Client-Centered Counseling for Behavior Change Foundations For Community Health Workers (2nd Edition) (2016) Berthold, T., Editor San Francisco, C.A.: Jossey-Bass Chapter Nine Copyright © 2000-2017 by John Wiley & Sons, Inc., or related companies. All rights reserved. Client-Centered Counseling for Behavior Change

Reflection of Last Session What did you learn? Comments on differing codes of ethics? Client interviewing Confidentiality Strength-based assessments Have students review what they learned from the last session on these key topics.

What You Will Learn Define client-centered counseling and the types of providers who use it Discuss client-centered counseling concepts, skills, and resources, including the stages of change theory, action planning, and harm reduction Explain key concepts and techniques for motivational interviewing Identify common challenges to providing client-centered counseling Evaluate your own performance in providing client-centered counseling Develop your own professional development plan to enhance your counseling knowledge and skills

Words to know Ambivalence Harm Reduction Relapse Relapse Prevention Risk-Reduction Counseling

Overview of Client-Centered Counseling Practiced by both licensed and unlicensed professionals, that act as facilitators Supports positive behavior change by enhancing the client’s autonomy Emphasizes what the client can do to promote change Is not therapy

CHWs and Client-Centered Counseling CHWs provide client-centered counseling to support clients to change behaviors related to issues such as: Nutrition & Physical Activity HIV Disease Mental Health Challenges Tobacco, Alcohol, and Drug Use Reproductive Health Chronic Health Disease Management

Characteristics of Successful Client-Centered Counselors Belief in the wisdom of their clients Desire to learn something new from each client Ability to set aside personal issues Cultural humility Expression of empathy in an authentic manner Acceptance of their limitations and mistakes Deep commitment not to discriminate Acceptance of a client’s ambivalence to change Understanding that resistance to change is natural and common

Developing an Action Plan The behavior change plan… identifies the client’s health goals outlines specific and realistic actions for reducing risks and promoting health

Developing an Action Plan The action plan includes: Basic client information Primary health risks Resources needed Internal and external resources Goals Actions/steps to reach the goal Notes and comments Follow-up appointments and referrals

Skills for client-centered counseling Harm reduction views any action that reduces harm to ourselves and others as positive. Example: Needle exchange programs Stages of Change Theory Pre-contemplation Contemplation Preparation Action Maintenance Relapse Return to pre- contemplation

Relapse Prevention: Role Play, Demo

Relapse Prevention: Role Play, Demo How did the CHW support the client with relapse prevention? What else would you do – or would you do differently – if you were the CHW?

Relapse Prevention: Role Play, Debrief, Faculty Interview

Motivational Interviewing Motivational Interviewing: The counselor has the clients talk about the ambivalence they may have about making change, and helps them in working through those feelings. OARS: Motivational interviewing counseling skills Open-ended questions Affirmations Reflective listening Summarizing

The Spirit of Motivational Interviewing Guiding values of motivational interviewing: Elicited from the client Client articulates and resolves ambivalence – not counselor Resolving ambivalence with direct persuasion is ineffective Counseling style is quiet and eliciting Counselor is directive in helping client to examine and resolve ambivalence Readiness to change is not a trait, but a product of interpersonal interaction Therapeutic relationship functions as a partnership

Providing an Affirmation: Role Play, Demo

Providing an Affirmation: Role Play, Demo How well did the CHW provide an affirmation to the client? How may this affirmation have benefited the client? What value have affirmations had in your own life? When do you provide affirmations to others?

Using a Motivation Scale: Role Play, Demo

Using a Motivation Scale: Role Play, Demo How did the CHW use a motivation scale in her work with this client? How might the use of a motivation scale be beneficial for this client? How and when do you like to use the motivation scale to work with clients?

Rolling with Resistance: Role Play, Counter

Rolling with Resistance: Role Play, Demo

Rolling with Resistance: Role Play In the counter role play, how did the CHW respond to the client’s ambivalence? How did the CHW’s response impact the client? In the demo role play, what did the CHW do differently to roll with resistance? What was the impact of the CHW’s approach on the client? How would you demonstrate rolling with resistance in working with this client?

Rolling with Resistance: Faculty Interview

Additional Resources and Techniques Using Silence Commenting on the Process Widening the System Role-Playing and Empty Chair Technique

The Use of Silence: Role Play, Counter

The Use of Silence: Role Play, Demo

The Use of Silence: Role Play How did the use of silence change the interaction? How does this impact the client? How would you have used silence in working with this client?

Common Challenges to Client-Centered Counseling Making Mistakes Not Understanding the Client Not Knowing What to Do Scope of Practice Anger, Aggression, and Conflict Crisis Mandatory Reporting

Self-Awareness The essence of client-centered practice is to focus on the client with unconditional regard and without judgment. If your cultural assumptions and beliefs, values, or emotional needs start to guide your work, you risk doing harm to others. If you become aware that this is happening, seek consultation immediately.

Self-Assessment Regularly stop to evaluate your work as a behavior change counselor - See Table 9.3 (p.253) for reference. Questions include: Did the client identify their own health goals and risks? Did the client determine a behavior change plan? Did I provide the client with affirmations? Did the client speak as much or more than I did? Did I share appropriate referrals?

Professional development plan Strategies for growth and improvement as a behavior change counselor include: Research behavior change counseling Attend conferences and trainings Shadow another counselor Self-reflection Debrief with colleagues Participate in supervision Learn from clients See Figure 9.5 (p. 254)for reference

Developing Your Client-Centered Practice: Faculty Interview

Practice  Take a few minutes to reflect on if/how your own issues may get in the way of your ability to provide effective client-centered counseling. How will you address this challenge?  Interview a family member utilizing these new skills! Report on that experience at our next session. Complete Chapter 9 HW & DB on Blackboard Read Chapter 10

Resources: Image on slide 2 digital-drugs-binaural-beats by digitalbob8 is licensed under CC BY 2.0 Image on slide 3 Bring Light Bulb is available in the public domain under CC0 Public Domain Image on slide 10 Heroin needle in the street by Eric Molina is licensed under CC BY 2.0 Video on slide 11 Relapse Prevention: Role Play Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 13 Relapse Prevention: Role Play, Debrief, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 16 Providing an Affirmation: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 18 Safer Sex & Using a Motivation Scale: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License

Resources: Video on slide 20 Rolling With Resistance: Role Play, Counter by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 21 Rolling With Resistance: Role Play, Demo by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 23 Rolling With Resistance: Faculty Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 25 The Use of Silence: Role Play, Counter by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 26 The Use of Silence: Role Play, Demo by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 32 Developing Your Client Centered Practice: Faculty Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Image on slide 33 Door is available in the public domain under CC0 Public Domain

Acknowledgements: MoSTEMWINs Adapted from the Foundations for Community Health Workers, 2nd Edition (Berthold) with permission from Wiley Publishing by the Institute of Workforce Innovation of the Metropolitan Community College Kansas City and the Workforce Solutions Group of St. Louis Community College. Unless otherwise noted this material by St. Louis Community College is licensed under a Creative Commons Attribution 4.0 International License. This product is partially funded by the MoSTEMWINs $19.7 million grant from the U.S. Department of Labor Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership MoSTEMWINs