How Do We Address PreContemplating Individuals?
♦ Build trust first – you may need to begin that with some issue other than the “problem” behavior.
♦ Explain that you will not be telling them what to do or how to change.
♦ Explain that they will be doing most of the talking because you want to know what is happening in their life and how they feel about it.
♦ Invite comments about what they hope to achieve.
♦ Discuss the events that precipitated treatment.
♦ Acknowledge strong emotions by using reflective listening.
♦ Ascertain what they see and believe to be true.
Help the person tip the balance scales towards change by:
♦ Eliciting and weighing the pros/cons of changing vs. not changing
♦ Shifting the focus from extrinsic motivation to intrinsic motivation
♦ Examining personal values and how they fit or don’t fit with use/current behaviors
♦ Other issues: Loss and grief, reservations/resistance, premature decision making
♦ Emphasizing free-choice, responsibility and self-efficacy (I can do this!) for change
♦ Clarify the person’s own goals and strategies for change.
♦ Offer options for change or treatment.
♦ With permission, offer expertise.
♦ Consider barriers to change and lower them.
♦ Help the person enlist social support.
♦ Explore treatment expectancies & person’s role.
♦ Elicit what worked in the past
♦ Negotiate and problem-solve potential barriers (transportation, finances, etc).
♦ Have the person publicly announce a plan to change.
♦ Engage the person in treatment and reinforce the importance of remaining in recovery.
♦ Support a realistic view of change through small steps.
♦ Acknowledge difficulties in early stages of change.
♦ Help them identify high-risk situations and develop appropriate strategies.
♦ Assist with finding new reinforcers of positive change. Maintenance Individuals?
♦ Do not imply that relapse is the same failure; this implies there are only 2 outcomes, success or failure.
♦ Provide support when the person is feeling discouraged to avoid quitting.
♦ Ask for the person’s perceptions of their use and their own reasons for still wanting to change.
♦ Have your person talk about the advantages of sobriety.
♦ Revisit values, hopes, purpose and goals in life.
♦ Recurrence is not considered a stage but rather, an event that can occur at any point along the recovery path.
♦ Be supportive and curious - avoid lecturing or framing it as a failure.
♦ Use reflective listening.
♦ Normalize the experience as common.
♦ Explore what was learned from the experience, perhaps within a functional analysis.
♦ Encourage discussion of the advantages of abstinence.