Summary: <p>Developing Momentum in Therapeutic Relationships<br> Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC<br> Executive Director: AllCEUs Counseling CEUs and Specialty Certificates<br> Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery</p> <p>Objectives<br> ~ Describe the ideal momentum in a therapeutic relationship<br> ~ Examine causes of “stuckness”<br> ~ Review phases of readiness for change and appropriate interventions to increase readiness<br> ~ Explore issues in the therapeutic relationship that may lead to stuckness and interventions</p> <p>Question<br> ~ What causes your client’s “stuckness?”</p> <p>~ What does “stuckness” look like for your clients?</p> <p>~ What do you do to keep momentum going?<br> Ideal Momentum<br> ~ Assessment: Client identifies problem, and is highly motivated to work on it<br> ~ First session: Client actively participates and is open and willing to hear feedback and take suggestions.<br> ~ Second session and beyond: Client thoroughly completes homework, arrives on time, participates actively and reports near continuous improvement<br> Reality for Many<br> ~ Assessment: Client identifies problem and is highly motivated to have us fix it<br> ~ First session: Client participates but often looks to the therapist to fix it. Expects what is done in session to be enough<br> ~ Second session and beyond: Client rarely or partially completes homework, participates passively (reports problems, but doesn’t draw connections or look for solutions) and reports sporadic improvement</p> <p> </p> <p>Stuckness vs. Plateau<br> ~ Expect clients to experience plateaus where gains seem to stall.<br> ~ A plateau lasting more than about a month in which the client has not reached maximal gains should be explored<br> ~ Is something else going on and the client doesn’t have the energy resources to devote to counseling right now?<br> ~ Or is has the client just lost steam?<br> ~ Do treatment plan objectives need to be changed?<br> Causes of Stuckness<br> ~ Client has competing priorities<br> ~ Client is not motivated to abandon old behaviors<br> ~ Wrong or incomplete problem/cause identification<br> ~ Goals are too broad, poorly defined or complicated<br> ~ Client doesn’t feel heard or understood (yes buts or the same issue repeatedly comes up)<br> ~ Client doesn’t understand the importance of homework or connection to recovery<br> ~ Client isn’t challenged through socratic questioning to arrive at own solutions<br> Readiness for Change<br> ~ Precontemplation: Not ready<br> ~ Contemplation: Realizing there may be a problem<br> ~ Preparation: Trying to figure out what to do and decide if they are ready to change their behaviors<br> ~ Action: Ready to change<br> ~ Maintenance<br> ~ Maintain progress on problem A while addressing B<br> Reflection<br> ~ Think about a change you wanted to make that lost it’s momentum.<br> ~ What happened?<br> ~ Why were the benefits of the new behavior not rewarding enough?<br> ~ What did you miss about the old behaviors?<br> Not (Totally) Ready for Change<br> Change causes crisis and crisis causes change<br> ~ Examine the benefits of the old behaviors<br> ~ Ensure interventions meet the same need to a similar degree<br> ~ Develop discrepancies between current behaviors and goals<br> ~ Explore & address the drawbacks to the interventions<br> ~ Increase frequency and or intensity of rewards for the new behavior<br> Wrong/Incomplete Problem Identification<br> ~ Examine the problem from a biopsychosocial perspective<br> ~ Depression<br> ~ Physical<br> ~ Cognitive<br> ~ Interpersonal<br> ~ Environmental/situational<br> ~ Examine what the person hopes to get out of the change (Miracle question)<br> ~ Depression Treatment Happiness Relationship Improvement<br> ~ Anxiety treatment Happiness Stop bingeing</p> <p>Issues in the Therapeutic Relationship<br> ~ Client</p>
