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Counselling Skills 3: Facilitating behaviour change

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Ching Li Lee

on 3 July 2013

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Transcript of Counselling Skills 3: Facilitating behaviour change

Counselling Skills 3:
Promoting behaviour change to facilitate self-management

Trans Theoretical Model
Explains how people change

5 stages of change
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance

How do we assess readiness to change?
Ask the right questions to get the right answer (Eg: Using Motivational Interviewing techniques)

Recognizing motivational statements used by the client

Using the Ruler of Change


Helping clients make changes
Motivational Interviewing
People are ambivalent

Counselor/Clinician’s advocacy for change evokes “resistance” for the patient and resistance predicts lack of change

Evoking the patient’s own change talk will enhance behavior change

MI is a directive, collaborative, person-centred approach to elicit and strengthen motivation to change
How to achieve?
Understand how people change
List and describe the stages through which clients pass in the course of changing behaviour with nutrition counselling.
Know how to assess client's mindset
Explain the skills used to assess the client’s motivation, confidence and readiness-to-change in a variety of nutrition situations where adherence may be a problem.
Know how to extract motivation
Describe common motivational strategies to promote and maintain behaviour change.
Extra reading:
Psychology notes
Understanding the patient notes
Nutrition Counselling 2 slides
Extra reading material on TTM

Four type of motivational statements - change talk:

Cognitive Recognition of the problem
"I guess this is more serious than I thought."

Affective Expression of concern about the perceived problem
"I'm really worried about what is happening to me."

Direct or Implicit Intention to change behavior
"I've got to do something about this."

Optimism about one's ability to change
"I know that if I try, I can really do it."
Sustain Talk: Any speech that favors status quo rather than movement toward a change goal

Change Talk: Any speech that favors movement toward a specific change goal

4 principles provide a conceptual foundation for the practice of MI:
Expressing empathy
Developing discrepancy
Rolling with resistance
Supporting self-efficacy
MI Principles
How do we achieve this?
MI Skills
O
pen-ended questions
A
ffirmation
R
eflective listening
S
ummary statements
Ruler of Change
Extra reading
4 principles of MI document
Skills practice
Practice these principles during Tutorial 5role-play
Open-ended questions
Information gathering backbone
Sets non-judgemental, collaborative tone
Answer with 1 or 2 reflections for every question
Affirmations
Instills hope
Communicate understanding & appreciation of positive behaviour, competence, personal strength, competence
Reflective listening
Used to express interest, acceptance, understanding, empathy
Can be used to develop discrepancy
Simple and complex reflections
Summaries
Used to help client organize thoughts and experiences
Enhances understanding of client
Can be used to guide conversation to 'change talk'
Skills practice
Practice using OARS during SCL
Elicit-Provide-Elicit
Elicit or draw out what the client wants to know
Provide information in neutral manner
Elicit what the client thinks about the provided information
Aim to evoke 'change talk' --> this will resolve ambivalence
Evocative questions
What worries you about your current situation?
Eliciting change talk
Using the ruler of change
Could you tell me more about your decision to choose the number 5 and not 8 or 3?
Exploring decisional balance
What do you like about your present diet? What concerns you about it?
Elaboration
Can you tell me more about / describe exactly what happened the last time this occured?
Questioning extremes
What concerns you most about?
What are the best results you could imagine if you made a change?
Looking back
What were things like before you...? What has changed?
Looking forward
How would you like things to be different a year / three years from now?
Exploring goals and values
What things are most important to you?
Full transcript