Stages of Change - Action Stage

We have been trained in the Stages of Change and often times experience the clinical dilemma of a client who is in two different stages for two different goals. For example, our client arrives in Action Stage for wanting to maintain placement, but in Precontemplation for discontinuing drug use. So the client will adhere to many requests in order to maintain placement. Dr. Mee Lee provides a solution to individualize treatment in his Tips and Topics Newsletter. He suggests in Tip 1 we ask our client to share what brought them to treatment and what they want to get from participating. This gives us a clear goal that the client is motivated to work on and the most appropriate interventions can then be provided. He then explained that we have structured procedures for rules broken by clients that can be individually tailored to meet both the site and client needs. For example a client may have an emotional outburst when medication is not stabilized. He suggests in Tip 2 that steps taken to stabilize medication be more of a priority than the consequence for the outburst. He also suggests in this tip that staff be trained on how to deescalate emotional outbursts and provide the client with training on how to effectively communicate their feelings and needs. Dr. Mee Lee states, “Thus the emphasis is on treatment and change, not on write-ups and consequences for behavioral infractions.” He then goes on to discuss in Tip 3 how we assess progress through treatment. He suggests gaining focus on the treatment plan by asking the client what they plan to do to gain progress on their own treatment to goals. He suggests saying, “I am asking about your treatment plan, not what level you are in the program, nor what you have to do to avoid loss of privileges or to move to the next level." Dr. Mee Lee went on to discuss clients in the later phase of treatment and our expectations of those clients to communicate well, be helpful to staff and provide order with their peers in treatment. He explained dilemmas we may experience in this phase of treatment. He provided the example: “The client is the oldest of three children of alcoholic parents. He was always the "hero" who rescued his younger siblings, putting aside his own needs. In the program he takes on a role almost like junior assistant counselor, more focused on giving feedback to others than on getting in touch with his own needs. What if his individualized treatment plan needs for him to NOT be a leader; NOT be always helping others and giving them feedback?” He suggests we assess progress individually on each client’s achievements in their own treatment plan, not the program goals. He then quoted:

"No single treatment is appropriate for everyone. Matching treatment settings, interventions, and services to an individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace and society." - Principle No. 2 in National Institute on Drug Abuse: Principles of drug addiction treatment: a research-based guide (NIH Publ No 09-4180). Rockville, MD: National Institute on Drug Abuse, 2009.

Tips and Topics Newsletter February 2013