Facilitating Change

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Transcript of Facilitating Change

  1. 1. FACILITATING CHANGE A Collaborative Approach By: Rosie Ford, HFS and Counselor Intern
  2. 2. BUILDING RAPPORT At the core of a positive collaborative relationship Particularly important EARLY in the relationship Establish open, trusting, collaborative relationship A poor collaborative alliance predicts premature client drop out Especially important within a change process Strength of collaborative alliance is directly related to the degree of change a client makes Reflects the extent to which client and coach are on the same wavelength Working together Collaboration for change
  3. 3. BUILDING RAPPORT COACHES QUALITIES Genuine - authentic, honest, congruent builds trust Empathetic - enter the clients worldview and convey understanding Non-judgmental Respectful - acceptance, unconditional positive regard may not agree with everything they do but ALWAYS show acceptance Collaborative/team player Agreement of goals Agreement of tasks that will help achieve goals Actively involved in process Positive relationship
  4. 4. BUILDING RAPPORT COACHES QUALITIES (CONTD) Warm and caring Flexible High degree of comfort in interpersonal relationships Easy to talk to Honest and sincere Understanding Not suspicious Not hostile or aggressive
  5. 5. SKILLS TO BUILD RAPPORT Attending Verbal and non-verbal Examples: Eye contact, facial expressions, minimal encouragers (uh huh, I see, yea, ok), body language, tone of voice Reflecting Demonstrates understanding Examples: Content So what I am hearing you say is. So you would like to learn more ways to prepare your veggies, is that right? Feeling You are very excited about this idea! You feel overwhelmed because you dont have time to prepare your veggies.
  6. 6. SKILLS TO BUILD RAPPORT (CONTD) Paraphrasing/Summarizing Examples: What I am hearing you say is you are hungry when you get home from work and tend to eat whatever is available. So it sounds like your main concerns are eating out, social situations and not having time to prepare your meals. Empathetic Understanding Ability to accurately understand a clients perspective in a given situation Examples: I can see how you could be confused in that situation. That must have been very difficult for you.
  7. 7. SKILLS TO BUILD RAPPORT (CONTD) Self-disclosure Used very sparingly and ONLY when it will benefit the client Examples: I know when I dont plan ahead, things never go well. Crock pot cooking helps me out a lot. Provide Information Examples: Recipes Educate on physiological concepts of program Tanita Reads Tips on eating out
  8. 8. NECESSARY CONDITIONS Relationship Vulnerability Genuineness Perception of Genuineness The client must FEEL the coach is genuine Unconditional Positive Regard Accurate Empathy
  9. 9. BEGINNING TASKS Build alliance or bridge relationship FIRST session will be likely to come back Increase importance of change move stage of change Build self-efficacy for change
  10. 10. STAGES OF CHANGE Precontemplation Unaware of the problem OR lack desire to change The cons of change outweigh the pros High drop out risk Contemplation Aware of the problem but are not ready to change it OR do not understand the problem Cons equal the pros Wonder if they can change or ambivalent about change Will drop out if suggested Preparation Develop an action plan The pros outweigh the cons Some problems plan is too vague (I want to be healthier) not supported by others/their network Preparation
  11. 11. STAGES OF CHANGE (CONTD) Action Actively changing the behavior and/or modifying environment Usually take a few steps forward and a few back this is OK! baby steps one day at a time Major problems changing too many things at once lack of support Coaches like this stage not everyone comes at this stage Maintenance HARDEST stage What you did in the action phase will be different than in the maintenance phase (ex: Loosing weight) Common problems streamlining the action plan coping with lapses/set backs incorporating change into the overall lifestyle Can cycle back and forth through stages Tailor approach to match stage of change
  12. 12. MOTIVATIONAL INTERVIEWING (MI) Basic Premise: Individuals become more committed to what they say to themselves than what they hear from others Effective and necessary at the pre-contemplation stage of change Skills used for building rapport also very important when using MI Motivational Interviewing Roll With Resistance Motivational Interviewing Express Empathy Create Discrepancies Roll With Resistance Support Self-efficacy
  13. 13. MOTIVATIONAL INTERVIEWING (CONTD) Express Empathy Know that acceptance facilitates change Use reflective listening Be empathetic to the ambivalence
  14. 14. EMPATHY Communicates respect for and acceptance of clients and their feelings Encourages a nonjudgmental, collaborative relationship Allows you to be a supportive and knowledgeable consultant Sincerely compliments rather than belittles Listens rather than tells Gently persuades with the understanding that the decision to change is the client's Provides support throughout the process
  15. 15. MOTIVATIONAL INTERVIEWING (CONTD) Create Discrepancies Developing awareness of consequences helps clients examine their behavior A discrepancy between present behavior and important goals motivates change The client should present the arguments for change
  16. 16. MOTIVATIONAL INTERVIEWING (CONTD) Roll With Resistance Avoid Arguments Arguments are counterproductive Defending breeds defensiveness Labeling is unnecessary Do not directly oppose resistance New perspectives are invited but not imposed The client is a valuable resource in finding solutions to problems Resistance is a signal to respond differently
  17. 17. MOTIVATIONAL INTERVIEWING (CONTD) Build self-efficacy Belief in the possibility of change is an important motivator The client is responsible for choosing and carrying out personal change There is hope in the range of alternative approaches available The coachs belief in clients ability to change becomes a self-fulfilling prophecy Youre awesome!
  18. 18. SELF-EFFICACY Elicit and support hope, optimism, and the feasibility of accomplishing change Self-efficacy is a critical component of behavior change you as the coach must also believe in your clients capacity to reach their goals Recognize the client's strengths and accomplishments and bring these to the forefront whenever possible
  19. 19. SELF-EFFICACY (CONTD) When client believes change is not possible perceived discrepancy between the desire for change and feelings of hopelessness result in rationalizations or denial in order to reduce discomfort Helpful to talk about how persons in similar situations have successfully changed their behavior other clients can serve as role models and offer encouragement One day at a time Education can increase clients sense of self-efficacy
  20. 20. RESISTANCE Unwillingness to work on their problems and initiate change Vital to learn how to work through resistance Likely to manifest itself in all clients at one point or another Thinking about motivation and resistance in a different way As a state changes OR as a trait unchangeable How you think about motivation influences how you deal with it!
  21. 21. CHALLENGING USE ONLY WHEN RAPPORT HAS BEEN ESTABLISHED! Confronting Point out discrepancies between words, goals and behaviors Example: Youve mentioned that you really want to meet your goal in time for the wedding yet your recent deviations have really slowed down your progress. I just wonder what your thoughts are on that. Interpreting Suggesting possible reasons for client behavior Example: I dont know but I am just wondering if your recent deviations might be because you are afraid of maintenance. What do you think?
  22. 22. CHALLENGING (CONTD) Feedback Sharing thoughts and impressions Examples: You know I have noticed that every time you get close to your goal you deviate. I just wonder what is going on with that. You get very excited when you talk about being able to play with your children. Pose it as a question or hunch The Columbo Approach Example: I dont know, but Im just wondering if preparing your food ahead of time would be helpful. What do you think?
  23. 23. INCREASING COMMITMENT TO CHANGE Promote an internal attribution for change Makes them more invested/active in the change process because you want to vs because you have to Provide Choices (menu) Input The more you get them to participate the more committed have to ask themselves. I must be very committed if I am participating so much.
  24. 24. INCREASING COMMITMENT TO CHANGE (CONTD) Minimize outside pressure or force May attribute behavior to external force rather than internal Reactance when freedom is impinged upon uncomfortable feeling will try to restore sense of freedom can feel pressured can cause opposite effect on behavior Be careful how you deliver information speak to stage of change Success seems to be largely a matter of hanging on after others have let go. ~William Feather
  25. 25. QUESTIONS
  26. 26. REFERENCES Erford, B., Hays, D., & Crockett, S. (2015). Helping Relationships. In Mastering the national counselor preparation comprehensive examination (2nd ed., Vol. 1, pp. 121- 152). Upper Saddle River: Pearson. Facilitating health behavior change. (2014). In G. Liguori (Ed.), ACSM's Resources for the Health Fitness Specialist (First ed., Vol. 1, pp. 249-263). Philadelphia: Lippincott Williams & Wilkins. RESOURCES G. Gintner, Ph.D., Associate Professor and Program Leader, Counselor Education, 122C Peabody Hall, Louisiana State University. Laura H. Choa