OBSTACLES AND STRATEGIES FOR A SUCCESSFUL CHANGE.

Adopted from Overcoming Obstacles to Change presentation by Dr. Deborah Dobson, Ph.D., R.Psych. For Presentation at Supportive Living Program Team Meeting. April 21, 2011, Marguerite House.

BACKGROUNDChange.

Most of us, at one time or another in our lives, reach a point when we know that something in our lives has to change, and that we have to be the ones to change it. The status quo is no longer satisfying our needs, and it’s time to do something about it. However, because the thoughts that have “fed” our behaviors for so long are deeply ingrained in our mind, and the habits of thought are hard to break, it is often a difficult task to make change. Much more difficult for persons with mental illness diagnosis.

OBSTACLES TO CHANGE

GENERALLY WHAT INTERNAL AND EXTERNAL OBSTACLES CAN YOU MENTION???..

Little Brainstorming Session.

OBSTACLES TO CHANGE

INTERNAL Lack of readiness Lack of motivation Lack of skills involved Cognitive barriers -belief

about self/others. Liking the statuesque, relative comfort, self defeating thought pattern, uncertainty

Avoidant behavior procrastination, indecision

Fear and anxiety…… Mental Illness …….

EXTERNAL Lack of resources, finances, Other peoples attitudes stigma

(could be internal too). Poor reinforces (AISH, EI

Benefits..). The cost for change is too high. Excessive work pressure

involved. Moving entails -packing, making calls, arranging cleaning,

THE FAILURE TO CHANGE IS RELATED TO A COMBINATION OF FIVE FEARS (DENNIS O’GRADY), :

FEAR OF THE UNKNOWN: The fear that when change occurs, one will lose control.FEAR OF FAILURE: If I commit myself to goals for change, there is a chance

for failure.FEAR OF COMMITMENT: Commitment to one option is not always fun because it

eliminates other options.FEAR OF DISAPPROVAL: If I change, I risk having people say they like me better

the way I was. FEAR OF SUCCESS: If I change, other people expect too much from me.

Barriers To Change Due to Mental Illness: consider symptoms

Anxiety disorders. GAD, PD, OCD Mood disorders…depression, BPD, Schizophrenia and psychotic disorders, Cognitive and intellectual barriers,

Other mental health diagnosis related barriers????????????

STAGES OF CHANGE

Psychologists Prochaska, Norcross, and others, have developed a theory/model about the process of change called the Transtheoretical Model.

The model involves a number of steps people go through in the process of change.

The model proposes five stages. See the model below.

Transtheoretical Model: Stages of Change

PRECONTEMPLATION STAGE- I HAVE NO PROBLEM In this stage, a client is unaware that he or she has a

problem, or is under-aware of the problem. There is no expressed desire to make any changes, and no real concern or immediacy for anything to be different. If asked, clients might say that things are fine, and that if nothing is different a year from now, it would be okay.

Any client experiences ? CONTEMPLATION STAGE- I THINK I SHOULD CHANGE In this stage, a client has become aware that there may be

a problem, and one has begun considering doing something about it.

COMMITMENT STAGE: I WILL CHANGE Clients have become more than aware that they have a problem

or a situation that demands change. Clients are motivated to do something to change it. Clients go beyond saying “I should” and begin saying “I will.” Interestingly, this is a difficult stage to get to. Clients often enter this stage and commit to change only when the alternative is no longer tolerable. The thought of NOT changing is unbearable. It is in this stage that change—and progress—are born.

PREPARATION: YES I CAN CHANGE, READY TO TAKE STEPS

This is a “could” stage. Clients think of every possible alternative and resources.   Clients look at options, and they choose the ones that will work for them. Clients devise a plan, and are intent on following it through. Clients are ready.

ACTION STAGE Clients are committed. Clients have prepared. Clients are

physically, emotionally, and spiritually ready to embark on a journey by which it will improve their lives. Clients take steps.

RELAPSE STAGE

When a client falls or slides back into a former state .

MAINTENANCE STAGE

Clients feel proud. They love the change . Clients hold their head higher. Clients have more self confidence. SUCCESS.

THE MAIN QUESTION IS

HOW DO YOU BRING ABOUT

A SUCCESSFUL CHANGE?

MOTIVATIONAL INTERVIWING, AN EVIDENCE BASED STRATEGY FOR

BRINGING FORTH SUCCESSFUL CHANGE.

MOTIVATIONAL INTERVIWING.

Motivational Interviewing (MI) is defined as a client-centered counseling style for enhancing intrinsic motivation to change by identifying and resolving ambivalence. Motivational Interviewing (MI) has been developed over the past 25 years by William Miller and Stephen Rollnick (Miller, W.R. & Rollnick S., 2002).

The central goal of MI is to examine and resolve ambivalence in order to create an opportunity for self-change. Ambivalence is defined as the conflict between wanting to change a given behavior and maintaining the status quo.

MI focuses on an individual's interests and concerns, reflecting the work of Carl Rogers on Client-Centered Therapy. Rogers view the therapist’s role as merely offering three critical conditions to prepare his/her client for natural change: empathy, unconditional positive regard and genuineness.

The therapist uses reflective listening to clarify and amplify the meaning that the client places on events (rather than the meaning that the therapist places on those events). Reflective listening, which uses statements instead of questions to uncover the meaning of the client’s discourse, is an effective approach to self discovery and , therefore, change.

General Principles

1. Express empathy using acceptance and reflective listening strategy. Let the client know that ambivalence about change is normal

2. Develop discrepancy. Help the client perceive the discrepancies between their present state and their own goals or values

3. Roll with resistance. Never argue with a client. Help the client become engaged as a primary resource to find hi/her own solution to the problem

4. Support self efficacy- the coordinator’s confidence in the client’s ability to change can help build the clients confidence.

A MI SESSION

Find the Target Behavior (e.g., smoking, and exercising, or moving to the next step in mental health recovery and wellness)

Clarify the target behavior about which there is ambivalence.

Ask about the positive (good things) aspects of the target behavior.

– What are some of the good things about _______?– People usually____ because there is something that has benefited

them in some way. – How has_______ benefited you?– What do you like about the effects of ___?

Summarize the positives

Ask about the negative (less good things) aspects of the target behavior:

– Can you tell me about the down side?– What are some aspects you are not so happy about?– What are some of the things you would not miss?– Summarize the negatives

Explore client’s purpose, life goals and values. – What sorts of things are important to you? – What sort of person would you like to be?– If things worked out in the best possible way for you, what would

you be doing a year from now?– Use affirmations to support “positive” goals and values.

Ask for a decision. – Restate their dilemma or ambivalence then ask

for a decision.– You were saying that you were trying to decide

whether to continue or cut down…?– After this discussion, are you more clear about

what you would like to do?– So have you made a decision?

MI: PRINCIPLES YOU NEED TO TAKE IN TO ACCOUNT FOR EVOKING CHANGE

Use Evocative Questions – Use Open-Ended QuestionsExamples:- Why would you want to make this change? (Desire)- How might you go about it, in order to succeed? (Ability)- What are the three best reasons for you to do it? (Reasons)- How important is it for you to make this change? (Need)- So what do you think you’ll do? (Commitment)

Use ElaborationWhen a change talk theme emerges, ask for more detail:

- In what ways? - How do you see this happening?- What have you changed in the past that you can relate to this issue?

Ask for Examples– When was the last time that happened? – Describe a specific example of when this happens.– What else?

Look Forward Ask about how the future is viewed:

- What may happen if things continue as they are (status quo).

- If you were 100% successful in making the changes you want, what would be different?

- How would you like your life to be in the future?

Query Extremes Ask about the best and worst case scenarios to elicit additional

information: What are the worst things that might happen if you don't make

this change? What are the best things that might happen if you do make this

change?

Explore Goals and Values Ask what the person's guiding values are.

- What do they want in life?

- What values are most important to you?

- How does this behavior fit into your value system?

- What ways does ________ (the behavior) conflict with your value systems

Strategies for Handling Resistance:

Simple Reflection: simple acknowledgement of the client’s disagreement emotion, or perception

Double- sided Reflection: acknowledge what the client has said and add to it the other side of the client’s ambivalence

Clarification: verify your understanding matches the client’s perspective

Shifting Focus: shift the client’s attention away from what seems to be a stumbling block.

Emphasizing Personal Choice and Control: assure the person that in the end, it is the client who determines what happens

THANK YOU

VISIT MY BLOG AT:www.mental-health-therapy.org

THE END

REFERENCES:

(http://www.afm.mb.ca/) Miller, W.R. & Rollnick S. (2002) Motivational Interviewing (2nd

Edition): Preparing People for Change. New York: Guilford. Overcoming Obstacles to Change presentation by Dr. Deborah

Dobson, Ph.D., R.Psych.