Facilitating Change

FACILITATING CHANGEA Collaborative Approach

By: Rosie Ford, HFS and Counselor Intern

BUILDING RAPPORT

At the core of a positive collaborative relationship Particularly important EARLY in the relationship

Establish open, trusting, collaborative relationship A poor collaborative alliance predicts premature client drop out

Especially important within a change process Strength of collaborative alliance is directly related to the degree of

change a client makes

Reflects the extent to which client and coach are on the same wavelength Working together Collaboration for change

BUILDING RAPPORTCOACHES’ QUALITIES

Genuine - authentic, honest, congruent → builds trust Empathetic - enter the client’s worldview and convey

understanding Non-judgmental Respectful - acceptance, unconditional positive regard → may

not agree with everything they do but ALWAYS show acceptance

Collaborative/team player Agreement of goals Agreement of tasks that will help achieve goals Actively involved in process Positive relationship

BUILDING RAPPORTCOACHES’ QUALITIES (CONT’D)

Warm and caring Flexible High degree of comfort in interpersonal relationships Easy to talk to Honest and sincere Understanding Not suspicious Not hostile or aggressive

SKILLS TO BUILD RAPPORT Attending

Verbal and non-verbalExamples: Eye contact, facial expressions, minimal encouragers (uh huh, I

see, yea, ok), body language, tone of voice Reflecting

Demonstrates understandingExamples: Content – “So what I am hearing you say is….”

“So you would like to learn more ways to prepare your veggies, is that right? Feeling – “You are very excited about this idea!”

“You feel overwhelmed because you don’t have time to prepare your veggies.”

SKILLS TO BUILD RAPPORT (CONT’D) Paraphrasing/Summarizing

Examples: “What I am hearing you say is you are hungry when you

get home from work and tend to eat whatever is available.”

“So it sounds like your main concerns are eating out, social situations and not having time to prepare your meals.”

Empathetic Understanding Ability to accurately understand a client’s perspective in

a given situationExamples: “I can see how you could be confused in that situation.” “That must have been very difficult for you.”

SKILLS TO BUILD RAPPORT (CONT’D) Self-disclosure

Used very sparingly and ONLY when it will benefit the client

Examples: “I know when I don’t plan ahead, things never go well.” “Crock pot cooking helps me out a lot.”

Provide InformationExamples: Recipes Educate on physiological concepts of program

Tanita Reads Tips on eating out

NECESSARY CONDITIONS Relationship Vulnerability Genuineness Perception of Genuineness

The client must FEEL the coach is genuine Unconditional Positive Regard Accurate Empathy

BEGINNING TASKS

Build alliance or bridge → relationship → FIRST session → will be likely to come back

Increase importance of change → move stage of change Build self-efficacy for change

STAGES OF CHANGE Precontemplation

Unaware of the problem OR lack desire to change The cons of change outweigh the pros High drop out risk

Contemplation Aware of the problem but are not ready to change it OR do

not understand the problem Cons equal the pros Wonder if they can change or ambivalent about change Will drop out if suggested

Preparation Develop an action plan The pros outweigh the cons Some problems

plan is too vague (“I want to be healthier”) not supported by others/their network

Preparation

STAGES OF CHANGE (CONT’D) Action

Actively changing the behavior and/or modifying environment Usually take a few steps forward and a few back – this is OK!

baby steps one day at a time

Major problems changing too many things at once lack of support

Coaches like this stage not everyone comes at this stage

Maintenance HARDEST stage What you did in the action phase will be different than in the

maintenance phase (ex: Loosing weight) Common problems

streamlining the action plan coping with lapses/set backs incorporating change into the overall lifestyle

Can cycle back and forth through stages Tailor approach to match stage of change

MOTIVATIONAL INTERVIEWING (MI)

Basic Premise: Individuals become more committed to what they say to themselves than what they hear from others

Effective and necessary at the pre-contemplation stage of change

Skills used for building rapport also very important when using MI

Motivational Interviewing

Roll With Resistance

Motivational Interviewing

ExpressEmpathy

CreateDiscrepancie

s

Roll With Resistance

SupportSelf-efficacy

MOTIVATIONAL INTERVIEWING (CONT’D)

Express Empathy Know that acceptance facilitates change Use reflective listening Be empathetic to the ambivalence

EMPATHY Communicates respect for and acceptance of clients and their

feelings Encourages a nonjudgmental, collaborative relationship Allows you to be a supportive and knowledgeable consultant Sincerely compliments rather than belittles Listens rather than tells Gently persuades with the understanding that the decision to

change is the client's Provides support throughout the process


Create Discrepancies Developing awareness of consequences helps clients examine

their behavior A discrepancy between present behavior and important goals

motivates change The client should present the arguments for change


Roll With Resistance Avoid Arguments

Arguments are counterproductive Defending breeds defensiveness Labeling is unnecessary

Do not directly oppose resistance New perspectives are invited but not imposed The client is a valuable resource in finding solutions to problems Resistance is a signal to respond differently


Build self-efficacy Belief in the possibility of change is an important motivator The client is responsible for choosing and carrying out personal

change There is hope in the range of alternative approaches available The coach’s belief in client’s ability to change becomes a self-

fulfilling prophecy

You’re awesome!

SELF-EFFICACY

Elicit and support hope, optimism, and the feasibility of accomplishing change

Self-efficacy is a critical component of behavior change you as the coach must also believe in your client’s capacity to

reach their goals Recognize the client's strengths and accomplishments and

bring these to the forefront whenever possible

SELF-EFFICACY (CONT’D) When client believes change is not possible

perceived discrepancy between the desire for change and feelings of hopelessness result in rationalizations or denial in order to reduce discomfort

Helpful to talk about how persons in similar situations have successfully changed their behavior → other clients can serve as role models and offer encouragement

One day at a time Education can increase client’s sense of self-efficacy

RESISTANCE

Unwillingness to work on their problems and initiate change

Vital to learn how to work through resistance Likely to manifest itself in all clients at one point or another

Thinking about motivation and resistance in a different way…

As a state – changes OR as a trait – unchangeable How you think about motivation influences how you deal

with it!

CHALLENGINGUSE ONLY WHEN RAPPORT HAS BEEN ESTABLISHED!

Confronting Point out discrepancies between words, goals and

behaviorsExample: “You’ve mentioned that you really want to meet

your goal in time for the wedding yet your recent deviations have really slowed down your progress. I just wonder what your thoughts are on that.”

Interpreting Suggesting possible reasons for client behaviorExample:“I don’t know but I am just wondering if your recent deviations might be because you are afraid of maintenance. What do you think?”

CHALLENGING (CONT’D) Feedback

Sharing thoughts and impressionsExamples: “You know I have noticed that every time you get close to

your goal you deviate. I just wonder what is going on with that.”

“You get very excited when you talk about being able to play with your children.”

Pose it as a question or hunch The Columbo ApproachExample: “I don’t know, but I’m just wondering if preparing your food ahead of time would be helpful. What do you think?”

INCREASING COMMITMENT TO CHANGE

Promote an internal attribution for change Makes them more invested/active in the change process

because you want to vs because you have to

Provide Choices (menu) Input

The more you get them to participate the more committed → have to ask themselves…. “I must be very committed if I am participating so much.”

INCREASING COMMITMENT TO CHANGE (CONT’D)

Minimize outside pressure or force May attribute behavior to external force rather than internal

Reactance → when freedom is impinged upon → uncomfortable feeling → will try to restore sense of freedom can feel pressured can cause opposite effect on behavior

Be careful how you deliver information speak to stage of change

“Success seems to be largely a matter of hanging on after others have let go.”

~William Feather

QUESTIONS

REFERENCES Erford, B., Hays, D., & Crockett, S. (2015). Helping Relationships.

In Mastering the national counselor preparation comprehensive examination (2nd ed., Vol. 1, pp. 121-152). Upper Saddle River: Pearson.

Facilitating health behavior change. (2014). In G. Liguori (Ed.), ACSM's Resources for the Health Fitness Specialist (First ed., Vol. 1, pp. 249-263). Philadelphia: Lippincott Williams & Wilkins.

RESOURCES G. Gintner, Ph.D., Associate Professor and Program Leader, Counselor

Education, 122C Peabody Hall, Louisiana State University. Laura H. Choate, Ed.D., LPC, NCC, Associate Professor, Counselor Education,

Louisiana State University.

Documents

Facilitating Change