COUC 505 Notes (week 7)
Week 7
FYI: You only report if they are an overdose risk, but you are doing harm reduction
Stages of change:
Pre-contemplation:
othinking about thinking about (maybe might need to change)
oNot acknowledging there is a problem
Example: addicted to opiates and don’t see it as a problem, sometimes
they just don’t see it as a problem.
Contemplation:
oThinking about changing.
oKnow it is a problem, but they aren’t ready to deal with it or they think it is
someone else’s problem
Preparation:
oMaking plans, but haven’t started making change
oWhat do they value? What motivates this person to make a change?
Action:
oWhere you spend the large majority of time. Making steps for change
oYou’re just making one step closer to change
oThe size of the goal doesn’t matter, they are moving it forward
Example: snorting heroin instead of iv injecting.
Example: they were able to identify a thought that isn’t serving them
Maintenance:
oEverything is fixed and your stabilized
oUtilize and need to learn more coping skills
oGo to either Stable Lifestyle or into relapse
“Relapse” (Return to “____” plan):
oThen goes to precontemplation
That part of AA that is not a healthy concept, don’t allow them to refer or you refer to
them as an addict. You don’t need to define yourself by something that you do, and to do
that it is very dangerous. If they say, “I am an addict” she responds, “you are a person”.
Don’t use “dirty” or “clean”. “You are not dirty; you are using an illicit substance”
De-escalate you let them tell their entire story, until their emotions are not as
Shame is the driving force behind most mental health symptoms
Goal: Stable Lifestyle
Motivational interviewing ( ):What is motivating them to change?
If they have shame related to their motivation, they are going to tell you something that is
not important to them
Addresses readiness/motivation to change
Point out inconsistencies without alienating the client
Accept the client’s resistance to change
Acknowledge the client’s point of view
Non-judgmental and non-adversarial (be careful not to lead and manipulate)
Support self-efficacy and the client’s ability to self-direct
Listen with and express empathy
Gently confront with a “double-sided reflection”
Empower competence
Reluctance or Resistance (take it as a challenge)
99% of the time there is going to be shame involved
Fear of intensity
Lack of trust
Fear of change
Treatment planning process: Goal Setting
Goal: client will increase positive self-talk by learning to address cognitive disorders
Objectives: what does client needs to do
“Client will” keep a record of negative thoughts (baseline)
“Client will” decrease frequency of negative thoughts by 30% over the following two
weeks
Interventions: What you have to do to help them achieve that
(tells the insurance company that you are worth being paid)
Client learns thought stopping techniques
Client received psychoeducation on neuroplasticity
Client learns Socratic questioning method
Client practices challenging negative
*Use an intervention cheat sheet, so you can go down that list to be
Open Ended Questions: “What” or “How”, no more than 2 per session, and never twice in
a row.
Initially. “Where would you like to bring today?”
When you need specific information
To bring it in the here and now
When you want to make a point or a connection
oWhat were thinking just now when you heard me say that?
oWhen you want to define goals.
oTo get things back on track. “Earlier you said what is.”
oWhen you want to motivate the client into action.
