What are the stages of change in the Transtheoretical Model of Change?
- 1. Precontemplation
- 2. Contemplation
- 3. Preparation
- 4. Action
- 5. Maintenance
What is the precontemplation stage?
Client is not interested in changing, may not think there is a problem
What is the contemplation stage?
the awareness of the problem but no plan to change
What is the preparation stage?
has goals for change, start-up is scheduled
What is the action stage?
Successful action to modify problematic thoughts, behaviors, environments. Commitment to change.
What is the maintenance stage?
consolidation of skills learned in action phase, relapse phase
What are four main components in Motivational Interviewing?
- Empathic understanding
- Helping patients establish what they want to change
- Evoking + eliciting patients motivation
- Planning/committing actions necessary for change
In resolving ambivalence for change, what techniques work?
- nonjudgemental approach
In resolving ambivalence for change, what is one thing that you should always remember?
remember that the client at least came to see you
In resolving ambivalence, what techniques don't work?
- Advice giving
- Being an enabling helper
What is an enabling helper?
colluding with patient's rationalizations of problems due to fear of patient's anger or rejection for addressing problems directly
What is a conscious or intentional decision not to use one's professional presence and skills to influence the client toward making a specific choice or change?
What does a Decisional Balance Sheet do?
- helps in beliefs clarification and decision making
- weighs costs and benefits of status quo & costs and benefits of changing
- Clinician maintains equipoise
Creating a list of the costs and benefits in continuing or abstaining from something is an example of _____.
Decisional Balance Sheet
When offering information or advice, what are three general things to remember?
- Don't tell the patient what to do
- Ask for permission before giving suggestions or information
- Ask the patient what he/she thought about your information or suggestions
How do you evoke a person's motivation for change using DARN CAT?
- Desire to change
- Ability to change
- Reason to change
- Needs to change
- Commitment to change
- Signs of Activation
- Taking steps towards change
define Evidence-Based Practice (EBP)
clinical practice that is informed by evidence about interventions, clinical expertise, patient needs, values and preferences, and their integration into decision making about individual care.
define Empirically Supported Treatments (EST)
clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population
What are commonly used ESTs?
- Cognitive Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Communication Therapy
- Interpersonal Therapy
- Solution-focused Brief Therapy
- Positive Psychology Interventions (PPI)
What is the development of working agreements among clinicians, patients, and others involved in the realization of the goals?
What are the components in contracting?
- enumerate the goals
- describe the roles and responsibilities of all parties involved
- include the interventions and methods to be used to attain goals
- describe the frequency, duration, and length of meetings, costs and payments
- means for evaluation of work/measuring progress
- include provision of how contract will be regulated
- discuss consequences of failure of either party
What are issues in contracting?
- should require informed consent
- risks and benefits of the work and other options and resources
- should be flexible
- realistic and upheld
- avoid built in problems
- can be changed
What are examples of built-in problems that should be avoided when constructing a contract?
- hidden agendas
- corrupt contracts
What four things to keep in mind when exploring feelings directly?
- use open-ended questions
- use empathy
- check-in with patients in following sessions
- think about negative effects of feeling exploration (timing and dosage)
What should you keep in mind when exploring feelings that could have a negative effect?
timing and dosage
What shouldn't you do when directly exploring feelings?
- judge or criticize expression of feelings
- overwhelm patient with too much feeling exploration
- Forget about cultural values
What is more effective in decreasing negative emotions?
building positive emotions
What are 8 ways to create or enhance positive feelings?
- 1. Regularly eliciting success stories from the client's
- 2. Recalling "Three Good Things"
- 3. Encouraging positive relationships
- 4. Asking the client to commit random acts of kindness and note how they feel afterward
- 5. Constructing positivity portfolios for emotions
- 6. Communing with nature
- 7. Imagining your best possible self
- 8. Practicing loving kindness meditation
What are types of automatic thoughts?
- All or nothing thinking
- Selective abstraction
- Emotional reasoning
What time of automatic thinking involves black or white thinking ignoring the middle ground?
all or nothing thinking
What time of automatic thinking imagines the worst for the future?
What type of automatic thinking is has biased attention to negative and ignoring positives?
What type of automatic reasoning occurs when 'feeling' interferes with logical thinking and ignoring the evidence?
What type of automatic thinking draws on conclusions with limited evidence 'labeling'?
What type of automatic thinking has rules about how people 'should' behave?
What type of thinking is certain about what other people are feeling and thinking without considering possibilities?
What are methods to introducing alternative perspectives?
- Questioning and the Socratic Method
- Using role play
- Recording interactions
- Encouraging contact with others
- Developing new metaphors
- Using spiritual practices (JESUS)
- Accentuating the positive
- Coping questions
- Exception questions
- Transferability of skills
- Construct positive future visions
- Act as a positive mirror
- Use appropriately timed hopefulness
- Build on here-and-now possibilities
Which EST focuses on mindfulness, interpersonal effectiveness, emotional regulation, and stress tolerance; helps patients cope in emotional situations?
Dialectical Behavioral Therapy
When would clinicians use Dialectical Behavioral Therapy?
To help patients with personality disorders (impulses), or bipolar
Which EST believes that it isn't the thought that is the problem, but rather the power that the patient gives hurtful ideas and experiences and subsequent abandoning of important personal values and goals
Acceptance and Commitment Therapy
When would a clinician use Acceptance and Commitment Therapy?
When the patient is struggling with anxiety, depression, or substance abuse
What are behavioral techniques in helping people change what they want to do?
- Setting priorities
- Step by Step (partializing and shaping)
- Exposure therapies
- Behavioral Rehearsal
What are exposure therapies?
- systematic desensitization
- Anxiety Hierarchy
What are ways clinicians can have a direct influence over clients?
- offering suggestions
- giving directives
- accompanying patient
- representing the patient
- authorities to enforce change
- warn of termination
If at the end of a session a patient tells you something has come up, what are they doing?
a cry for help
What are guidelines as a clinician explores to support behavior change?
- identify behaviors to change and new skills to learn
- create concrete and specific goals and motivation for change
- look for behavioral context (when, who, under what circumstances)
- antecedents and consequences of behavior
- exceptions to stated behaviors or behavioral sequences
- skills and behavioral sequences to learn
- resources and support
- realistic goals
What is a type of transference in which a client idealizes clinician and experiences clinician as incomparably wise, caring, or helpful?
What is a type of transference in which expressing/acting out the moment in old/happy/stuck scenarios with the clinician as though clinician was the one who has harmed the client?
What is a type of transference in which previous interethnic/interracial or cultural experiences are displaced onto the clinical relationship?
What is a type of transference in which clients attribute power and knowledge to the clinician?
What is the type of transference in which a clinician's unconscious reaction to a patient is elicited?
What are reasons to address the relationship process?
- clarify expectations
- accomplish designed tasks
- develop relational competencies
- promote a collaborative relationship and build the working alliance
- address problems in the relationship
- summarize work and affirm gains at ending
What is one of the hardest things to recognize, own, and discuss with supervisor?
Aversion to clients
How can aversion to clients be triggered?
- prejudice, bias, stereotyping
What are the power, expertise, and influence clients may attribute to clinicians by virtue of their roles and authority?
Sometimes clients blame misfortunes on the clinician's intervention or mere presence in their lives.
What is it when a person feels unable to cope with perceived challenges that threaten to overwhelm his/her normal coping mechanisms?
What is it when catastrophic crisis provoked by sudden, massive, and/or threatening events?
What is it when crisis is cumulative?
What type of trauma is a reaction to ongoing interpersonal violence?
What is it when the patient starts showing or saying that their symptoms are worsening after discusing termination?