Increasing Readiness for Change

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1 Increasing Readiness for Change

2 Objectives Define ambivalence and its relationship to the change process Define the righting reflex Show the connection between ambivalence and the righting reflex Identify ways to increase readiness to change

3 Ambivalence Feeling two ways about change at the same time. It is normal. The part that wants to stay the same may be equal to or slightly greater than the part that wants to change. Ambivalence feels comfortable and may become chronic. Ambivalence can be resolved if she or he feels understood (empathy!). Wants to Stay the Same Wants to Change

4 Righting Reflex Comes from concern and caring Helpers, healers, and teachers want to set things right or make it better Counselor is a fixer: There s a problem? Let s fix it! Fails to consider ambivalence in the change process

5 Righting Reflex Meets Ambivalence Increasing need to protect this part of herself leads to decreasing motivation to change Wants to stay the same Wants to change Your righting reflex puts pressure here Your urge to set things right feels like pressure she must resist!

6 Recognizing Ambivalence By showing her that you understand her as she is now... Wants to stay the same Wants to change... she will feel free to explore her own arguments for change! This may increase her motivation to change.

7 Stages of Change Model of health behavior change Useful in tailoring an individualized intervention to meet your client s stage of readiness to change

8 Precontemplation Stages of Change (cont.) No intention to change behavior Contemplation Aware of the situation, but no concrete plans to change Preparation Decides to change and plans to take action Action Made the behavior change Maintenance Works to sustain the change and prevent relapse/recycle Relapse/Recycle

9 Stages of Change Examples Stage Precontemplation Contemplation Preparation Action Maintenance Relapse/Recycle Example I don t see a reason for change. I can t change, so I m not going to think about it. I m thinking about changing. I m preparing to change. I ve made the change I m working to maintain change. I made the change, but I slipped.

10 Stages of Change Model Preparation Action Stable Behavior Maintenance Contemplation Relapse Precontemplation

11 Summary: Stages of Change Readiness is not static Change is nonlinear It is important to match counseling strategies to client level of readiness Ambivalence persists across stages

12 Change planning script What would you like to be different? What could you do to get started? Who could you ask for support or assistance? What would be signs that things are going well?

13 Evoking Change Talk Desire Ability Reasons Need Commitment Activating language Taking steps

14 Evoking change Elaboration: Why would the change be good? Evocative questions: Why is change important? What happens if it doesn t happen? Scaling rulers: On a scale of 1 to 10 Reflect: You think; You feel; You are Ask key questions: Where does this leave you? What are your next steps?

15 Readiness Ruler On a scale of 1 10, how ready are you at the present time to change [insert behavior]? Not ready at all Extremely ready

16 Readiness Ruler On a scale of 1 10, how important is it for you at the present time to change [insert behavior]? Not ready at all Extremely ready

17 Readiness Ruler On a scale of 1 10, how sure are you at the present time that you can change [insert behavior]? Not ready at all Extremely ready

18 Decisional Balance Helps your client think about: Benefits and costs of changing the behavior What is involved in her decision to change Scale needs to tip so the benefits outweigh the costs Start with client s ideas about the good things about the behavior Then ask about the less good things about the behavior Avoid arguing for change/persuading Reflect her reasons for change

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20 Summary Ambivalence can be resolved if your client feels understood. Suppress the righting reflex so that you can stay client-centered and avoid building resistance. Change is not static and ambivalence exists across the stages of change. Use rulers to assess and increase your client s readiness to change. Decisional balance can be used to explore your client s ambivalence about drinking or contraception.

21 Contact information: Jessica D. Hanson, PhD Sanford Research 2301 E. 60 th Street North Sioux Falls, SD Phone: Website:

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