How Therapy Works-Foundation of Change.pptx

Foundation of Change Dr. Ian Grey UAEU Objectives Definition of counselling Counselling V Psychotherapy Model of Change Definition Counselling is a structured, systematic process that is organized in a series of steps, and has the objective to help clients better understand and cope with situations...

Foundation of Change Dr. Ian Grey UAEU Objectives Definition of counselling Counselling V Psychotherapy Model of Change Definition Counselling is a structured, systematic process that is organized in a series of steps, and has the objective to help clients better understand and cope with situations that they are struggling with. This often involves helping the client to be aware of and understand their own emotions, thoughts, and feelings and be ready, able, and willing to make positive alternative choices and decisions that will facilitate their aspirations and life goal First Big Question for Us How does change therefore happen? How does psychotherapy actually work? There are three basic things going on in psychotherapy There is the type of Therapy (CBT etc) There is the type of Therapist (characteristics) There is the client (what you call patient) Change is the result of all three things, not just one. Always have to think about all three Common Factors Meta-analysis studies reveal that the effectiveness of therapy actually relies on common therapeutic factors; all forms of therapy bank on almost identical common factors to produce positive client change (Asay & Lambert, 1999; Lambert, 1992; Glass, Smith, & Miller, 1980; Wampold, 2010). The finding of these studies led Wampold (2010) to claim “The common factors are indeed the ‘heart and soul’ of therapy” (p. 54). Common Factors The analysis by Asay and Lambert (1999) shows a specific breakdown of the common factors and how they contribute to success in therapy: Client factors 40 percent The therapeutic relationship 30 percent Hope and expectancy 15 percent Specific techniques 15 percent Client Characteristics Accounting for 40 percent of the therapeutic outcome, the client factor stands out as the best predictor of therapy success. The question is: what exactly does the client factor entail? The first client factor involves the characteristics of the client, including client functioning level and client motivation. The more disturbed the client is, the less positive the therapeutic outcome. The more intelligent and open the client is, the better the therapeutic outcome. The more motivated a client is to change during therapy, the more positive the outcome. Please note, the motivation to change at the beginning of therapy is less predictive than the motivation to change during therapy Client Inherent Resources The following have proven to be essential elements of the client factor: clients’ resiliency, ability to tolerate anxiety and strength of the support system. As therapists, we need to tap into these inherent powers within the clients. In addition to resiliency, the client’s ability to identify at least one problem to work on in therapy significantly contributes to a positive outcome. Identifying a problem makes it possible to set a realistic goal to work toward. Finally, a client’s capacity to relate to others (and to the therapist) plays a part in the therapeutic success. Other Factors Therapeutic relationship Expectancies Techniques We will return to later How Change Happens? People do not change behaviors quickly and decisively. Rather, change in behavior, occurs continuously through a cyclical process. The Transtheoretical Model (also called the Stages of Change Model), developed by Prochaska and DiClemente in the late 1970s. The model is called Stages of Change- there are six stages 1 Precontemplation In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences. People in this stage often underestimate the pros of changing behavior and place too much emphasis on the cons of changing behavior. 1 Precontemplation 1.If a person at this stage does show up for counseling, it is typically someone else who has requested it—perhaps the court, the supervisor, the school, the spouse, etc. 2.The dropout rate stacks high at this stage. Therefore, don’t take it personally if the client does not come back. If your client stays, don’t proceed with the standard counseling process. Instead, use motivational interviewing to see whether the client might start to acknowledge that there exists an issue, and they might then move ahead to the next stage of change 2 Contemplation In this stage, people are intending to start the healthy behavior in the foreseeable future (defined as within the next 6 months). People recognize that their behavior may be problematic, and a more thoughtful and practical consideration of the pros and cons of changing the behavior takes place, with equal emphasis placed on both. Even with this recognition, people may still feel ambivalent toward changing their behavior. 2 Contemplation If your client is stuck in the chronic contemplation stage, you can continue to use motivational interviewing and help them take only baby steps of change—steps so small as to bypass the clients’ defense of their minds. 3 Preparation (Determination) In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life. 3 Preparation (Determination) At this third stage of readiness, the client has developed a commitment to change and has begun to entertain the idea of overcoming the barriers to change. You will know when your client has entered this stage because you will begin hearing reports about small changes they have made and how these changes benefit them. In this stage, the clients need you to help them set realistic goals. Goals too vague or too high may set them up for failure. 4 Action In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change. People may exhibit this by modifying their problem behavior or acquiring new healthy behaviors. 4 Action This stage involves the most active behavioral changes. Here, the client is highly motivated to do the work and to initiate tangible behaviors to change for the better. This stage, therefore, is also known as the reorientation stage (Stoltz & Kern, 2007). Not every deep issue will be resolved, which leaves room for occasional relapses. Even with occasional relapses, the clients’ efforts of change often allow others in their life to begin to respond to them favorably. 5 Maintenance In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward. People in this stage work to prevent relapse to earlier stages. 5 Maintenance In the final stage, the client learns how to take cautious steps to prevent relapse. Even after the client has renewed her daily functions and has changed her relating styles, relapse may still occur. Typically, when under stress, people tend to revert to previous ways of coping. If your client is in this stage, you are likely to provide supportive counseling and stress management counseling. You want to help your client learn how to avoid triggers that might cause a relapse, how to continue her recovery and take preventive measures to maintain the gains made during the previous stage of action. 6 Termination In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse. Since this is rarely reached, and people tend to stay in the maintenance stage, this stage is often not considered in health promotion programs. Strategies To progress through the stages of change, people apply cognitive, affective, and evaluative processes. 1.Consciousness Raising - Increasing awareness about the healthy behavior. 2.Dramatic Relief - Emotional arousal about the health behavior, whether positive or negative arousal. 3.Self-Reevaluation – Self-reappraisal to realize the healthy behavior is part of who they want to be. 4.Environmental Revaluation - Social reappraisal to realize how their unhealthy behavior affects others. Strategies 5. Social Liberation - Environmental opportunities that exist to show society is supportive of the healthy behavior. 6. Self-Liberation - Commitment to change behavior based on the belief that achievement of the healthy behavior is possible. 7. Helping Relationships - Finding supportive relationships that encourage the desired change. 8. Counter-Conditioning - Substituting healthy behaviors and thoughts for unhealthy behaviours and thoughts Strategies 9. Reinforcement Management - Rewarding the positive behavior and reducing the rewards that come from negative behavior. 10. Stimulus Control - Re-engineering the environment to have reminders and cues that support and encourage the healthy behavior and remove those that encourage the unhealthy behavior. Stages of Counseling/Psychotherapy Stage Stage Stage Stage 1: 2: 3: 4: Problem Exploration (Initial Stage) Awareness Cultivation (Middle Stage) Problem Resolution (Later Stage) Termination Stage 1: Problem Exploration The problem exploration stage of counseling might correspond to Prochaska’s contemplation stage. The tasks in this stage are: Conduct a thorough intake. Explain the counseling process to the client. Establish rapport (by focusing on the client’s experiences and emotions). Reassess the central problem (focusing on the client’s actions and failed problem solving attempts). Look for the client’s resources and strengths. Skills Needed 1.To accomplish these tasks, the therapist uses at least two primary skills: ATTENDING! Empathic responding skills—reflection of feelings, thoughts, needs, and values, paraphrasing, affirmation, perception checking, periodical summarization, and advanced empathy (later lecture). Probing skills, including focusing, probing, and clarifying statements (later lecture). If the client proves ambivalent about change, use motivational interview techniques (later lecture). Stage 2 Awareness Cultivation 1.Stage 2: Awareness Cultivation (Middle Stage) 2.This stage might correspond to Prochaska’s contemplation stage or preparation stage. The tasks are: Help the client increase his awareness of ineffective coping patterns. Help the client work through resistance. Help the client accept, own up to, and honor old patterns. the client recognize and draw on forgotten strengths. Help the client visualize what he wants out of his life. Skills Needed To accomplish these tasks, the therapist uses a wider range of skills and interventions that focus on raising awareness, facilitating fuller expression, and enhancing emotion regulation. These skills include the following: Empathic responding skills. Influencing skills which include identifying patterns, self-disclosure, caring Confrontation, giving feedback, and immediacy Basic and advanced intervention techniques Stage 3 Problem Resolution Stage 3: Problem Resolution (Later Stage) The problem resolution stage might correspond to Prochaska’s action stage. The tasks of counseling at this stage are: Help the client reconstruct her schema by in-session training for new behaviors or skills. Support the client in integrating disowned parts of her experiences through experiential techniques. Empower the client to exercise her freedom of choice, and implement an action plan in her life. Skills Needed 1.In an effort to accomplish these tasks, the therapist has to use a wider range of skills and interventions including: Empathic responding skills. Influencing skills. Advanced intervention techniques, such as role playing, role reversal, mindfulness training, guided imagery, experiential techniques, Stage 4 Termination 1.Stage 4: Termination 2.The termination stage does not correspond to Prochaska’s stages but might resemble the maintenance stage somewhat. The tasks of this stage are: Help the client evaluate his progress and transfer his learning to real life. Assist the client in anticipating future challenges and envisioning strategies for coping. Help the client bring closure to therapy. The counseling skills used in the termination stage include all skill levels.