The Stages of Change : A Closer Look

1. The �Stages of Change�: A Closer Look John D. King, MDiv, LAC Personal Performance Training Ft. Walton Beach, FL

2. In this session we will focus our efforts on : Developing a more thorough understanding of The Stages of Change By examining each stage individually And practicing the concepts via learning exercises in order to gain more practical application But first �.

4. Since we will be practicing some skills Let�s pair off as partners for the rest of this session.

5. What we are doing today is related to an earlier training, therefore let�s Recall What MET is � MET is a client-centered �directive method of communication �for enhancing intrinsic motivation �by exploring and resolving ambivalence �about a particular change.

6. And � let�s recall some Keywords: Ambivalence: the inability or reluctance to commit to a particular course of action. Dissonance: discord �lack of agreement or harmony. Given these definitions .. MET seeks to resolve ambivalence so that change can take place in a particular direction. We do this by addressing the dissonance in our relationship with our client so harmony of purpose can result and change that is sought can take place.

7. Remember � in MET We should not ask: �Why isn�t the client motivated?� We should ask: �What is the client motivated for?� Most importantly � MET allows the client to teach us : The Dance

8. MET is�

9. And lest we forget �in MET we Row our OARS We ask Open-ended questions We Affirm our client We listen Reflectively We Summarize what they have said

10. OK � let�s reviewing the Stages of Change Precontemplation: not yet considering it Contemplation: beginning to consider the consequences of a problem and reasons for changing the behavior Determination: decision made to change Action: implements methods for change Maintenance: practice, practice, practice Relapse: important to begin cycle again

11. Stages of Change were first laid out by James Procheaska and Carlo DiClemente (refer to handout) First developed while working with clients who were trying to quit smoking They noticed that all persons seem to pass through a similar process to get to the ultimate behavioral goal they sought. They saw that change was a process � not an event Mistakes and set backs are common and should be expected And since all persons are unique and different, although the stages are the same, how we enter them, what our plan looks like � will always be individualistic. Now, let�s consider some tools: - Using the Stages of Change Model - Readiness to Change Ruler

12. Stage One: Pre-contemplation: �I�m fine just the way I am. Why change?� In this stage people are � not thinking seriously about changing not interested in any kind of help will defend their current behaviors. Statements like: �I don�t have a problem� or �There�s nothing I want to change in my life� are common Denial is alive and well here � BUT it could also be the person hasn�t come across the information that would lead to a decision to change. It�s important to remember that for the most part, change is voluntary � even a judge�s orders may not change that.

13. A word of caution � Clients in the precontemplative stage are often seen as: - argumentative, - hopeless or - in "denial," and the natural tendency is to try to "convince" them �which usually engenders resistance

14. Precontemplation Exercise "What would have to happen for you to know that this is a problem?" "What warning signs would let you know that this is a problem?" "Have you tried to change in the past?" �On a scale of 1 � 10 how serious is your ____?� �What would it take for you to see your situation as a ___?�

15. Stage Two: Contemplation�Ya know, it wouldn�t hurt to cut back on my drinking. There have been times �� For various reasons client begins to believe that behaviors that were okay before aren�t okay anymore Client becomes aware of the negative consequences of those old behaviors. Begins to weigh the pros and cons of changing And asking: are the long-term benefits worth the short-term costs

16. Contemplation is a Critical Time Consider that � IF the client is now seeing things differently, for whatever reason, these can be times filled with guilt � shame � hopelessness � and desperation. Getting to a place where the client can begin to take a good look at his / her behaviors can be a huge � and uncomfortable journey. One that can become a true crossroads.

17. Contemplation Exercise "Why do you want to change at this time?" "What were the reasons for not changing?" "What would keep you from changing at this time?" "What are the barriers today that keep you from change?" "What might help you with that aspect?" "What things (people, programs and behaviors) have helped in the past?" "What would help you at this time?" "What do you think you need to learn about changing?"

18. Stage Three: Determination � to do something An important part of the process of change � too many skip over it � often failure is the result Client needs to begin to ask: now what? It�s the step of �gathering tools Change in mind set Resistance lessens Self-talk, statements to others Becoming �open�

19. During Determination Stage � be prepared for: Client�s desire to experiment with options �and not the one�s you want to ultimately see ..(e.g.): �Cutting back� �Changing drug of choice� �I�ll try a couple of meetings� Though not what is desired, they all are steps in the right direction � remember: change is an evolving process � CLIENT may still be dealing with �the never invalidated hypothesis!

20. How We Can Help in a Client�s Determination Stage Praise the decision to change behavior. Prioritize behavior change opportunities. Identify and assist in problem solving re: obstacles. Encourage small, initial steps. Assist patient in identifying social supports. Now let�s get a couple of volunteers and practice this ! (use the Helping the Client in the Determination Stage handout)

21. Stage Four: Taking Action�Hi, my name is ___ and I�m an alcoholic� Work with client to �write� a plan of action Review it to make sure it is reasonable, achievable � and not grandiose Emphasize the plan should be dynamic and subject to change and that he/she should utilize the tools and resources identified during the preparation stage .. AND that everyone is unique and not all persons achieve the same results in the same time frame. Utilize the SOCRATES instrument � which we will now review.

22. Stage Five: Maintenance�Has it really been two months? I have NEVER been sober this long � ever� Maintenance is just that - maintaining the new behavior. Finding ways to avoid temptation by using the tools acquired This new stage is becoming � the status quo Client will be more open to help and further development BECAUSE he/she is seeing results NOTE: for each new successive change � client can usually make it through the stages for that change much quicker � finds self constantly reevaluating and redefining tools and plan This can be the �tipping point� stage (Malcolm Gladwell): where the unusual becomes commonplace. Its NEW and can be both exhilarating and scary.

23. Stage Five Exercise The Health Belief Model Using the �Locus of Control� Questionnaire

24. Stage Six: Relapse�Dammit! Why is all this crap happening to me now?� The �other� stage � not necessarily the �next� stage. Actually, can occur at any stage � as we well know. Most likely between pre-contemplation and contemplation. Important to remind client change is a process NOT an event. They need to be aware that set backs CAN happen. But they should NOT be viewed as failure Relapse � IF it occurs � is a STAGE not a permanent state. Make sure client understands this fact � and that reworking tools, plans, or finding new ones will restore confidence. Support is vital at this stage. Ask: What have you learned from this (relapse)? And .. What do you think needs to be done to not repeat it?

25. Stage Six Exercise In groups of 4 or 5 discuss how you approach relapse as a topic with your client and what you have used or said that seems to work.

26. A good resource tool for relapse prevention: www.tie.samhsa.gov/TAPS/TAP19/TAP19ex8.html www.unhooked.com/lifering.com/workbook/WorkbookRelapse.pdf

27. As I conclude, I must remind us that even with learning new skills and finding better ways to help our clients reach their goal of successful and sustained recovery � we are always confronted by the fact that our work is never really finished � is it?

30. Thank you once again! John D. King Personal Performance Training jdkingbear@aol.com