Hi everyone, my name is Katrina Lobs and I will be presenting on the therapeutic
relationship. Making a lifestyle change is definitely challenging, especially
when you want to change many things at once. Lifestyle changes are a process
that take time and require support. According to a March 2010 APA poll
conducted by Harris Interactive, " Fewer than 1 in 5 adults report being
very successful and making health-related improvements such as;
losing weight, starting a regular exercise program, eating a healthier diet,
and reducing stress. Myself, as a health care provider, designing interventions
to yield changes and behavior is best done with an understanding of different
behavior change theories and the ability to use them in practice. Understanding
patients readiness to make change, appreciating barriers to change, and
helping patients anticipate relapse can improve patient satisfaction.
Both the Transtheoretical Model, abbreviated TTM, and Motivational
Interviewing, abbreviated MI, are a natural fit. According to Miller and
Rollnick, "TTM is intended to provide a comprehensive conceptual model
of how and why changes occur, whereas MI is a specific clinical model
to enhance personal motivation for change. The sages of TTM provides a
logical way to think about the clinical role of MI and in turn and MI provides a
clear example of how practitioners could help clients move from one stage to the
next. It is essential to match behavior change interventions to people stages.
Without a planned intervention, such as a MI, people will lack motivation to
proceed through the stages. In the pre- contemplation
stage and the contemplation stage clients are lacking confidence,
motivation, and direction to make a behavior change. In these stages the
practitioner should encourage a client to create their own motivation for
change. It is a practitioners job to "draw out"
the clients motivation and skills for change, and not tell them what to do. In
the preparation stage the client has made a commitment towards change and
they may have even attempted to develop a plan for change, but have not yet taken
any formal action. MI can work in conjunction with TTM here by
collaboration. Collaboration at this stage can produce a partnership between the
client and the practitioner. In this stage, goals and plans are created "with"
and "for" the client that can lead to change. In the action stage the client is
actively involved in changing behavior. Most people in this stage require some
form of assistance to reach their goal. This is where the practitioner, and
previous work, come into play. The practitioner can begin to empower the
individual, which gives the client responsibility for their actions. In the
action phase the practitioner can remind the client there is no right way to
change, but there are multiple ways to make a change instead. By doing this they
do not get discouraged if they are not making the change like they have
originally planned. In the maintenance and termination stage, the client has
developed an aspect of efficiency and will eventually continue to improve. At
this point the client is typically living their change and may not need
help of the practitioner anymore. But, because their relationship
has been built on trust the client is confident that they can
continue their behavior change without the guidance of the practitioner. Because
MI and TTM are used together, it can create a more successful environment
for the client to make change. To
successfully navigate MI the practitioner must recognize change talk
when it occurs. Change talk statements made by the client that
indicate they are moving towards making a positive change in a problematic
behavior. The acronym "DARN CAT" is used to help
practitioners describe various types of change talk. The two parts of the acronym
are separated purposefully. "DARN" representing the preparatory phase. "DARN"
stands for; Desire, Ability, Reasons, Needs. And this means the client is preparing
to make a change. So in the first three stages, the first part of change talk may
have occurred. So the acronym "DARN" represents the preparatory phase and
informs a practitioner the client is preparing to make a change.
The acronym "CAT" represents mobilizing phase. "CAT" stands for; Commitment language,
Action, and Taking steps towards change. Simply spotting change talk is not MI
and does not elicit behavior change. Recognizing the type of change talk a
client is using; for example, preparatory or mobilizing words, a client is using
can help the practitioner choose his or her response intentionally with the goal
of steering the conversation toward action oriented change talk. Different
techniques are used to elicit change talk. Examples of some techniques that
help clients shift from the preparatory phase to the action phase are; asking
evoking questions, asking for elaboration, the practitioner can ask for examples,
and they can explore goals and values. When the practitioner can identify
change talk and use it in conjunction with MI the client is better suited to
make a behavior change. Empathy is an important capability which all
practitioners and therapists must develop. The ability to disconnect from
your personal feelings is particularly important in creating an effective and
constructive relationship with your client. Empathy is defined as a capacity
to share and understand another state of mind or emotion. It is often
characterized as the ability to put oneself in another's shoes. So in other
words, it is in some way experiencing the outlook or emotions of another being
within oneself. Empathy has been found to be a consistent predictor of change. It
was found that there was a significant direct relationship between therapists
empathy and behavior change, showing the clients perceptions of therapists
empathy was associated with significant improvement in behavior change. One study
showed that not only must the provider be empathetic towards a client, but the
client must perceive genuine empathy from the therapist to make a behavior
change. Because of this, empathy should characterize all health care
professionals and clients communication in order to achieve the desired goals.
Because making lifestyle changes are difficult for most people, it is our job
as practitioners to create a successful program to elicit change. The combination
of MI and TTM can can create an ideal space for a client to make a behavior
change. The next two slides are my references for this PowerPoint and thank
you for listening!
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