Session 13 Counseling behaviour change.pptx

ogg

1. MODULE CODE: PT05212 MODULE NAME: COUNSELLING SKILLS

2. Counseling for behavior change

3. Related tasks Describe counseling process Describe counseling for behavioral change Identify stages of change cycle during counseling process (pre-contemplation, contemplation, action, maintenance and relapse) Identify roles of ethical counseling Demonstrate skills for building rapport

4. COUNSELLING PROCESS S kills in counseling process Step 1: Relationship Building The first step involves building a relationship and focuses on engaging clients to explore issue that directly affect them. The first interview is important because the client is reading the verbal and nonverbal messages and make inferences about the counselor and the counseling situation ; Is the counselor able to empathize with the client? Does the client view the counselor as genuine?

5. Steps for Relationship Building includes; Introduce yourself Invite client to sit down Ensure client is comfortable Address the client by name Invite social conversation to reduce anxiety Watch for nonverbal behaviour as signs of client’s emotional state Invite client to describe his or her reason for coming to talk Allow client time to respond Indicate that you are interested in the person

6. Step 2: Problem Assessment While the counselor and the client are in the process of establishing a relationship, a second process is taking place, i.e. problem assessment. This step involves the collection and classification of information about the client’s life situation and reasons for seeking counseling

7. Step 3: Goal Setting Like any other activity, counseling must have a focus. Goals are the results or outcomes that client wants to achieve at the end of counseling. Sometimes, you hear both counselor and client complain that the counseling session is going nowhere . This is where goals play an important role in giving direction.

8. Guidelines for setting goals selection that can be used with students includes; Goals should relate to the desired end or ends sought by the student. Goals should be defined in explicit and measurable terms. Goals should be feasible. Goals should be within the range of the counselor's knowledge and skills. Goals should be stated in positive terms that emphasize growth.

9. Step 4: Intervention There are different points of view concerning what a good counselor should do with clients depending on the theoretical positions that the counselor subscribes for example, the person- centred approach suggests that the counselor gets involved rather than intervenes by placing emphasis on the relationship that the behavioral approach attempts to initiate

10. Step 5: Evaluation, Follow-up, Termination 0r Referral For the beginning counselor, it is difficult to think of terminating the counseling process, as they are more concerned with beginning the counseling process. However , all counseling successful termination aims towards Terminating the counseling process will have to be conducted with sensitivity with the client knowing that it will have to end.

11. Counselor always mindful of avoiding fostering dependency and is aware of own needs Preparation for termination begins long before Open door / plan for possibility of future need Termination considered not just at end of successful relationship, but also is considered when it seems counseling is not being helpful Think of this as a means of empowering client Role to review progress, create closure in client counselor

12. Most common non-helpful Behaviors include : Advice Giving Lecturing Excessive Questioning Storytelling Asking “Why?” Asking “How did that make you feel ?”

13. Interrogating Judgmental Controlling rather than encouraging Non guarantying reassuring Labeling Jokes

14. Describe counseling for behavioral change Stages of Behavior change cycle during counseling process Pre-contemplation contemplation, Action Maintenance Relapse

15. Stage 1: Pre-contemplation This stage is characterized by two distinct elements: The person not being able to see or understand what the problem is, and/or The client wanting some other person to change (the problem is them, not me). Pre-contemplators usually come to counseling because of some form of pressure from another person (spouse, employer, the courts, school, friends). Concurrently , pre-contemplators also resist change and therefore employ denial-minimization tactics to disown any responsibility for their contribution to the issue(s) at hand. Thus , one of the initial goals in counseling is to determine how much denial or minimization the client is experiencing that prevents change

16. Stage 2: Contemplation This stage is characterized by the client wanting to better understand what the "bump in the road" is, to see the causes and as well to explore what options are available to resolve the demise. The key point to remember here is that even though a person may know what is the issue and what needs to be changed, contemplators are not quite yet ready to make a commitment to action (fourth stage of change).

17. The second stage is a critical time for those in counseling to better understand two (2) key themes before action is undertaken: who am I (their map of orientation) and what strengths and resources do I have to support my journey (map of direction)? Hence, in counseling the client and counselor will know when the time for action arises when the language and thoughts in counseling focus around the "solution versus the problem" and a "view more about today and the future than the past."

18. Stage 3: Preparation This stage is characterized by the client going through additional areas of mindfulness, learning and growth. Sometimes the client needs to improve their communication skills, career goals, parenting behaviors, intimacy practices, and further strengthening their self-esteem. In particular, we use this stage as an opportunity to identify the client's values and supporting behaviors in four key areas of life: defining the self, self-development, work and relationships. The primary goal here is to actualize individual awareness so that a sense of self-control, comfort and security are present when the client goes from preparation to action. In short, a mindful sense of well-being.

19. Stage 4: Action Probably the most misunderstood and misapplied stage of all in counseling. The common problem here is that most clients and counselors believe that change means action, and action now at the onset of counseling. However , if the first three stages of change are not properly addressed in counseling, failure in counseling and/or after counseling can occur (in fact, over 45% of all clients stop counseling before the third session as they feel their therapist or family want action before they are actually ready for action).

20. This stage is characterized by the basic premise in positive psychology and cognitive behavioral sciences that before we can "change" a behavior, we must first change or reframe our thought patterns (our mental tapes we play if you will). While most of us want to "see" some form of change, often times the more important change must occur in the way we think where we often don't see that change until some future point and time. Once the action stage in counseling has allowed us to change our thoughts (reframing), then can we commence with the more visible desired actions, behaviors and feelings in and outside of counseling.

21. Stage 5: Maintenance This stage is characterized by the counselor and client (and in most cases his or her social support network) to identify what possible trigger points or other conflictual issues exist in the work and social/family setting that could cause a relapse. Whether a client is coming in to quit smoking or improve his communications at work or in the marriage, the counselor and client in this stage shall develop a strong commitment to establishing positive reinforcement activities (validation, cheerleading, acknowledgement, praise, rewards) to sustain the change made in the action stage. In other words, change never ends in the action stage, it merely takes a new form and presence in our life.

22. Stage 6: After-care There are some thoughts, behaviors or feelings we wish never return  (the former smoker who doesn't take up smoking again when he gets stressed). However , some healthcare professionals believe there are certain behaviors, thoughts or feelings we never completely remove (traditional 12 step programs for example propose that alcoholics will always remain "an addict in recovery").

23. This stage is characterized by determining what types of behaviors, thoughts or feelings can realistically be terminated, and equally as well, what types require a lifetime of support and maintenance. The ultimate goal though in the after-care stage is to ensure that the client understands that by embracing lifelong learning he or she increases the chances for a more healthier and happier life. We believe that the lifelong learning process can be experienced both in counselling and other environments. In short, our doors are always open for tune-ups and new learning sessions.

24. Identify roles of ethical counseling Ethical counseling promote; Respect human rights and dignity Protect the safety of clients Ensure the integrity of practitioner-client relationships Enhance the quality of professional knowledge and its application Alleviate personal distress and suffering Foster a sense of self that is meaningful to the person(s) concerned Increase personal effectiveness Enhance the quality of relationships between people Appreciate the variety of human experience and culture Strive for the fair and adequate provision of counselling and psychotherapy services

25. Demonstrate skills for building rapport Richardson identified Six useful skills for rapport building essential in differentiating yourself and establishing a personal connection. Presence : Ability to project confidence, conviction, and interest in body language and voice Relating : Ability to use acknowledgment, rapport, and empathy to connect

26. Questioning : Ability to explore needs and create dialogue Listening : Ability to understand content and emotional message Positioning : Ability to leverage client needs to be persuasive Checking : Ability to elicit feedback

27. The first two skills — Presence and Relating C ome into play immediately upon contact. This is the “breaking-the-ice” stage, where showing empathy and reducing tension is key. The next two — Questioning and Listening A re layered on top when you begin a dialogue. Nonverbal communication plays a key role here, building a connection subconsciously through body language, eye contact, facial expressions, and tone of voice .

28. The last two — Positioning and Checking Reinforce your approach and strengthen rapport. These involve asking open-ended questions, summarizing what you’ve heard, and building on the ideas presented.

29. Key issues to note The point is:  You’re building rapport with a person, not an organization. You’re interacting with a human being who is likely more emotional than logical. EQ , or emotional quotient, is more important than IQ in establishing rapport. Sometimes, acting as if you already have a good rapport is a good starting strategy. Talking as if the other person were a close friend with mutual trust sends subconscious signals to the other person to view you in the same way.

30. Key points Stages of Behavior change cycle during counseling process Pre-contemplation contemplation, Action Maintenance Relapse

31. Skills in building rapport include Presence Relating Questioning Listening Positioning Checking

32. E valuation What is rapport What are the points in creating rapport

33. Refferences MoHSW . A Practical Handbook for Improving HIV Testing and Counselling Services in Tanzania. September, 2010 . Ministry of Health and Social Welfare Primary Health Services Development Programme MMAM 2007-2017, (2007) MoHSW . Prevention of Mother to Child Transmission of HIV: National Guidelines (PMTCT) in Tanzania. July, 2011. MoHSW . Standard Operating Procedures for HIV Testing and Counselling (HTC) Services National Bureau of Statistics (NBS) Tanzania and ICF Macro. Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania: NBS and ICF Macro. 2011.