How Do You Define Someone Is On Pre Contemplation Stage Of Change

"The job for individuals in Precontemplation is to become conscious of and concerned well-nigh the current pattern of behavior and/or interested in a new behavior. From a change perspective, it is more important to recognize an individual's current views on alter and address her or his reasons for not wanting to change than it is to sympathise how the status quo came to be."

—DiClemente, 2018, p. 29

Fundamental MESSAGES

•

In the Precontemplation stage, clients do not recognize that they accept a trouble with substance use or they recognize the problem but are not set up to modify their substance use behaviors.

•

Counselors should be nonjudgmental about clients' low motivation to change and instead focus on building a strong working alliance.

•

A key strategy to helping clients move from the Precontemplation stage to contemplating change is to heighten their level of business concern and sensation of the risk associated with their current substance employ behaviors.

•

Involving family members and pregnant others (SOs) can increase clients' business about substance use.

Affiliate 4 discusses strategies you can use to help clients heighten doubt and concern near their substance use and related health, social, emotional, mental, financial, and legal issues. It highlights areas of focus and central counseling strategies that will help clients move from the Precontemplation phase to Contemplation. This chapter also addresses issues that may arise for clients mandated to treatment.

In the Stages of Alter (SOC) model, clients who are unconcerned about their current substance utilise or may be concerned but aren't considering change are in Precontemplation. They may remain there or in the early Contemplation stage for years, rarely or possibly never thinking well-nigh change.

You can accept advantage of many opportunities and scenarios to aid someone who is misusing substances start on a journey toward change—to motion from Precontemplation to Contemplation. A customer in Precontemplation is often moved to enter the cycle of change by extrinsic sources of motivation. The post-obit situations might lead a person who is misusing a substance to treatment:

•

A higher coach refers an athlete for treatment subsequently he tests positive for cocaine use.

•

A married woman worries most her husband's drinking and insists she'll file for divorce unless he gets handling.

•

A tenant is displaced from a federal housing project considering of his substance use.

•

A driver is referred for treatment by the courtroom for driving while intoxicated.

•

A adult female tests positive for substances during a prenatal visit to a public health dispensary.

•

An employer sends an employee whose job operation has declined to the company'south employee assist program, and the employee is later on referred for substance utilise treatment.

•

A physician in an emergency department treats a commuter involved in a serious machine crash and discovers alcohol in his system.

•

A family doctor screens a patient for alcohol use disorder (AUD) and suggests treatment based on the patient's high score on the Alcohol Use Disorders Identification Exam.

•

A mother whose children were taken into custody by Kid Protective Services because of fail learns that she cannot get them back until she stops using substances and seeks treatment.

In each situation, someone with an important relationship to the person misusing substances stated his or her concerns about the person's substance misuse and its negative effects. The response to these concerns depends, in function, on the person's perception of the circumstances as well as the fashion feedback about substance misuse is presented. An individual will be improve motivated to abstain from or moderate his or her substance use if these concerned others offer relevant information in a supportive and empathic manner rather than in a judgmental, dismissive, or confrontational fashion.

Exhibit four.1 presents counseling strategies for Precontemplation.

Box

EXHIBIT 4.ane. Counseling Strategies for Precontemplation.

Develop Rapport and Build Trust

Before yous heighten the topic of modify with people who are not thinking about it, establish rapport and trust. The challenge is to create a safe and supportive environs in which clients can feel comfortable about engaging in authentic dialog. As clients become more engaged in counseling, their defensiveness and reluctance to modify decreases (Prochaska, Norcross, & DiClemente, 2013). Some motivational strategies for establishing rapport in initial conversations about beliefs alter include:

•

Asking the client for permission to address the topic of changing substance apply behaviors; this shows respect for the client's autonomy.

•

Telling the client something well-nigh how you or your program operates and how yous and the client could work together. State how long sessions will last and what you expect to reach both now and over a specified fourth dimension. Try non to overwhelm the new customer with all the plan'southward rules and regulations. Specify what assessments or other formal arrangements will exist needed, if appropriate.

•

Raising confidentiality issues up front end. You must inform the client which information will exist kept private, which can be released with permission, and which must be sent back to a referring agency.

•

Explaining that you will not tell the client what to do or how and whether to change. Rather, you volition be asking the customer to do most of the talking—giving him or her perspective about what is happening while inviting the client to share his or her own perspective. You can also invite comments about what the client expects or hopes to achieve.

•

Asking the client to tell y'all why he or she has come to treatment, mentioning what y'all know about the reasons, and asking for the client'due south version or elaboration (Miller & Rollnick, 2013). If the customer seems particularly hesitant or defensive, one strategy is to choose a topic of interest to the client that can be linked to substance apply. (For more information about setting an agenda, see Affiliate 3.) Such data might be provided by the referral source or can exist learned by request whether the customer is dealing with any stressful situations, such as illness, marital discord, or extremely heavy workload. This can lead naturally to questions such every bit "How does your utilize of alcohol fit into this?" or "How does your utilise of heroin affect your health?"

•

Fugitive referring to the client'south "problem" or "substance misuse," because this may not refect the client's perspective nearly substance utilize (Miller & Rollnick, 2013). Y'all are trying to sympathize the context in which substances are used and the client'southward readiness to change. As mentioned previously, labels can raise a person'south defenses.

•

Aligning your counseling arroyo to the customer's electric current stage in the SOC. For case, motion to strategies more appropriate to a afterwards stage in the SOC if you find that the client is already contemplating or committed to alter. (For more information on the after stages in the SOC, see Chapters five and vi.)

Box

COUNSELOR NOTE: Bureau POLICY Nearly CLIENT INTOXICATION.

Elicit the Client'southward Perception of the Problem

To engage clients, invite them to explain their understanding of the trouble. Exist straight, but remain nonjudgmental. You might say, "Can you tell me a bit about what brings you here today?" or "I'd similar to understand your perspective on why y'all're here. Can nosotros start at that place?" Asking these open up questions invites clients to tell you their story and shows your 18-carat interest in their perspective.

Explore the Events That Led to Entering Treatment

Explore what brought the client to handling, starting past recognizing his or her emotional state. The emotional state in which the customer comes to treatment is an important part of the context in which counseling begins. A client referred to handling will exhibit a range of emotions associated with the experiences that led to counseling—for example, an arrest, a confrontation with a spouse or employer, or a health crisis. People may enter treatment feeling shaken, aroused, withdrawn, ashamed, terrified, or relieved and are frequently experiencing a combination of feelings. Strong emotions can become obstacles to modify if you practise not acknowledge them through reflective listening.

Your initial conversation with clients should focus on their recent feel. For instance, an athlete is likely to be concerned about his or her continued participation in sports, as well every bit athletic performance; an employee may desire to keep his or her task; and a driver is probably worried about the possibility of losing his or her license, going to jail, or injuring someone. A meaning woman wants a salubrious child; a mother may want to regain custody of her children; and a concerned hubby needs specific guidance on encouraging his spouse to enter treatment.

Many people with substance use problems seek treatment in response to external pressure from family, friends, employers, healthcare providers, or the legal system (Connors, DiClemente, Velasquez, & Donovan, 2013). A client sometimes blames the referring source or someone else for pressuring him or her into treatment and study that the referring provider simply doesn't view the state of affairs accurately. Start with these external sources of motivation as a way to raise the client's awareness near the touch on of his or her substance use on others. For example, if the customer's wife has insisted he outset handling and the customer denies any trouble, you lot might ask, "What kind of things seem to bother her?" or "What practise you call up makes her believe there is a trouble associated with your drinking?" If the wife's perceptions are inconsistent with the client's, you might propose that the married woman come up to treatment so that y'all can explore their unlike perspectives.

Similarly, yous may have to review and confirm a referring agency's account or the concrete testify forwarded by a healthcare provider to help y'all introduce culling viewpoints to the client in nonthreatening ways. If the client thinks a probation officeholder is the problem, you can ask, "Why do you lot think your probation officeholder believes y'all have a trouble?" This lets the client limited the trouble from the perspective of the referring party and can raise awareness. Apply reflective listening responses to let the customer know you are listening. Avert agreeing or disagreeing with the client's position.

Assess the Customer'southward SOC and Readiness to Change

When you first meet the client, determine his or her readiness to modify and where he or she is in the SOC; this determines what counseling strategies are likely to piece of work. Information technology is tempting to assume that the customer with obvious signs of a substance use disorder (SUD) must already exist contemplating or set for change. Withal, such assumptions may be wrong. The new client could be at any betoken on the severity continuum (from substance misuse to astringent SUD), could have few or many associated health or social problems, and could exist at any stage of readiness to change. The strategies you use to engage clients in initial conversations almost modify should be guided by your assessment of the client'due south motivation and readiness.

The Importance and Conviction Rulers

The simplest style to assess the client's readiness to change is to utilise the Importance Ruler and the Confidence Ruler described in Chapter three (see Exhibit 3.nine and Exhibit 3.x, respectively). The Importance Ruler indicates how important information technology is for the client to make a alter right now. The Confidence Ruler indicates a client's sense of self-efficacy near making a change right now. Together, they signal how ready the customer is to change target behaviors. Clients in Precontemplation will typically be at the lower end of the rulers, mostly betwixt 0 and three.

Go on in mind that these numerical assessments are neither fixed nor always linear. The client moves forward or backward across stages or jumps from one part of the continuum to another, in either direction and at diverse times. Your office is to facilitate movement in the direction of positive change.

Identification of the client'south fashion of Precontemplatio

You should tailor your counseling approach to the ways in which the client talks nearly beingness in Precontemplation. Clients will present with dissimilar expressions of sustain talk (run into Chapter 3), which is the status quo side of ambiguity about changing substance use behaviors. Exhibit 4.ii describes dissimilar styles of expressions of ambivalence about change during the Precontemplation phase (known as the 5 Rs) and counseling strategies aligned with these different expressions of sustain talk during Precontemplation.

Box

EXHIBIT four.ii. Styles of Expression in the Precontemplation Stage: The 5 Rs.

Readiness assessment instruments

Use assessment tools to help make up one's mind the client's readiness to alter and identify in the SOC. These instruments tin requite overall scores that represent to levels of readiness to change. You may find it useful to explore client responses to specific questions to enhance sensation of his or her substance utilize and what may be getting in the way of making a change. Several cess tools widely used in clinical and research settings are discussed briefly beneath and presented in total in Appendix B:

•

The Academy of Rhode Island Change Cess Scale (URICA) was originally adult to measure out a client's modify phase in psychotherapy (McConnaughy, Prochaska, & Velicer, 1983) in terms of four stages of the SOC: Precontemplation, Contemplation, Action, and Maintenance. Information technology has been adjusted for addiction handling and is the near common way of measuring the client'due south stage of alter in clinical settings (Connors et al., 2013).

-

The scale has 32 items—8 items for each of the 4 stage-specific subscales. A customer rates items on a five-signal scale from ane (strong disagreement) to 5 (potent agreement). The instrument covers a range of concerns and asks clients general questions about the client'south "problem." URICA subscales have skillful internal consistency and validity for SUDs (Field, Adinoff, Harris, Brawl, & Carroll, 2009).

-

To use this tool, the client is asked to place a specific "problem" (due east.g., cocaine use) and then fills out the course keeping the specific problem in mind. There may be more than one "trouble" for which the customer is seeking help, so yous may want to accept the client fill out the musical instrument more than than one time. You can employ the URICA to track a customer's motility through the SOC by asking the client to fill up it out periodically.

•

The Stages of Alter Readiness and Treatment Eagerness Scale (SOCRATES) measures readiness to alter. The original SOCRATES was a 32-item questionnaire that used a 5-point scale ranging from v (strongly agree) to 1 (strongly disagree). A 19-item version was developed for clinical apply and is a self-administered newspaper-and-pencil questionnaire (Miller & Tonigan, 1996). The SOCRATES 8A is for alcohol use, and the SOCRATES 8D is for drug use. The items on the short version appraise the recognition of the problem, ambivalence, and efforts to have steps.

SOCRATES provides clients with feedback nearly their scores every bit a starting signal for give-and-take. Changes in scores over time can assist you learn the bear on of an intervention on problem recognition, ambivalence, and progress on making changes.

•

The Readiness To Modify Questionnaire was developed to help healthcare providers who are non addiction handling specialists assess the stage of alter of clients misusing alcohol (Rollnick, Heather, Gilded, & Hall, 1992). The 12 items, which were adapted from the URICA, are associated with iii stages—Precontemplation, Contemplation, and Action—and reflect typical attitudes of clients in each readiness level. For example, a person not yet contemplating change would likely give a positive response to the statement "It's a waste material of time thinking about my drinking because I do not accept a problem," whereas a person already taking action would probably agree with the statement "I am actively working on my drinking problem." Another individual already contemplating alter would probable agree with the detail "Sometimes I recall I should quit or cut down on my drinking." A v-point scale is used for rating responses, from 5 (strongly agree) to i (strongly disagree).

Commend the Client for Coming to Handling

Offering clients affirmations over responsible behaviors, like entering treatment, tin increase their conviction that change is possible. Clients referred for handling may experience they take little control in the procedure. Some will expect to exist criticized or blamed; some volition expect yous to cure them; and still others will promise that counseling tin solve all their problems without too much effort. Whatever their expectations, affirm their courage for coming to handling past maxim things like, "It took you lot a lot of attempt to get here. You lot are determined to figure out what'south going on and how you can modify things." For case, you tin praise a client's decision to come to treatment rather than gamble losing custody of her kid by proverb, "You must care very much about your kid." Such affirmations are supportive and remind clients that they are capable of making good choices that match their values.

Agree on a Management

In helping clients who are not yet thinking seriously of changing, plan your strategies advisedly and piece of work with them to find an adequate pathway. Some clients will agree on one option but not on some other. It may be appropriate to give advice based on your ain experience and business organization. However, always ask permission to offer advice and make sure that clients want to hear what you accept to say. Asking permission demonstrates respect for client autonomy and is consequent with person-centered counseling principles and the spirit of MI (as discussed in Chapter 3). For example: "I'd like to tell you nigh what nosotros could practise here. Would that be all right?"

Whenever you express a dissimilar viewpoint from that of the client, exercise so in a way that is supportive, not authoritative or confrontational. The client notwithstanding has the pick of whether to accept your advice and to agree to a plan. It is non necessary at the beginning of the process to concord on treatment goals; however, you can use motivational strategies, similar the agenda mapping discussed in Chapter 3, to hold on how to proceed in the current chat.

Throughout the procedure of establishing rapport and edifice trust, use the OARS (asking Open questions, Affirming, Reflective listening, and Summarizing) approach and person-centered counseling principles (described in Chapter 3) to create a sense of condom and respect for the client, equally well equally a genuine involvement in the customer'southward perspective and well-being. Emphasizing personal autonomy volition become a long way toward showing the client that you are not pressuring him or her to change.

Raise Doubts and Concerns About the Client'southward Substance Apply

One time y'all have engaged the client and developed rapport, utilize the following strategies to increase the customer's readiness to change and motility closer to Contemplation.

Provide Information About the Effects and Risks of Substance Misuse

Psychoeducational programs tin can increase clients' ambivalence about substance misuse and related problems and move them toward contemplation of modify (Yeh, Tung, Horng, & Sung, 2017). Be certain to:

•

Provide basic information about substance utilize early in the treatment procedure if clients have not been exposed to drug and alcohol education before.

•

Utilise the motivational strategy of Elicit-Provide-Elicit (EPE, described in Chapter 3) to engage clients in a joint discussion rather than lecture them (Miller & Rollnick, 2013).

•

Ask permission, for example, "Would it exist okay to tell y'all a flake about the furnishings of ________?" or inquire them to describe what they know almost the furnishings or risks of the substances used.

•

Talk about what happens to any user of the substance rather than referring just to the client.

•

Country what experts have institute, not what you retrieve happens.

•

Provide small chunks of information and so arm-twist the client's understanding. For instance, "What do you make of all this?"

•

Describe the habit process in biological terms. Understanding facts well-nigh habit can increase hope as well equally readiness to change. For instance, "When you first first using substances, it provides a pleasurable sensation. Every bit you keep using substances, your heed begins to believe that yous need these substances in the same fashion you need life-sustaining things like nutrient—that you demand them to survive. You're non stronger than this process, just you can be smarter, and you lot tin regain your independence from substances."

Box

EXPERT COMMENT: LIVER TRANSPLANTATION—PRECONTEMPLATION TO CONTEMPLATION.

Similarly, people who have driven under the influence of alcohol may be surprised to larn how few drinks are needed to meet the definition of legal intoxication and how drinking at these levels affects their responses. Women hoping to have children may not understand how substances can diminish fertility and potentially damage the fetus even before they know they are pregnant. Clients may non realize how alcohol interacts with other medications they are taking for low or hypertension.

Box

Counselor NOTE: Employ MOTIVATIONAL LANGUAGE IN WRITTEN MATERIALS.

Evoke Business organization Well-nigh the Customer's Substance Use

You tin help move clients from Precontemplation to Contemplation by raising doubts nearly the harmlessness of their substance use and concerns virtually their substance use behaviors.

As clients move across the Precontemplation phase and become aware of or acknowledge some problems in relation to their substance use, change becomes increasingly possible. Such clients become more aware of conflict and feel greater ambiguity (Miller & Rollnick, 2013).

I way to enhance concern in the client is to explore the "positive" and "less-positive" aspects of his or her substance use. For example:

•

Start with the client'due south views on possible "benefits" of alcohol or drugs and move to less-beneficial aspects rather than simply ask about bad things or problems associated with substance utilise.

•

Do non focus only on negative aspects of substance use considering the customer could end upwards defending his or her substance use while you push for unwanted change.

•

Avoid spending too much time exploring the "expert" things about substance employ that may reinforce sustain talk. Higher levels of client sustain talk is associated with lower motivation to alter and negative treatment outcomes (Lindqvist, Forsberg, Enebrink, Andersson, & Rosendahl, 2017; Magill et al., 2014).

•

Be aware that the customer may non be prepare to accept he or she has experienced whatsoever harmful effects of substance use. By showing that you understand why the client "values" booze or drug experiences, you assistance the client become more open up to accepting possible problems. For example, you lot might ask, "Help me empathise what you like virtually your drinking. What do yous enjoy about information technology?" Then inquire, "What do you lot like less nigh drinking?" The client who cannot recognize any things that he or she "likes less" about substance use is probably not ready to consider modify and may need more information.

•

After this exploration, summarize the interchange in personal linguistic communication then that the client can clearly hear any ambiguity that is developing.

Every bit mentioned in Affiliate 3, you can use double-sided refections to respond to client ambivalence and sustain talk (Miller & Rollnick, 2013). For example, you can say, "So, drinking helps you relax. Notwithstanding, you say you lot sometimes resent all the money you are spending, and it'due south hard for you to become to piece of work on fourth dimension, particularly Mon mornings." Chapter five provides boosted guidance on working with ambiguity.

You can also motility clients toward the Contemplation stage by having them consider the many ways in which substance utilize tin bear upon life experiences. For example, you might ask, "How is your substance use affecting your studies? How is your drinking affecting your family life?"

As you explore the effects of substance apply in the private's life, utilise balanced cogitating listening: "Assist me sympathize. Y'all've been saying you see no need to change, and y'all are concerned about losing your family. I don't meet how this fits together. I'grand wondering if this is confusing for you, likewise."

Provide Personalized Feedback on Assessment Findings

Some other constructive strategy for raising doubt and concern is to provide clients with personalized feedback about assessment findings. As mentioned in Chapter 2, giving personalized feedback nigh clients' substance utilize is effective (Davis, Houck, Rowell, Benson, & Smith, 2015; DiClemente, Corno, Graydon, Wiprovnick, & Knoblach, 2017; Field et al., 2014; Kahler et al., 2018; McDevitt-Murphy et al., 2014; Miller et al., 2013; Walker et al., 2017). In cursory interventions, the feedback is usually brusque and focused on screening results. In specialty habit handling settings, feedback can focus on results of a comprehensive cess, which often includes:

•

Substance utilize patterns and history.

•

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for SUDs.

•

General operation and links between substance use and lowered operation.

•

Health and biomedical furnishings including slumber disorders, HIV, and diabetes.

•

Neuropsychological furnishings of long-term substance use.

•

Family history of mental disorders and SUDs, which put clients at risk for SUDs and co-occurring substance utilise and mental disorders (CODs).

•

CODs and effects of substance use on mental illness.

•

Functional analysis of substance use triggers.

Provide clients with personalized feedback on the risks associated with their own substance use and how their consumption compares with others of the same civilisation, age, or gender.

When clients hear virtually assessment results and empathize the risks and consequences, many recognize the gap between where they are and where their values lie.

To make findings from an cess a useful part of the counseling process, make sure the client understands the value of such data and believes the results volition be helpful. If possible, schedule formal assessments after the client has had at least one session with you or use a motivational interviewing (MI) cess strategy that involves having a brief MI chat before and after the cess (see Chapter 8 for more data). This arroyo will help establish rapport, determine the client'southward readiness for change, and measure his or her potential response to personalized feedback.

Get-go a standard cess by explaining what types of tests or questionnaires will be administered and what information these tools will reveal. Guess how long the process usually takes, and requite any other necessary instructions. Make sure the customer is comfortable with the cess format (e.one thousand., have self-administered tests available in the client's first language, do a face-to-face interview instead of a self-administered assessment if the customer has cognitive challenges).

Box

Advisor NOTE: Clarification OF A TYPICAL DAY.

One time the client completes the assessment, review findings with the client. Present personalized feedback to the client in a way that is likely to increase his or her sensation and develop discrepancy between the client's substance employ and values. Appendix C provides a link to the Motivational Enhancement Therapy Transmission, which includes an example of a personal feedback written report to include in a comprehensive cess. You should adjust this report for the specific kinds of assessment information yous gather at your plan.

When providing all-encompassing feedback about assessment results, divide it into pocket-sized chunks, and use the EPE arroyo, otherwise, the client might feel overwhelmed. You may just need to provide one or two pieces of feedback to raise doubts and concerns and to motility the customer toward Contemplation.

Involve Significant Others

Including people with whom the client has a close relationship can make treatment more constructive. Many people who misuse substances or who have SUDs answer to motivation from spouses and SOs to enter treatment (Connors et al., 2013). An And so is typically a parent, spouse, alive-in partner, or other family fellow member only can be any person with a close personal relationship to the client.

Supportive SOs can help clients become intrinsically rather than just extrinsically motivated for beliefs change (Bourke, Magill, & Apodaca, 2016). Including supportive SOs is cost effective and can foster positive client outcomes, including increased client change talk; increased client commitment to modify; and reduced substance apply, alcohol consumption, and alcohol-related consequences (Apodaca, Magill, Longabaugh, Jackson, & Monti, 2013; Bourke et al., 2016; Monti et al., 2014; Shepard et al., 2016; Smeerdijk et al., 2015).

SOs can encourage clients to utilise their inner resources to identify, implement, and sustain actions leading to a lifestyle free from substance misuse. They can be important in increasing clients' readiness to modify by addressing substance utilize in the following means:

•

Reminding clients nearly the importance of family, their human relationship to an SO in their lives, or both

•

Providing helpful feedback to clients almost the negative effects of their substance apply behavior

•

Encouraging clients to change substance use behaviors

•

Alerting clients to social and individual coping resource that support recovery

•

Providing positive reinforcement for using social/coping resource to change substance use

Box

EXPERT Annotate: INVOLVING AN SO IN THE Alter Process.

Before involving an And then in the customer'south treatment:

•

Inquire the customer for permission to contact the SO.

•

Describe the benefits of And then support.

•

Review confidentiality concerns.

•

If the client agrees, obtain the necessary written releases.

Some strategies for engaging an So in an initial meeting with yous and the client include the following:

•

Utilize MI strategies to appoint the SO in the counseling process (Belmontes, 2018).

•

Praise the And then for his or her willingness to participate in the client'due south efforts to change.

•

Offer chat guidelines (e.m., use "I" statements, don't use language that blames or shames).

•

Define the SO's function (e.g., offering emotional/instrumental support, giving helpful feedback, reinforcing positive reasons for alter, working with customer to alter substance use behavior).

•

Exist optimistic about how the SO'southward support and nonjudgmental feedback can be an important factor in increasing the client's motivation to change.

•

Invite the And then to be on the client'due south team that is working to reduce the impact of substance misuse on the couple or family.

•

Provide brief instructions to the SO on how to ask open up questions, utilise reflective listening, and back up client change talk (Smeerdijk et al., 2015).

•

Invite the Then to place the family unit'due south values and how the substance use behavior might not fit with those values (Belmontes, 2018).

•

Reinforce positive comments fabricated past the Then nearly the client's current modify efforts. Refocus the chat if the feedback from the And so is negative or reinforces the customer'south sustain talk.

•

Use EPE to give the And then information on support services (e.yard., Al-Anon, family peer back up providers, individual counseling) that volition help focus on his or her own recovery while supporting the client.

•

If the SO cannot exist supportive and nonconfrontational or has substance misuse or behavioral health concerns that interfere with his or her ability to participate fully and supportively in the client's treatment, consider limiting the SO's part to mainly information sharing. Refer the SO to SUD treatment or behavioral health services and a recovery support grouping (e.g., Al-Betimes).

•

If the So cannot attend counseling sessions with the client, invite the So to the session figuratively by evoking and reinforcing client change talk associated with the significance of family and friends in the customer'due south motivation to change (Sarpavaara, 2015). For example, yous might ask, "You have mentioned that your human relationship with your daughter is very important to you. How would not drinking, impact the quality of your human relationship?"

For more data on families and SUD treatment, see Treatment Improvement Protocol (TIP) 39: Substance Abuse Treatment and Family Therapy (Substance Abuse and Mental Health Services Assistants, 2015a).

Limited Concern, and Leave the Door Open

In the initial engagement and assessment phase, if the customer remains in Precontemplation and you cannot mutually agree on treatment goals, express business almost the customer'due south substance misuse and leave the door open for the client to return to treatment whatsoever time. Do this past:

•

Summarizing your concern based on screening or assessment results or feedback from SOs.

•

Presenting feedback in a factual, nonjudgmental way.

•

Reminding the customer that yous respect his or her decision, fifty-fifty if data suggest a different pick.

•

Emphasize personal choice to maintain rapport with clients in Precontemplation.

•

Making certain the client has your contact information and appropriate crisis or emergency contact information before catastrophe the session.

•

Asking the client's permission for you or someone at your program to contact him or her past phone in a month to check in briefly. If the client says yes, follow up. This is an opportunity to appraise the state of affairs and encourage the client to return to treatment if desired.

Empathise Special Motivational Counseling Considerations for Clients Mandated to Treatment

An increasing number of clients are mandated to treatment (i.e., ordered to attend) by an employer, an employee assistance program, or the criminal justice arrangement. In such cases, failure to enter and remain in treatment may result in penalty or negative consequences (e.k., job loss, revocation of probation or parole, prosecution, imprisonment), often for a specified fourth dimension or until satisfactory completion.

Your challenge is to engage clients who are mandated to the treatment procedure. Although many of these clients are at the Precontemplation stage, the temptation is to utilise Action stage interventions immediately that are not compatible with the client'southward motivation level. This can be counterproductive. Clients get in with stiff emotions considering of the referral process and the consequences they will face if they practise not succeed in changing a blueprint of use they may not believe is problematic.

In addition, evidence shows that clients mandated to treatment tend to engage in a bang-up deal of sustain talk, which is consistent with being in the Precontemplation stage and predicts negative substance use handling outcomes (Apodaca et al., 2014; Moyers, Houck, Glynn, Hallgren, & Manuel, 2017). An of import motivational strategy with these clients is to lessen or "soften" sustain talk before trying to evoke modify talk (Moyers et al., 2017). (See Chapter 3 for strategies for responding to sustain talk that you can apply to clients who are mandated to treatment.)

Despite these obstacles, clients mandated to treatment take similar treatment outcomes as those who attend handling voluntarily (Kiluk et al., 2015). If you use motivational counseling strategies appropriate to their stage in the SOC, they may get invested in the modify process and do good from the opportunity to consider the consequences of use and the possibility of change.

You may have to spend your outset session "decontaminating" the referral process. Some counselors say explicitly, "I'thou sorry yous came through the door this way." Important principles to proceed in mind are to:

•

Honour the client'due south anger and sense of powerlessness.

•

Avert assumptions nigh the blazon of treatment needed.

•

Brand it articulate that you will help the client explore what he or she perceives is needed and useful from your fourth dimension together.

When working with clients who are mandated to treatment, you are required to establish what information volition be shared with the referring agency. In add-on, you lot should:

•

Formalize the release of data with clients and the bureau through a written consent for release of information that adheres to federal confidentiality regulations.

•

Inform clients nigh what information (e.g., attendance, urine test results, handling participation) volition be released, and get their consent to share this information.

•

Be sure clients empathize which choices they have nigh the information to be released and which choices are not yours or theirs to brand (e.g., information related to child abuse or neglect).

•

Accept into business relationship the role of the clients' attorneys (if any) in releasing information.

•

Clearly delineate different levels of permission.

•

Be clear with clients about consequences they may feel from the referring agency if they practice not participate in treatment as required. Motivational strategies to assistance maintain a collaborative working alliance with clients while presenting such consequences (Stinson & Clark, 2017) include:

-

Admit clients' ambivalence about participating in counseling.

-

Differentiate your role from the authority of the referring bureau (e.chiliad., "I am here to help you make some decisions well-nigh how you might want to change, not to pressure you lot to change").

-

Describe the consequences of non participating in handling in a neutral, nonjudgmental tone.

-

Avoid siding with clients or the referring agency about the fairness of possible consequences and punishments. Take a neutral opinion.

-

Emphasize personal choice/responsibility (e.g., "It's upwards to you whether yous participate in treatment").

Exhibit four.3 provides an example of an initial chat with a customer who has been required to attend counseling equally a condition of parole.

Box

Showroom iv.3. An Opening Dialog With a Client Who Has Been Mandated to Treatment.

Although this counseling scenario relies primarily on cognitive-behavioral therapy strategies, the advisor engages the customer in the spirit of MI past emphasizing partnership and acceptance of the client. The counselor also uses affirmations and maintains a nonjudgmental, neutral tone throughout the conversation, emphasizing the client'due south autonomy and values. This approach is consistent with an effective way to engage a client in Precontemplation who has been mandated to treatment.

Determination

The outset step in working with clients in the Precontemplation stage of the SOC is to develop rapport and institute a counseling alliance. The side by side pace is to assess their readiness to change, then help them begin to develop an sensation that their apply of substances is linked to problems in their lives. Motivational counseling strategies from motivational enhancement therapy (e.k., providing personalized feedback about assessment results) and MI (e.g., using reflective listening to engage, emphasizing personal choice and responsibility, exploring discrepancy) are suited to helping clients motion from Precontemplation to Contemplation.

Source: https://www.ncbi.nlm.nih.gov/books/NBK571072/

Posted by: martinpervou.blogspot.com

Share this post