1. 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 ©  by John Wiley & Sons, Inc., or related companies. All rights reserved.
Client-Centered Counseling for Behavior Change

2. 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.

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Relapse Prevention: Role Play, Demo

12. 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?

13. Relapse Prevention: Role Play, Debrief, Faculty Interview

14. 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

15. 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

16. Providing an Affirmation: Role Play, Demo

17. 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?

18. Using a Motivation Scale: Role Play, Demo

19. 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?

20. Rolling with Resistance: Role Play, Counter

21. Rolling with Resistance: Role Play, Demo

22. 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?

23. Rolling with Resistance: Faculty Interview

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

25. The Use of Silence: Role Play, Counter

26. The Use of Silence: Role Play, Demo

27. 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?

28. 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

29. 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.

30. 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?

31. 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

32. Developing Your Client-Centered Practice: Faculty Interview

33. 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

34. 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

35. 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

36. 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
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