Transcript Stages of Change

Stages of Change
Steve Carlson, Psy.D.
Spectrum Community
Mental Health
“Change is the
manifestation
of our ability to
grow and become”
Anne Wilson Schaef
Agenda
 The nature and types of change
 Brain injury and change
 Stages of change
 Tools and tasks that help facilitate
change in a positive direction
Why change?
“Hard work pays off in
the future; laziness
pays off now”
Steven
Wright
Two types of change
 Forced
 Intentional
With life there is pain
 Physical
 Emotional
 Psychological
 Existential
Pain can motivate
us towards change
Or we can cope with pain by…
 Avoid it
 Resist it
 Anesthetize it
 Minimize or deny it
 Blame others
Intentional change is hard work!
 Too much change
causes stress
 Too much stability is
boring
Stability
Change
Coping with another’s pain
“Whenever we fix
other people’s
problems, we
give them a
bigger problem:
powerlessness”
Give a fish?
Teach to fish!
Anna Christie
Building motivation for change
 What does not work
 Telling people what to do
 Persuading with logic
 Warning
 Reassuring, consoling
 The “expert” trap
 So what can we do?
Spirit of Motivational Interviewing
 Collaboration
 Evocation
 Autonomy
“It is the truth we
ourselves speak
rather than the
treatment
we receive that
heals us”
O. Hobart Mowrer (1966)
“What people
really need is a
good listening to”
Create a rich environment
through listening
 Undivided





attention
Body language
Eye contact
Genuine interest
Set aside
assumptions
Silence &
presence
Brain injury and change
 Cognitive deficits
 Decreased memory and new learning
 Decreased attention and speed of processing
 Decreased judgment, insight, and planning
 Behavioral deficits
 Depression
 Anxiety
 Impulsivity
Stages of change
 Pre-contemplation

“Who, me?”
 Contemplation

“Yes, but”
 Preparation

“Uh-oh”
 Action

“Do it”
 Maintenance

“The grind”
 Relapse

“Back to the
drawing board”
Stages of change and
treatment tasks
 Precontemplation
 Contemplation
 Preparation
 Action
 Maintenance
Increase concern and
hope for change
Tip the decisional balance
Commitment and effective
plan
Problem solving; support
self-efficacy
Prevent relapse; resolve
context problems
Stage 1: Precontemplation
“We don’t know what we don’t know”
 No plan to
change in the
foreseeable
future
 Usually
a six
month time
frame
 Unaware a
problem exists
Stuck in precontemplation
 Five R’s
 Reveling
•
 Reluctance
 Rebellion
 Resignation
 Rationalizing
Treatment task for
“precontemplators”
 Increase concern and hope for change
“It’s all grist to the mill”
 Defn: “Everything can be used to move
toward a profit or conclusion”.
 Social
pressure
 Aging
 Illness
 Personal
concerns
 Human development
 Shift in values
“Cultivating seeds for change”
Stage 2: Contemplation
“We begin to know that we don’t know”
 To change or not to
change, that is the
question.
 Increased instability
 Ambivalence
 Taking stock
Creating an atmosphere for
change
“Contemplating
change in an
atmosphere of fear,
hopelessness,
or exhaustion is a
self-defeating
exercise”
Strategies that promote
contemplation
 Provide feedback at the
proper time
 Demonstrate as much
objectivity as possible
 Provide feedback in the
context of concern
 Effective and doable
consequences that
reinforce your
expressions of concern
Processes of change:
Cognitive/experiential
 Consciousness




raising
Emotional
arousal
Self-reevaluation
Environmental
reevaluation
Social liberation
“Surveying the
landscape of my life”
Treatment task for
“contemplators”

The goal: A firm decision
to change
 The tasks:
1.
2.
3.
Gathering decisional
considerations
Examining them
Compare pro’s and con’s

Desired outcome: Tip the
decisional balance
 The hope: Increased
self-efficacy

Confidence about performing a
specific behavior
Payoff Matrix
Change
Pros
Cons
No Change
Stage 3: Preparation
“Yes, I want to change. But how?”
Preparation stage
 Transition stage
 Decision to change
is made
 Reduced
ambivalence
 Exploration of
options for change
Treatment tasks for
“preparation” stage
1. Making & strengthening a commitment
adequate to support the attempt to
change
2. Developing a plan for action that is
sound, reasonable, and feasible
Action plan worksheet
1.
2.
3.
4.
The changes I want to
make are:
How important is this
goal (level of
motivation)
The most important
reasons to change
are:
The steps I plan to
take in changing are:
5.
6.
7.
8.
9.
The ways other people
can help me are:
I will know if my plan is
working if:
Some things that
could interfere with my
plan:
How will you manage
these barriers?
Level of confidence
(self-efficacy)
Stage 4: Action
 Breaking free
from the ties that
bind us to the
problem behavior
 Physiological
ties
 Psychological ties
 Social ties
Main tasks of “action stage”
1. “Breaking free”

Utilizing behavioral change processes &
strategies of the plan
2. Commitment
3. Revising the plan as needed
4. Managing temptations & slips that can
provoke relapse
Processes of change:
Behavioral
 Reinforcement
 Counter-
conditioning
 Stimulus control
 Self-liberation
 Helping
relationships
Relapse
 The role of relapse
 Relapse vs slips
 Trial & error learning
 Recycling
 Regrouping before
the next attempt to
quit
Stage 5: Maintenance
“Making change permanent”
Sustaining recovery
involves developing
new, strong, and
healthy habits as
well as repairing the
damage done by the
addiction.
The successful person…
1. Actively counters threats &
temptations
2. Checks and renews commitment
3. Makes sure decisional balance
remains negative for reengaging in the
problem behavior
4. Establishes a protective environment
and satisfying lifestyle
Best Practices




Exercise patience & adjust expectations
Consistent routines & meeting structure
Minimize distractions
Learning strategies




Interactive teaching
Break down information
Check for understanding
Summarize (you and client)
 Measurable goals
 Step by step plans for change