From Action to Maintenance - Stabilizing Change

The real test of change for…addictive behavior…is long-term sustained change over several years…In this (maintenance) stage, the new behavior is becoming firmly established, and the threat of…a return to the old patterns becomes less frequent and less intense…Helping clients increase their sense of selfefficacy is an important task at (these) stages…Individuals in the action and maintenance stages may need skills training in addition to motivational strategies. DiClemente, 1991

EXPECTATIONS 

- Clinicians may believe the motivational portion of treatment is in the pre-contemplation through the preparation stages. 

- However, this is not true because once change is made, continued support is needed in order to continue that change. 

- The early stages ask one to think about change, now there is actual change and continuing it, which threatens the lifestyle. This requires motivation.

RETENTION 

- Making sure you and your client know how long tx will be and what to expect increases possibility of retention. 

- Showing your interest by doing things like phone calls between sessions. 

- Studies show motivational interviewing is useful in combination with the tx to increase retention. 

- Please assess how ready your client is for change, not how ready you are & adjust treatment accordingly.

Develop Rapport – What are your client’s unique perspectives, values? They will talk when they feel comfortable with where they are and who you are.

Invite clients into their Role – Tell them exactly what to expect, what is expected from them, what the rules are, encourage questions; use language they get.

Explore Expectations – What do they think will happen in treatment? What happened before? Ask permission before asking personal questions and discussing private goals. Explore their fears and hopes about treatment and if there are any discrepancies. Be honest about what treatment can and cannot do.

Resolve Barriers to Tx – If they don’t feel ready or they reconsider give them options. Discuss options for taking a break from tx or stopping before tx is finished. Give a plan of how to re-enter tx when they want to return.

Reach Out – Certain major events in a client’s life may lend itself to reaching out to them to grieve with them, walk with them or celebrate with them. Ask ahead of time who they consider their social support and encourage those relationships as well as how they would prefer we keep in touch in times of need.

Functional Analysis

- Help client’s understand their triggers. 

- Label 2 columns “Triggers” and “Effects” 

- Explain, “I’d like to know how drug use fits into the goals you have for your life.” 

- Have them list when they are most likely to use (days, times, events, people). 

- Use reflectively listening to assure them you understand. 

- Ask what they liked about using without providing judgment and list them under “Effects”.

- Discuss options to obtain desired effects without using and create a plan. Emphasize the freedom in the choice.

Motivational Counseling During Maintenance 

- Do not use Relapse as the same word as Failure. 

- This implies there are only 2 outcomes, success or failure. 

- Avoid lecturing if your client relapses. 

- Provide support when client is feeling discouraged to avoid quitting. 

- Ask for your client’s perceptions of their use and their own reasons for still wanting to change.

- Explore what was learned from the experience, maybe a functional analysis. 

- Normalize the experience as common. 

- Have your client talk about the advantages of sobriety. 

- Revisit their values, hopes, purpose and goals in life and make a new plan.