Clients may also be conscious or semi-conscious that change is necessary but maybe ambivalent. 'The Skilled Helper'. That’s where we as Community Workers come in! This guide will examine the theories of: Motivational Interviewing. 3. as well as others mentioned in the Reference Section. or not. The goals of using the model are to help people 'to manage their problems in living more effectively and develop unused opportunities more fully'. and to 'help people become better at helping themselves in their everyday lives. Thus there is an emphasis on empowerment. or may lack the motivation or self-belief required for positive change. or on a theory of the ways difficulties develop. it can often seem clear to the worker what we believe might be a restrictive or negative element in the client’s life. before we can get to that point we have to assist in the illumination of what the client would like to change or achieve. Also the person s own agenda is central. Helping clients to set goals is an important part of the case management process. and the model seeks to move the person towards action leading to outcomes.After workers have conducted an intake and holistic assessment of the client’s issues. Miller and DeJong. As an exercise. It is a framework for conceptualising the
. Egan's skilled helper model This 3-stage model or framework offered by Egan is useful in helping people solve problems and develop opportunities. This model is not based on a particular theory of personality development. it is however necessary if we are to set goals and achieve them. This is not always easy as clients are not always able to express. or are not yet conscious of what they believe needs to change or even how they would like their future to look like.. As you can see understanding what you want to achieve is not always straightforward. 1998. Solution Focused Therapy Questioning techniques put forward by: Rollnick. and value. 1.
Diagram of the Model
STAGE 1 STAGE 2 Preferred Scenario STAGE 3
2a – Possibilities 3a . However. The model works best if attention is paid to Rogers' 'core conditions'. as appropriate.Best fit strategies (What will work for me?)
1c . and mentoring/comentoring can be done using other models. and at times people may move back into previously answered ones. respect. the skilled helper will work with the speaker in all or any of the stages. the model can be used in many kinds of helping relationships.Commitment (Check goals are right)
3c – Plan (What next and when?) Action Leading to Valued Outcomes
. The model can and should be used flexibly.Possible actions 1a . and empathy. As with any model. and move back and forward. For simplicity.com/hub/The-core-conditions-which-Carl-Rogersconsidered-essential-for-effective-counselling The helpers approach to the speaker being based on genuineness. For more details on this subject. or congruence. and if principles of good active listening are remembered throughout.The story (What's going on?) (Ideally.Leverage (Focusing/prioritizing)
2c . it provides a map. which can be used in exploring. 'What do I want instead?' 3. (or none!). realness. 'How might I get to what I want?' Not everyone needs to address all 3 questions. 'What is going on?' 2. The Egan model and mentoring are not synonymous. but which is not the territory itself. what do I want instead?) (How many ways are there?) 2b .helping process. we'll look at the model sequentially. The Egan model aims to help the speaker address 3 main questions: 1.Blind spots (What's really going on?)
3b .Change Agenda (SMART goals)
1b . and is best used in working on issues in the recent past and the present. (genuineness.hubpages. unconditional positive regard and empathic understanding). check out the following linkhttp://garethmartin.
or from different angles. “. open questions. distortions.active listening. Useful Questions: How do/did you feel about that? What are/were you thinking? What is/was that like for you? Keep them open! What else is there about that? 1b . and to be fully heard and acknowledged. helps them to explore and unfold the tale. reflecting. all the jumble began to make sense. "I'd never thought about how it might feel from my colleague's point of view. It is about a space where a person can hear and understand their own story. incomplete awareness. For some.a challenging part Since they are in the situation. and by using good active listening skills and demonstrating the core conditions. the impact of their behaviour on the situation. their strengths. for others it is just the beginning. In this stage. specifics. patterns and connections. what's not said). blind spots (discrepancies. paraphrasing. as you summarised what I said. Then choose an area that they have the energy to move forward on. that is why they want to talk. and to find a point from which to go forward with hope.. negative self-talk. strengths. With the help of empathic reflections and challenges. ownership.an expansive part The helper encourages the speaker to tell their story. it can be difficult for the person speaking to see it clearly. of others and of themselves . 1a . summarising. this is enough. "I see now the key place to get started is my relationship with K"
.their patterns. shoulds and oughts.." Skills in Stage 1a: . that would make a difference and benefit them.What's going on? Stage 1 is about providing a safe place for the speaker to tell their story in their own way. checking understanding."
Skills: Challenging. the helper seeks to move the speaker from stagnation to hope by helping. things implied. different perspectives. and to reflect. Useful Questions: o How do others see it/you? o Is there anything you've overlooked? o What does he/she think/feel? o What would s/he say about all this? o What about all of this is a problem for you? o Any other way of looking at it?
1c -Focussing and moving forward People often feel stuck. It is also about gently helping them lift their head to see the wider picture and other perspectives.STAGE 1 .. the speaker uncovers blind spots or gaps in their perceptions and assessment of the situation.
and has a time frame attached. are motivating. i.e. Quality Anything goes . what would it be like?' The speaker is encouraged to broaden their horizon and be imaginative. in their circumstances). or in what way their problems might be opportunities. "At first it was really difficult but after a while I Jet my imagination go and began to get really excited about what we could achieve in the department". "It feels good to be clear that I want a clear understanding with my colleagues about our respective rules and responsibilities. rather than reflect on practicalities. Useful Questions: o What in all of this is the most important? o What would be best to work on now? o What would make the most difference? o What is manageable?
Stage 1 can be 5 minutes or 5 years. the speaker formulates goals. realistic (with reference to the real world).a reality testing part From the creative and visionary brainstorm. like your ideal world. don't analyse or judge o Keep prompting . i. 2a . which are specific.'what else?' o Don't hurry. and how things could be better. For some people this is scary. SMART goals. achievable/appropriate (for them. Stage 2 is about this. about helping the speaker to open up a picture of what they really want. for some liberating. allow lots of time Useful Questions: o What do you ideally want instead? o What would be happening? o What would you be doing/thinking/feeling? o What would you have that you don't have now? o What would it be like if it were better / a bit better?
2b .What do I want instead? People often move from problem to action.
Stage 2 . o Quantity vs. without reflecting on what they really want.have fun o Write down ideas verbatim.
Skills: Brainstorming. which are demanding yet achievable.e. or problem to solution. it may be all someone needs. Goals.a creative part The helper helps the speaker to brainstorm their ideal scenario.• •
Skills: Facilitating focussing and prioritising an area to work on."
. This stage is very important in generating energy and hope. facilitating imaginative thinking. 'if you could wake up tomorrow with everything just how you want it. measurable.
Skills: facilitating selecting and reality checking with respect to internal and external landscape. breaking out of old mind-sets.moving forward This stage aims to test the realism of the goal before the person moves to action. Useful Questions: o What exactly is your goal? o How would you know when you've got there? o What could you manage/are you likely to achieve? o Which feels best for you? o Out of all that. how will the person move towards the goals they have identified in Stage 2? It is about possible strategies and specific actions. and checking commitment to goal. and to help the speaker check their commitment to the goal by reviewing the costs and benefits to them of achieving it. organisations could help? The aim is to free up the person to generate new and different ideas for action. about doing something to get started.. ideas."
Skills: facilitation of exploring costs and benefits. "There were gems of possibilities from seemingly crazy ideas".another creative part! The speaker is helped to brainstorm strategies . What people. 3a .. places. whilst considering what/who might help and hinder making the change.How will I get there? This is the 'how' stage. Is it worth it? "It feels risky but I need to resolve this.101 ways to achieve the goal again with prompting and encouragement to think widely. Useful Questions: o What will be the benefits when you achieve this? o How will it be different for you when you've done this? o What will be the costs of doing this? Any disadvantages/downsides to doing this?
Stage 3 . what would be realistic? o When do you want to achieve it by?
Skills: Facilitation of brainstorming Useful Questions: o How many different ways are there for you to do this? o Who/what might help? o What has worked before/for others? o What about some wild ideas?
consistent with their values? Force field analysis can be used here to look at what internal and external factors (individuals and organisations) are likely to help and hinder action and how these can be strengthened or weakened respectively. is to keep the speakers agenda central. and to use the model for the person. The strategy is broken into bitesize chunks of action. rather than vice versa. I will organise this before Friday". it's also important not to push the speaker into saying they'll do things to please the helper.
Skills: Facilitation of action planning. I will book a meeting. and the model can be used over a series of sessions. the individual in the foreground and theory in the background.focussing in on appropriate strategies What from the brainstorm might be selected as a strategy that is realistic for the speaker. that's fine too. The helper works with them to turn good intention into specific plans with time scales.
Reference: 'The Skilled Helper . Brooks Cole.moving to action The aim is to help the speaker plan the next steps. Here the speaker is doing almost all the work. Whilst being encouraging. Useful Questions: o What will you do first? When? o What will you do next? When?
If the end point of producing an action plan has been reached. as with any theory or model.
Skills for Stage 3b: Facilitation of selecting and reality checking. the experience of trying it out could be the starting point for a follow-up mentoring/co-mentoring session.3b . in their circumstances. so that we can be sure of quiet uninterrupted time. producing their action plan. The key in using the model. The work would start in stage I again. Useful Questions: o Which of these ideas appeals most? o Which is most likely to work for you? o Which are within your resources/control?
3c . "I will make sure we have time together before the end of the month. 6"' edition 2010
. If an action plan had not been reached.a problem management approach to helping' by Gerard Egan. "I would feel comfortable trying to have a conversation with him about how he sees things". telling a new story.
and how the strategies employed could be beneficial to the ‘helping process’.Activity 1.
Activity 2. classmate. The counsellor/worker:
. We all have things in our lives we would like achieve.
When working with clients a skilled worker will employ a range of counseling techniques depending on the situation and the client. housemate or family member. Try to imagine a tool . Motivational interviewing was a step away from labeling people and focusing on the behaviors. Working through ‘Egan’s Stages’ interview each other one at a time and identify and record 3 goals that each person would like to achieve. In your own words write down what the 3 stages are. Counselling techniques and characteristics Drug and alcohol problems are seen by many as something unusual that needs to be handled in a special way and best left to the 'experts'. or less time to. This is not the case. Find a partner. The skills used by counsellors and health and welfare workers in their day-to-day work are the skills utilised by a drug and alcohol worker/counsellor.
Motivational interviewing.box filled with different skills and questioning techniques. improve or devote more.
These can be strong emotions so naturally if you were feeling this way you would want the person you are seeking help from to respond in an appropriate manner. which requires highly developed listening skills. If you are going to conduct a motivational interview it is necessary to develop or consolidate your knowledge of some basic counselling skills. worried. but motivation means different things to different people. Many people talk of feeling embarrassed. particularly telephone counselling. Many of these skills can only be developed with practise. which is positive. and vulnerable. stupid.
Motivational interviewing is one way of exploring the issues that concern the client with a view to behavioural change.• • •
Needs to develop trust and understanding with the client Should not impose his/her views on the client Needs to help the client address issues the client sees as problematic.
What is motivation? Most people would agree that they think motivation is a good thing.
Activity 3. We often hear welfare workers. when really that person is simply motivated to behave in a
. How might you describe motivation?
Most people regard motivation as behaviour. teachers and counsellors describing a student or client as unmotivated. of feeling a failure. confused. Consider how you were thinking and feeling when you asked someone for help. Take some time to consider and write down the characteristics that you believe a good counselor should have. The underpinning theory of motivational interviewing is that all human behaviour is motivated.
• • •
Inherent Essential Belonging naturally. Motivational interviewing attempts to free people from the trap of ambivalence. Ambivalence Being ambivalent (in two minds) about a particular behaviour is normal.
Activity 4. then change is unlikely.
. If people are ambivalent about a particular behaviour and can think of many costs but also many benefits for that behaviour.
Or it can be extrinsic. The person has not become unmotivated as a result of his/her drug use but rather is motivated toward drug use.
Create a caption for each of these characters that might describe their motivations.
• • •
Not inherent Not essential Not belonging naturally.
It is important that you consider the implications of the differences of the two and how they might impact on motivational interviewing.manner other than the one the teacher or welfare worker wants. If in doubt do nothing.
Motivation can be intrinsic.
ASSESSMENT ACTIVITY 1
CREATE YOUR OWN CASE STUDY. Is the motivation the same today? How did they feel when they used? How do they feel now when they use? How has it affected their lives with regard to relationships and employment? What does a normal day look like for them? What sorts of emotions do they experience? What would they like to achieve in the future?
. People use substances for a range of reasons. consider if you will change your current behaviour. Include the person’s original motivation for using. See if you can name 5.” The story must include the issue of substance abuse and at least two other issues of your choosing. Think about a behaviour. a decision matrix with these headings. Write a fictional story of around 500 words that begins with the words: ‘My name is.. design.Activity 5. This story must also contain two strengths (positives). Don't be surprised if you have decided not to. which you are ambivalent about then. Activity 6.
• • • •
Benefits of maintaining my current behaviour are Benefits of changing my behaviour are Negatives of maintaining my current behaviour Negatives of changing my behaviour are…
When you have completed the matrix.
Empathy involves seeing the world through the client's eyes. This guides therapists to help clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be vs.
Roll with resistance. When clients perceive that their current behaviours are not leading toward some important future goal. as you will need this case study in other sections of the assessment. the counsellor does not fight client resistance. Having clients share their experiences with you in depth allows you to assess when and where they need support.
Motivational interviewing Continued.
Develop discrepancy. MI encourages
. When clients feel that they are understood. resistance tends to be decreased rather than increased. MI counsellor’s work to develop this situation through helping clients to examine the discrepancies between their current behaviour and future goals. feeling things as the client feels them. they are more able to open up to their own experiences and share those experiences with others. Expression of empathy is critical to the MI approach. Using this approach. Instead the counsellor uses the client's "momentum" to further explore the client's views. thinking about things as the client thinks about them. but "rolls with it. In short. sharing in the client's experiences. as clients are not reinforced for becoming argumentative. and what potential pitfalls may need focused on in the change planning process.
Miller and Rollnick identified general principles of motivational interviewing that are necessary to achieve a successful result. However keep a reasonable amount of realism. Techniques used can include decisional balance sheets. They are: Express empathy. how they currently are (or between their deeply-held values and their day-to-day behaviour). In MI.Try to be creative and put yourself into the shoes of someone who is in a situation that your future clients may find themselves in." Statements demonstrating resistance are not challenged. they become more motivated to make important life changes. the counsellor’s accurate understanding of the client's experience facilitates change.
and if a given plan for change does not work. As clients are held responsible for choosing and carrying out actions to change in the MI approach. not the counsellor’s. Support self-efficacy. and exploration instead of explanation.clients to develop their own solutions to the problems that they themselves have defined. counsellors may invite clients to examine new perspectives. In exploring client concerns. counsellors focus their efforts on helping the clients stay motivated. the spirit of the method. such as "What makes you think this is a problem for you?" or "How does ______ interfere with things that you would like to do?" It is important to keep in mind that client behavioural issues are common in the process of motivational interviewing. not the exception. and is not imposed from outside forces 2. One source of hope for clients using the MI approach is that there is no "right way" to change. and oriented in the present and/or future. autonomy rather than authority. realistic. in that they help the client to examine and resolve ambivalence 6. Knowledge alone is usually not sufficient to motivate change within a client. For example. but counsellors do not impose new ways of thinking on clients. and supporting clients' sense of self-efficacy is a great way to do that. evocation not education. Readiness to change is not a trait of the client. important to the client. therapists must recognize that motivational interviewing involves collaboration not confrontation. This guides therapists to explicitly embrace client autonomy (even when clients choose to not change) and help clients move toward change successfully and with confidence. Motivation to change is elicited from the client. elicit change talk. Change often takes a long time. While there are as many variations in technique as there are clinical encounters. to articulate and resolve his or her ambivalence 3. change talk can be elicited by asking the client questions. is more enduring and can be characterized in a few key points: 1. Rolling with resistance allows therapists to accept client reluctance to change as natural rather than pathological. however. The counsellor is directive.
The main goals of motivational interviewing are to establish rapport. It is the client's task. Effective processes for positive change focus on goals that are small. The counselling style is generally quiet and elicits information from the client 5. and the pace of change will vary from client to client. and relapse behaviours should be thought of as the rule. and establish commitment language from the client. Direct persuasion is not an effective method for resolving ambivalence 4. specific. The therapeutic relationship resembles a partnership or companionship
. clients are only limited by their own creativity as to the number of other plans that might be tried. but a fluctuating result of interpersonal interaction 7. Ultimately.
. with its client-centred approach and acknowledgement of the Stages of Change is seen to be more effective in supporting clients to reflect upon their substance use and to make their own decision to change. It is not seen to be effective in working towards supporting change. Emphasis on personal make-up. acceptance of diagnosis is seen as essential for change.G. Washington.. (1998) 'Motivational Enhancement Therapy Manual. Journal of Consulting and Clinical Psychology 71 (5): Also remember to avoid argumentation. Carolina E.· ^ a Miller. Arguments are counterproductive Defending breeds defensiveness Resistance by the client is a signal for the counsellor to change strategies Labelling is unnecessary. Miller. Michael. Laura (2003). Therapist presents perceived evidence of problems in an attempt to convince the client to accept the diagnosis. William R. Palmer. a trait or characteristic requiring confrontation. Zweben. C. which reduces personal choice. "Client commitment language during motivational interviewing predicts drug use outcomes". Confrontation/denial approach
Heavy emphasis on acceptance of self as having a problem. Yahne. Rychtarik. Paul C. A. R. The confrontation/denial approach has traditionally been used in America and does not acknowledge the reasons behind the clients' behaviour. Motivational Interviewing....C.
• • • •
How does Motivational interviewing differ from other methods of counselling when working with clients experiencing drug and alcohol issues? Approaches to working with AOD clients. DC:National Institute on Alcohol Abuse and Alcoholism · ^ Amrhein. Fulcher. W.R. The points listed below outline two approaches that have been used in working with clients who use alcohol and other drugs. Resistance is seen as 'denial'. judgement and control.. DiClemente..
. gaze. objects. reflecting and summarising skills. However. Treatment goals and change strategies are negotiated between client and therapist based on data and acceptability. Non-verbal communication is sent via posture. Egan (2007) summaries how our body language sends a message to the client that we are attending to him/her. clothing. Resistance is seen as an interpersonal behaviour pattern influenced by the therapist's behaviour. use of space facial expression. We might smile and make appropriate eye contact but send signals of our irritation by a tapping foot or strained voice. which demonstrate to the client that you are there mentally as well as physically. Resistance is met with reflection. Some non-verbal communication is deliberate and conveys messages we intend to give. This can be demonstrated by:
Whilst it is important for the counsellor to be focused and to use appropriate questioning. proximity. acceptance of 'alcoholism' or other label is not seen as necessary for change to occur. It has been suggested that as much as 70% of communication is non-verbal. client's involvement in and acceptance of goals are seen as vital. the client is seen as in denial and incapable of making sound decisions. Therapist conducts objective evaluation but focuses on eliciting the client's own concerns.
Motivational interviewing approach
De-emphasis on labels. with the following acronym. physical layout of the space. eye contact. we should never underestimate the power of non-verbal communication. which can convey messages we do not intend to send. gestures and body movement. we must become aware of non-verbal behaviour.
Attending behaviours Attending behaviours are behaviours. Goals of treatment and strategies for change are prescribed for the client by the therapist. Emphasis on personal choice and responsibility for deciding future behaviour.• •
Resistance is met with argument and correction.
stated that to really listen we need to have empathy with the clients. Ordering. a psychotherapist and counsellor who developed a client centered therapy method. He suggests that to develop this skill. like all acts of perception. Listening. directing or commanding Response: You need to stop drinking now. Thomas Gorden (1995) has outlined 12 kinds of responses that block or inhibit two-way communication. Warning or threatening Response: If you don't stop using heroin you will be dead within six months. the counsellor should use the client's own words to repeat what the client has said. We should attempt to understand what the client is saying without filtering it through our beliefs and life experiences. or providing solutions Response: The best thing you can do is tell your mother that. If the client wants to keep going he/she has to go around the obstacles placed in his/her way.
Roadblock/Barriers to communication A key element of reflective listening is how the counsellor responds to what the client says.. Persuading with logic. These responses are called roadblocks as they block the client's efforts to communicate. Carl Rogers. before the counsellor replies. We need to attend to what is being said and to observe the non-verbal communication.. Giving advice. making suggestions.• • • • •
S face the client Squarely O adopt an Open position L Lean towards the client E maintain good Eye contact (being mindful of cultural differences) R be Relaxed
Good listening skills. arguing or lecturing Response: You may think that but experts tell us differently. then interpret the messages or signals we are receiving. is an active not a passive process. Moralising or preaching Response: You must realise that you cannot be a good mother when you are drinking like this. to the client's satisfaction.
It is important to try to demonstrate that you have a genuine interest in the client and his/her issues. criticising Response: No matter how strong the cravings are there is no excuse for stealing. Reassuring.
• • •
. Inappropriate questioning Response: This may be a question that is not relevant to the intervention and thereby limiting client willingness to respond. judging. Agreeing. humouring or changing the subject Response: I think most of us drink in excess of the guidelines on occasions. your father had a drink problem so naturally you drink heavily. Withdrawing. Did you have any luck in finding a job? Empathy Empathy shows the client that you are trying to understand what it is like to stand in his/her shoes and see the world through his/her eyes. Response: It seems to me that your wife is behaving like that to get a reaction from you. This can be done by:
having an ability to recognise and understand the client's problems and concerns showing sincerity and warmth being able to reflect understanding of and interest in the issues being aware of your own strengths. Why won't you stop? Interpreting or analysing. ridiculing or labelling Response: Your children are suffering as a result of your drinking.Disagreeing. Shaming. approving or praising Response: It is very hard for you. It is important that you do not filter what the client is saying through your own values and beliefs system. sympathising or consoling Response: Don't worry we will sort everything out. distracting. This skill can be demonstrated by:
• • •
displaying a non-judgemental attitude reflecting and validating what the client has said respecting and acknowledging the strengths and resources of the client. limitations and boundaries.
Counsellors should also have skills in delivering specific educational information and facilitating the client's self-confrontation. closed questions can lead to a counsellor-controlled session in which the client feels interrogated. They can be useful when you need specific information. how or phrases such as 'I would like to hear a little more about that'. expressing feelings and emotions can be very difficult.. We have often spent years trying to mask both our feelings and emotions.. Open questions allow a more detailed response. It is important that you don't add anything. or. 'Was that for yourself or both of you?' 'What you seem to be saying is. If a lot of information needs to be gathered a pre-interview questionnaire can be useful. clarification and illustration. Clarifying goes a little further. 'Tell me what concerns you?'
. Open questions often start with words such as what. Closed Questions Closed questions are designed to curtail or close the client's response. Clients should be encouraged to express their emotions and accept them for what they are. some obvious and others not so obvious. To do this the counsellor may respond with a statement such as: 'It seems that you are feeling. especially in the early stage of an interview.Paraphrasing and clarifying Paraphrasing shows the client that you are listening to him/her and provides an opportunity for the client to hear your understanding of what he/she has said and to respond to that. If they are overdone. where..' Reflecting During a counselling session a client may convey many feelings and emotions. Open Questions Open questions should be used to provide opportunity for elaboration.. when. For many of us. It provides an opportunity for the counsellor to admit that he/she is a little confused and to explain the counsellor's understanding of what is being said and to clarify or to ask for another example of what the client is trying to say.'
Questions The counsellor should use his/her skills to ask appropriate questions and guide the session. The counsellor needs to reflect the client's feelings by picking up on all the messages he/she is sending and then reflecting and clarifying the feeling. They are often answered with one or two words and don't allow exploration.
People who use alcohol and other drugs do so for a reason.. More difficult than you would think?
Getting Down To Business. to wait until later in your meeting to get these details. I hope you have not been waiting long. If it's okay with you I would like to spend a little time today to explore this issue a little further.. It's good to see you again..
. or positives supports your engagement with a client. You are trying to understand their use of alcohol and other drugs from their perspective. It may be possible however. I believe you want to talk about your use of.. 'Hello.' OR 'Last time we spoke you mentioned that you thought your use of cannabis had increased and this sometimes concerns you.
Opening structure If it is the first time you have met you will need to introduce yourself and say a little about your role within the agency. You may also need to gather a few personal details by use of closed questions.. especially if the client has not completed a preinterview questionnaire.?' • 'What do you enjoy about using. Many clients' experience of talking about drugs is the focus on the negative aspects.?' It can be a good idea to list them in a notebook or on a whiteboard. as a visual record can be a powerful tool when summing up the benefits and costs of drug use. It is important for you as the counselor to know what the client perceives as being the 'good things' as these may be the basis of the client's conflict about changing his/her behavior. Asking about the good things will indicate the role of substances in the client’s life. to talk about the good things.'
Discuss the good things
A useful strategy in reducing defensiveness is to ask the client what they enjoy about their drug use. you know there must be some 'good things' about the drug use. With a classmate/friend/or relative ask them a range of questions that do not allow them to give a one-word response. Make sure you acknowledge and summarise all the good things about the client's drug use..Activity 7. So ask them directly: • 'What are the good things about your use of. It shows you do not think he/she is mad.
Counsellor `Can you tell me some of the good things about your amphetamine use?' Client 'It gives me loads of energy..' Counsellor 'So you enjoy feeling more energetic?' Client 'Yes I get more done..
To help raise issues or concerns it can be useful to look back to when the client was 18 and ask how he/she imagined life would be. It is important that you don't assume that just because the client has mentioned a negative aspect of drug use that it is a problem. Ask then how the client sees himself/herself in two years time if he/she carries on as things are now.. For example. This time when he/she raises an issue you are going to explore it in more detail and try and find out how it affects the client personally. Now let's look at the other side of the coin.' Rather than just listing the less good things focus on the aspects that the client thought was cause for concern. (Pause). the client needs to talk about the direct relevance to his/her life. I was too tired. summarise what has been said. Try to use the client's words as much as possible. The aim is to help the client see that concerns outweigh the positives. You might say something like. You have the energy to go out and when you drink alcohol you don't feel like you are getting drunk. I feel alive.. 'So on one hand you're your use of amphetamine is enjoyable because. What are some of the less good things about your use?'
Once you have talked about the good things and explored the less good things. Ask the client how he/she feels about that. Is there anything else you like about using speed?'
Examine the less good things
This is an opportunity for the client to express some of the negative things associated with use. Now I just have a bit of speed and off I go. and how that fits with life now. Allow the client time to react or comment on the summary you have made before you move on to other strategies.' Counsellor 'So your use of speed has very real benefits. Would the client like to make changes? What is stopping him/her?
. Remember today nearly everyone knows smoking cigarettes is linked to cancer and yet it does not motivate smokers to stop. Counsellor 'You have told me why you enjoy using speed and it sounds as if it has some real benefits for you. I also like the fact I can have a few drinks and I don't get drunk. and on the other hand it . I work as a waitress and when I finished work I never felt like going out.
In later stages. Wilkinson and Allsop call the psychological squirm. Motivation is multidimensional and not easily assessed. Explore the responses and again summarise before asking.
Stages of Change Model
People go through a series of stages when they change health behavior. ask if there is anything you can do which might help to make a decision. Anything that moves a person through the stages toward a positive outcome should be regarded as a success.
User versus self
Another useful strategy is one which Saunders.The timescales need to be appropriate to the concerns mentioned and the client's age." Importance is determined by what value a person places on making the
. Ask the client how he/she would describe him/herself as a drug user. Explore what the client says. In addition to readiness to change. In the early phases. The Stages of Change Model describes seven stages of readiness and provides a framework for understanding the change process. interventions can be tailored to the individual's "readiness" to progress in the recovery process. and impede change. If the client decides to remain the same. people are actively doing things to change or maintaining the changes that they have been able to make. use reflective listening and then summarise. workers should also consider the key factors of "importance" and "selfefficacy. To do this you ask the client to describe his/her best qualities or to tell you what qualities his/her best friend. create resistance. It encourages the client to think about discrepancies between himself/herself as an individual and the client as a drug user. If the client has not reached a decision. Ask the client directly if he/she has made a decision about what he/she wants to do. Interventions that do not match the person's readiness are less likely to succeed and more likely to damage rapport. give the client information and tell the client that if he/she wants to talk to you again. With a younger person you may focus more on the immediate future and talk in terms of months rather than years. By identifying where a person is in the change cycle. The stages are cognitive and behavioral. child or mother would say the client has. Motivation is multidimensional. people tend to focus on thinking about change-whether change is something they need to consider. you are available. wife. 'How do these two images fit together?'
Ask for a decision
You may find the client says he/she wants to change or the client will indicate that he/she wants to do something.
".-).5$% "#$% 3-+4$! &'()$*+.-((. This 3-+4$! &'()$*+.' (!
&'()$*+.()$(-(1$!has re-lapsed. "Denial" might describe this stage for people who have a long history of alcohol or drug use but insist they can handle it.-). Teenagers are generally in this stage and some people may be stuck here for years.-). It helps workers to tailor an appropriate strategy and helps clients identify at which stage they are at.'(! approach promotes engagement and allows greater self-efficiency and identifies the person's greatest needs and goals.
When individuals think that change is beyond their capabilities.-((.-).'(!!
01). They also need specific ideas about how to do it.
01). This realization can accelerate the changing process and it also can be ". Self-efficacy is the belief or confidence in one's ability to achieve change.'(!
2-.'(! change. as they can view the process as cyclic an individual who and on going.'(!
Pre-Contemplation Stage: A state of unawareness where the user has no concerns about the consequences of their alcohol or drug use.
.(/! of comfort to2-. they may not try. The stages of change model is a useful tool for both clients and workers. People who are high on importance but low on confidence need encouragement that change is possible.
) Maintenance Stage: The stage where the person uses 'relapse prevention' strategies to ensure new behaviors are maintained.
. In the process of stopping quickly. Finding the right support is the key to success in any significant personal change. If you move too quickly and stop using without a proper plan or without putting the necessary support in place. The consequences are not yet so bad that they feel the need to take action. has begun to think about the issue. The preparation stage is perhaps the most important in the process. Few people are able to get on top of substance abuse or dependence without a "slip". the chances of long-term success are not great. Preparation Stage: The stage where the client is beginning to try things such as going to AA. Strategies in this stage might include: • • • • • • On-going counselling Attending a support group such as AA or NA Telling friends and family of their plan Avoiding friends they used to "use" with Self-esteem building processes Finding replacement activities
Lapse: The process of learning to cope with a "slip" to prevent it turning into a full-blown relapse.Contemplation Stage: The stage where the person has become aware that there are problems associated with their substance use. However some of the best learning comes from having a slip which is brought under control before the user relapses completely. where they start using again. or the consequences are serious. looking at the options. and has committed to an attempt to cut back or stop using (preferably on a certain date. Action Stage: The stage where the person is actively attending counselling or AA/NA or both. and making a plan to stop or cut down. but is not yet ready to deal with it. new skills are learnt which then become part of the user's relapse prevention repertoire. but the person feels that getting control of the situation is just too hard.
However all is not lost as both the client and the worker can reflect on what strategies worked and what went wrong. These lessons are invaluable to achieving success in the future. would you say that they are experiencing?
Do the clients appear to have a lot of issues in common?
.php Identify 5 of the main characters.com.au/watch/watch-film. and answer the following questions: What are their issues?
At the films conclusion. The client need not go through all seven stages again as they can begin to plan a soon as possible.Relapse: Unfortunately a “slip”. often becomes a full re-lapse. – The film can be viewed here: http://www. Watch the Oasis movie.
Activity 8.theoasismovie. at which “stage of change”.
Check out these clips on You Tube: http://www.au/HealthProfessional/Docs/Motivation.youtube.com/watch?v=cj1BDPBE6Wk http://www.com/watch?v=K7m9vCFa6H8&feature=related Then have a look at this power point presentation.pdf
Activity 9 In pairs write down as many of the motivational interviewing and solution focussed techniques as you can. http://www.risen. Then write down what is the perceived benefit or hoped intention of asking each question.
. Ask about the less good things: o be specific o individualise using reflection and amplified reflection o probe to find out how the client feels (just because something is less good does not mean the client sees it as a problem).
Components of a Motivational Interview A motivational interview consists of the worker using the following skills and strategies throughout. Ask about life goals: o how the client sees himself/herself in a year if things work out well o how he/she sees the future if he/she maintains current behaviour. If so. Affirming and summarizing are used appropriately throughout the interview. They may not be ready to change. where the worker uses reflective listening and open questions to elicit self-motivational statements. Ask the client to describe his/her good qualities through the eyes of a partner of friend. people can be in contemplation for a long time. If so you would assist them with problem solving and goal setting.
Summarise the positives and less positive aspects of behaviour . Focus on one aspect of ambivalence.ask the client to be specific. It is not a linear process.Checklist for undertaking a motivational interview
• • • •
Begin with an opening/welcoming statement. investigate harm reduction strategies. Ask about the positive/benefits of the client's substance use . individualise the importance. They may want to make changes but don't know where to start or they feel there are barriers they need to overcome. or they may want to remain the same.let the client hear the dilemma again. Ask for a decision. They may want to discuss things further. Then ask how the client would describe himself/herself as a user. more of a weaving process.
Solution focused therapy ignores what is past. and come up with exactly what he wants. they have never really thought about what their ideal future would look like. The Miracle Question focuses your mind on exactly how to achieve what you want. Focusing on your future goals is the essence of Solution Focused Therapy. doing more of the same is wrong. Solution focused therapy stops you thinking about past failures and makes you focus only on what you want to be. or to one that you believe the client will identify better with. They cannot visualize success. They have been so busy going over the past and how bad their present problems are. Solution focused brief therapy aims to get the client to imagine change. not what happened in the past. And because of that. not what cannot be changed.
. They do not have a clear idea of what success would mean for them. The therapist's job is identify what can be changed and to change it. Here is one example: Suppose you woke up one morning and by some miracle everything you ever wanted. except in very general terms. In fact. What will you notice around you that let you know that the miracle had happened? What will you see? What will you hear? What will you feel inside yourself? How would you be different? The key to success is knowing what you want. Solution focused brief therapy is about here and now. The Miracle Question lets the client focus on his own solution. Think about it now. Solution focused brief therapy focuses on what can be done. Solution focused brief therapy focuses on the solution the client wants. and whatever works. the history of the problem. Solution focused brief therapy believes that current solutions are the problem. had actually happened . Solution focused therapy gets the client to focus on what they want to become and how they will get there. You can tailor the question to something that either you feel more comfortable with. The Miracle Question is instant therapy.Solution Focused therapy. what has happened.
The essence of solution focused brief therapy is the client is the expert and it is the client's goals that are important. everything good you could ever imagine for yourself. not what the therapist wants. that change. any change is success. they will never achieve it. not the problem. when asked.your life had turned out exactly the way you wanted it. to imagine the future. It takes people out of the problem situation and into the solution space. get done more. most people cannot answer the miracle question. Solution focused brief therapy is about what is possible.
Unless you can answer the question immediately with exact details of what your ideal outcome would be. think about what you need to know about each issue to establish a holistic picture. The Miracle Question is the starting point for effective solution focused therapy. For example: the issue of Mental Health. Now that you have your lists. So how do you work out what you really want? The Dare Question may have an answer for you.
ASSESSMENT ACTIVITY 2. If so when? Did they seek treatment? Have. because they are so focused on the daily routine that they just don't take the time to think about their own future. The miracle is that if you do know what you want. you are not yet in a position to take charge of your life. What areas of a person’s life need to be explored to gain a holistic picture? What sorts of issues might one of our clients encounter? In pairs create a comprehensive list of all the subjects or potential issues one would have to ask about to gain a holistic picture of a clients situation. what they might be capable of.
By now you should have some idea about the intake and assessment stages of case management. decide what you want. The Miracle Question is your test of whether you are really serious about wanting success.
. And not knowing what you want is the route to a wasted life.The Miracle question forces you to think about exactly what it is you want from life. Until you get a clear idea of what you want you will drift through life. and you will achieve it. how would you know what to choose? One way is to ask yourself the Dare question: "What would you do if you knew you could not fail?" Most people in fact have never really thought about what they want. We would need to know if: They had ever suffered a mental illness. Think for a moment about holistic assessments. Now that you have thought about what needs to be asked. that will start to motivate you. You must know what you want first before you can have any chance of getting it. and visualize it clearly. anything at all. or do they take medication for a mental illness? If anyone in their family had suffered a mental illness. How many did you come up with? You should have at least 10. Suppose somebody said you could have anything you wanted in the world.
Make sure that you fill in the answers. who will utilise their verbal and nonverbal communication skills to conduct a holistic assessment using the assessment questionnaire. And then ask them how a stranger in the street may see them. One student will assume the role of the character they created. Once each pair has completed their holistic assessment questionnaire. You might ask them: What did they imagine they would be doing today when they were 15? (Adjust age appropriately)
. You probably would not begin with Mental Health. and ASSESSMENT. using the case studies you created in ‘Assessment Activity 1’ conduct an informal role-play. In this situation perhaps Egan’s second stage of brainstorming (What do I want?). Once completed swap over and repeat the task. You are not required to adhere to one particular theory of technique. For this task you will be required to use your ‘questioning techniques toolbox’ as previously discussed. Rather. and then the less positive aspects. Now that you have fulfilled the ‘case management stages’ of: ENTRY/SCREENING. You may ask them what someone close to them might say are their best personal qualities. Motivational interviewing would also be useful in this situation. or have a lack of direction or motivation because they cannot see change as a realistic possibility. and the other will take on the role of a case manager. Maybe you might look at the positive aspects received by the client for the use of a substance or the continuation of behaviour.Create your own holistic assessment form that poses all of the required questions as briefly and unobtrusively as possible.
ASSESSMENT ACTIVITY 3
Formal Role-Play. Remember to include all personal details and an explanation and acceptance of confidentiality to begin with. for example. Could be appropriate. For example you might begin with “Egan’s first stage of: What’s going on?” Your client maybe stuck in a stage of ambivalence. try to use strategies and questions from each as you fell would be most useful to achieve a positive outcome. Or perhaps a more solution focused approach of asking the miracle question. It is time to meet up with the client again and to begin the PLANNING process. Then try to pose the questions in a logical and polite manner.
And then ask them: What would it take to achieve a higher grade. At the same time do not forget to apply your verbal and non-verbal communication micro-skills.
. future vocational and emotional needs. Try to make it as enjoyable as possible. Remember that the best case plans not only address issues of immediate need but also include activities directed at social. Now you are ready to research appropriate agencies and programs to put a case-plan together to present to your client. hopefully you have identified both areas of immediate need as well as some goals to work towards into the future.Then have they achieved any goals towards that? What do they think has held them back from achieving those goals? You could ask them how badly they want to achieve change on a scale from 10-to10. Feel free to create your own variations of these techniques and try to pose them in a logical order. Once you have concluded the role-play you can begin to write up your case notes. By the end of the role-play.
Activity 1. and how the strategies employed could be beneficial to the ‘helping process’ 1. This can be very useful as it can inject an amount of hope and positivity into the situation. and what might hold the client back from achieving progress. 'What is going on?' This stage is about listening to the client’s story. It is about clarifying areas where we can focus. understanding and establishing rapport.Activity Answers. Using all of your’microskills”. Encouraging them to explore their desires through the brainstorming of ideas both realistic and unrealistic gives them an opportunity to step outside of themselves for a moment and experience some positive energy. Also reflecting and carefully challenging possible false perceptions and maladaptions. and opportunities. Where to start. 'How might I get to what I want?' This section is about how to achieve the goals. practically and emotionally. This section then examines practical ways to achieve their goals. In your own words write down what the 3 stages are. 'What do I want instead?' Is about taking the time to examine what the client really wants. and move forward with. often for the first time in a long time.
3. At the end of this section an action plan should be complete and as time to review progress set. Often clients are stuck in their situation and find the possibility of positive change to be out of reach. It is also a creative part of the process as it calls on the client to think of all the possible avenues of support. This is a creative exercise that allows the client to step out of themselves and initially imagine limitless possibilities. who can help.
non-judgmental. For example if a client expressed that they wanted to become a “rock star”.T achievable goals.
Activity 4. Create a caption for each of these characters that might describe their motivations.
Activity 2. and listening skills. Take some time to consider and write down the characteristics that you believe a good counselor should have. I feel more creative and have been getting back into my art. however could include: empathy. patients.R. and he never spends time with us” Counsellor-
Activity 3. You might suggest that they begin to take some music lessons.A. Whether or not the initial goal is achieved is insignificant as the positive action of the activity can be extremely beneficial to the client and can serve as a distraction from other less productive negative behaviours.” Users’ parents“Brian spends all of his time in his bedroom and is completely unmotivated.M. It relaxes me and gives me a buzz. questioning skills. Answers will vary one possible example might be: User“ I enjoy smoking. Answers will vary. Answers will vary according to student’s individual situations. He won’t get up in the mornings.This positivity can be capitalised upon by breaking the ideas up into S.
Activity 6. Substance abuse issues. Think about a behaviour. Escapism/dealing with trauma. accommodation.
. financial. financial was a victim of physical abuse and neglect. More difficult than you would think? Answers will vary according to the questions asked. as she has planned to de-tox numerous times but has failed to engage the service. which you are ambivalent about then. Answers may vary. Here are some examples. Owen. Activity 8. Substance abuse. was a victim of emotional and physical abuse. Answers will vary according to student’s individual situations. Halley.“When working with clients it is important to ascertain the direction of their motivation. accommodation. With a classmate/friend/or relative ask them a range of questions that do not allow them to give a one-word response. The Oasis Movie. and a decision matrix with these headings. Emma & Trent. accommodation. mental health. design.Maintenance stage. People use substances for a range of reasons. See if you can name 5. Boredom/risk taking behaviour Activity 7. Peer pressure/to fit in. She has substance abuse issues. was a victim of abuse. some examples would be: To get high.”
Activity 5. That is we wish to understand. financial. There are many reasons people use substances.Maintenance stage. and for the client to understand exactly what benefits they receive from continuing with their use or behaviours. Self-medication for mental or physical illness.
Unlike Rogerian therapists. For example: if the client made a statement such as: “ My drinking is not really an issue”. Reflective listening is the key to this work. The worker might respond with: “ Oh so your saying everything is going pretty well at the moment?” Not arguing with the client in this situation gives the client an opportunity to correct the worker. such as active listening summarising and reflective responses. He has substance abuse. It is the workers role to support the decisions of the client. effected your work and that your doctor is worried about your health. as he has identified his drinking as being an issue and has ideas of activities that could replace his behaviours. and where they want to be. What moved them forward and shifted them backward. In this situation they might say something like:” Well actually not. and Expressing empathy is essential. His child hood is not spoken about. Rolling with resistance allows the worker to pose empathetic responses to statements of resistance. The best motivational advice we can give you is to listen carefully to your clients.. They will tell you what has worked and what hasn't. Activity 9. Beau. Expressing empathy accelerates the clarity of understanding and it also helps the client to feel understood and more comfortable to open up and explore their issues in a more relaxed and reflective fashion. If a client expresses that they are not ready for change then the worker would support that decision and let the client know that help will still be available in the future if they change their minds. Roll with resistance. Develop discrepancy. listen. & Rollnick. encouraging them and trying to keep them motivated. Whenever you are in doubt about what to do. what they value. not only to the motivational interviewing process. The worker would also employ their “micro-skills”.Maintenance stage. You will focus on their change talk and provide less attention to nonchange talk. but you are quite aware that your drug use has caused concerns in your relationships. "You are not quite sure you are ready to make a change. Developing discrepancy helps the client to identify a discrepancy between who they believe they are. When employing motivational interviewing techniques the speaker would always pay homage to the four elements: Express empathy. or not. the doctor says I have liver damage”. 1991 ) Reframing Reframing is a strategy in which you invite clients to examine their perceptions in a
. or not. you will actively guide the client towards certain materials. His child hood is not spoken about. Then write down what is the perceived benefit or hoped intention of asking each question. Mental health issues. so we do not know if he was a victim of abuse. but to welfare work in general. Supporting self-efficacy allows the client to feel a sense of control over the decisions they make and the direction they will take. so we do not know if he was a victim of abuse. But remember this is a directive approach. legal issues. S. and their current lifestyles and behaviours.Tommy. R.Contemplation/Planning stage. behavioural." (Miller. For example. In pairs write down as many of the motivational interviewing and solution focussed techniques as you can. W.
" The counselor can reframe this as "this person must care a lot about you to tell you something he (or she) feels is important to you. This can be of great assistance in clarifying the clients priorities for both worker and client." Open-ended questions are those therapist utterances that client's cannot answer with a "yes". in some cases a shocking realisation that if things continue. or negative aspects of their life are." (Miller. or “cons” can be an opportunity for the client to verbalise their concerns with their use/behaviour often for the first time. they tried to alter their behavior and it didn't work. and then asking them what would have to change to achieve a higher score. Beginning with a look at what benefits the client receives from using the substance/behaviour gives some legitimacy to the clients actions.. For example. but you did it anyway. For example. & Rollnick. you are willing to put up with a lot just to do it. For example. "You really need to get in treatment and deal with these problems. particularly in areas where they observe only failure. I'm not sure. That is. This can be. but it seems like that if you decide something is important enough. Although close-ended questions have their place . as they in conjunction with the client look at other means of achieving those benefits.indeed are necessary and quite valuable at times . For example: If the client suggested that they “use to relax” the worker might suggest other forms of relaxation to see if something interested the client. clients come to us demoralized or at least suspicious of the assertion that change is possible. How were you able to stay sober for that week?" We also use resistance as a source for affirmations. Writing them down and reflecting on each point can provide considerable motivation to change. Most people begin treatment sessions with an open-ended question . As a result." the client may view this as "she's such a nag" or "he is always telling me what to do. as they are that they will encounter serious consequences. We side firmly with Carlo Di Clemente that many people who come for our assistance are failed self-changers. This condition means that as therapists. W.the open-ended question creates a forward momentum that we wish to use in helping the client explore change. In this way. 1991 ) Looking at the “pros and cons” of continuing with using a substance or continuing with a certain behaviour can be a powerful tool. "no" or "three times in the last week". Asking the client to give a score between 1 & 10 how committed to making a change they are. "So you stayed sober for a week after treatment. We often explore prior attempts at change.
. knowing that you will likely get angry with him (or her). Looking at the less good things. It is also useful information for the worker in later stages of the process. "You didn't want to come today. This helps them feel more comfortable as it is understood that there are advantages received from the use/behaviour and that they are not “stupid or crazy”. Or the same style of question could be asked with reference to how important certain positive. new meaning is given to what has been said. R. Scaling questions can also be very useful. if a client reports a spouse or loved one as saying. S. One method of doing this is to point out client strengths. For example. we must help clients feel that change is possible and that they are capable of implementing that change. "So what makes you feel that it might be time for a change?" Affirmations are statements of recognition about client strengths.new light or a reorganized form."What brings you here today?" or "Tell me about what's been happening since we last met?" An open-ended question allows the client to create the impetus for forward movement.
Firstly it may be used as a summary to reinforce a clarity of understanding. Finally it maybe used in a false way to encourage the client to correct you. Psychological squirm. A reflection of emotion statement like: ‘It sounds like your fed up with the lifestyle that goes along with your use. (Age appropriate). At that time: How did they imagine their lives would look like today? If the client can observe a decided difference between their previous ambitions and the reality of today. Life satisfaction. or variations of it also helps the client to understand more clearly the direction they would like to go. Then ask the to describe how a stranger might describe them who has observed them on an average day doing the things they have to maintain their lifestyle. The Miracle Question. It is also very useful for the worker to know as they can develop a more relevant treatment plan that has a far better chance of success. like their teenage years. As a worker you could try many different variations of this question. For the worker it is also useful as it highlights the issues that the client believes is holding them back. then ask them if they can see a discrepancy between the two. and it can in some cases accelerate the decision process to make a change. but also behaviour replacement activities that bring the client closer to achieving goals previously held. For example. Another way to ‘develop discrepancy’ is to ask the client to think back to a time before they were using. the worker could ask them: ‘What do they believe held them back from achieving their goals?’ – Or: ‘What is holding them back from achieving said goals now?’ This can be a useful tool in helping the client to identify and verbally acknowledge what has been. The client may have been previously unaware of the cyclic nature of dependency. Ask for a decision. Summarising and asking reflective questions are useful in establishing a clear understanding and a better rapport with the client. When exploring their response further the worker can ask how badly do they want to achieve these things. This will aid greatly when tailoring a treatment plan that not only looks at the issues of concern. This strategy can be beneficial in many ways. The client feels understood and is more likely to ‘open up’ further. Asking this questions.” Can be used in three ways. Asking for a decision can help the client to make their mind up. If the client does identify a discrepancy the uncomfortable feeling can be a powerful motivator to make a change. to better understand or to accelerate the acknowledgment of an issue. or it may be used encourage the client out of the state of ambivalence. It could be of comfort to them to see that they are not the only one who has experienced these cycles. Firstly it allows the client to step out of their current reality and to imagine a life free of all of the worries and issues that are holding them back.Showing the client a visual representation of the “stages of change model” can also be useful. or if they are not yet ready it lets them know that help will be available when they are ready. Again reflect and summarise. Take time to respond reflectively and summarise. but also lets the worker know exactly what the more positive goals are for the client. This can inject a significant amount of motivation. if the client is in a state of denial the worker might suggest that: ‘So it sounds like you are pretty happy with the way things are going at the moment” If the client then corrects the worker the situation can be explored in a more productive fashion. or is a restrictive issue in their lives. with the hope that the desire is strong
. It can also help them to conceptualise at which stage of the cycle they are at. energy and positivity into the situation. One example would be to ask the client to describe what they believe a loved one would describe as being their ‘best qualities’.
Posing this question can take the weight of the situation off the clients shoulders and get the process moving.
.enough to consider changing some of the less positive behaviors. Finally this question helps the worker to understand the direction the client would ultimately like to take which is essential knowledge when constructing a holistic case plan. when asked people struggle to identify exactly what it is they would like to achieve. Another variation is the: Dare question. -"What would you do if you knew you could not fail?" Often.
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