Strengthening Commitment to Change

1. Strengthening Commitment to Change

2. Pointers for RecognisingReadiness to Change • Decreased Resistance • Decreased Questions - Sense of being finished; ready for something new. • Resolve - The client seems to be more at peace and has made a decision. • Self-Motivational Statements - The client is making them

3. Pointers (cont.) • Increased questions about change. • Envisioning - Client begins talking about life after a change or wondering about possible advantages and problems of movement. • Experimenting - trying little things out; like going to N.A. or reading a self-help book or using less....

4. Four Point Strategy for StrengtheningCommitment to Change:- • Recap • Key Questions • Information/Advice • Negotiating a Plan

5. Recapitulation • Summarise the clients current situation - going through as many of the following points as you can:Summary of the client's perception of the problem • Summary of the client's ambivalence, including the attractions to the problem behaviour • Review of objective evidence for risks and problems • Restatement of any (positive) thing the client has said regarding change  • Your own assessment, with focus on where your thoughts and those of the client converge

6. 2.Key Questions • Asking what the client wants to do. • Key questions are open-ended and cannot be answered with a simple ‘yes’ or ‘no’. Its key theme is • “What Next?” • "What do you think you will do?" • "What's the next step?" • ""How are you going to do it?" • "Where do we go from here?"

7. Key Questions, cont. • The answers to these questions are met with reflection - in order that the client gets time to clarify their thoughts and encourage further reflection. Emphasis throughout will be on personal choice and responsibility. • Be careful not to slip into a wholly problem-solving mode; earlier strategies are still very important.

8. 3.Information and Advice • Never be too eager to offer advice because you can easily slip into the confrontation-denial trap... - "Why not try this...No, that wouldn't work because... • Always qualify any suggestions you make, presenting advice in a non-personal way.. •  If you are asked something that you don't know - feel free to say "I don't know", but say that you will find out for the client later.

9. 4.Negotiating a Plan This follows a three point route: • Setting goals, • Considering Options, and • Arriving at a plan.

10. Setting Goals • By setting goals we highlight the discrepancy between where the client wants to be and where they are - thereby, motivating change.  • "How would you like for things to be different?" • [This also allows for checking that your goals for the client and their own goals are in line. If they are very different, it is better to work with the client. If the goals are misguided, this will become apparent soon enough.]

11. This also allows for checking that your goals for the client and their own goals are in line. • If they are very different, it is better to work with the client. • If the goals are misguided, this will become apparent soon enough.

12. Consider the options • There is no single treatment that works for everyone, so it is better for you to be open to many choices. • The client will probably choose their option regardless of what you want - and it may even be wrong! • Relapse is to be expected and worked with.

13. Arriving at a plan: • Summarise the client’s main responses so far. - The most important reasons why I want to make a change are... - The main goals for myself, in making a change, are...

14. Arriving at a Plan - cont. • - I plan to do these things in order to reach my goals... • Plan of Action • When • The first steps that I plan to take in changing are... • Other people could help me in changing in these ways..Person Possible ways to help • I hope that my plan will have these positive results:

15. Arriving at a Plan, cont. • When this is all done - summarise for the client what has been agreed. This is best done in "you" language. • "You wanted to know.... • “You're thinking that • “You considered.... • “And if you decide that it’s not working then you can ....

16. Eliciting Commitment • Get verbal agreement - but don't be afraid to investigate, with the client, their reticence(s) to the plan. • Go public. Encourage the client to tell a loved one or one of their supports about the plan. The more the plan is verbalised to others, the more chance that commitment to it will be strengthened. • It is also a good way to get other supports on board, thereby giving the plan a better chance of success.

17. However, there are HAZARDS to watch out for… Understimating Ambivalence : Ambivalence is always present, with people often entering action while still being unconvinced that they should be making the change. Make sure you don't forget to use strategies from the earlier times here as well. Over-Prescribing a Plan: Don't forget that you are there for the client and begin saying "Now that you're ready for change, here's what you have to do". Allow the client to continue the active role of coming up with ideas themselves.

18. Hazards (Cont.) But also Insufficient Direction: • The client does want assistance, so this is a good to offer a list of alternatives rather than reflection. Offer alternatives that will ease the client into a workable plan - remembering that we want to strengthen their commitment rather than scare them with radical, life altering schemes.

19. In Summary: • Re-cap in ‘you’ language • Ask Key Questions • Offer Information/Advice if helpful • Negotiate a Plan: Setting goals, Considering Options, and Arriving at a practical plan