Drug Counseling Video #10 Individual Counseling Skills.

Drug Counseling Video #10 Individual Counseling Skills.

Two basic drug counseling skills involve the use of motivational enhancement and the knowledge of the stages of change a client may be moving through. Stages of change include pre-contemplative, contemplation, preparation, action, maintenance, and possible relapse. Skills needed for motivational interviewing include the ability to express empathy, develop discrepancies, roll with resistance, and support self-efficacy.

What are the stages of change?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Changing your life

Time for a life change?
Photo courtesy of Pixabay.com

How do people really change?

The stages of change model comes originally from a book titled “Changing For Good” by Prochaska, Norcross, and DiClemente.

This model has been widely applied to substance abuse treatment but is also applicable to mental health, weight loss or even improving test scores in underperforming schools.

We teach this model to beginning students in Substance abuse counseling programs and it is gradually becoming a part of Professional Clinical Counseling and Marriage and Family Therapy training.

It is helpful for professionals to understand how it is that people change so we don’t get ahead of or behind our clients in the process of change. This model also helps predict the possibility of relapse and is applied to relapse prevention.

The Stages of Change model is not just for professionals. It is included in the Mental Health First Aid program and is now being taught to clients and consumers.

Below are the links to a series of post I wrote on the stages of change. This is my explanation of the model and some additional insights from Ken Minkhoff at Zia Partners and my fellow Change Agents.

My apologies to Prochaska, Norcross, and DiClemente if I have in any way distorted their model. For their version read the book. See also materials on Stages of Change at the SAMHSA website.

Stages of Change or How Do We Change Pre-Contemplation

Stages of Change part two – Contemplation

How do People Change? Preparation

Stages of Change – Early Action

Stages of Change – Late Action

Maintenance is a Part of Change

Related posts are at:

Is Relapse a Part of Recovery?

Four Stages of Recovery

Getting some recovery – preventing relapse

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

4 Stages of recovery

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Ball recovery

Recovery and Resiliency. Photo courtesy of Pixabay.com

How does recovery grow and develop?

Recovery does not happen suddenly, out of nowhere. It takes time and work. From my way of thinking there are customary predictable stages of recovery. People may move through these stages at varying rates, some people move backward at times, but the goal for all should be to reach a final place where recovery is stable and less at risk.

The concept of recovery used to be mostly applied to substance abuse. Recently the concepts of wellness and recovery have been incorporated into Mental Health and physical health issues.

In a series of earlier posts, we talked about stages of change. Those stages begin with Pre-contemplation, the I don’t have a problem and even if I did I wouldn’t want to change anything, to Contemplation, yeah so – maybe I do have a problem but I am not sure I am ready to do anything about it. After that is Preparation, sometimes called Determination, and finally the action process, which we divided into Early Action and Late Action phases. The last part of this recovery journey was Maintenance.

In this model, Relapse is seen not as part of recovery but as the inability to maintain recovery once we reach it. This is understood as a common result of failure to do the maintenance activities. There has been lots of literature on relapse, triggers and lifestyle changes to make to avoid relapse. Much less has been written about what someone might expect during recovery.

Here are the four stages of recovery as I see them

1. In recovery.

People in this stage are seeking answers, working on themselves and investing time in their recovery. This is the time when people are taking action steps or may begin to do maintenance to hold onto the gains they have made. Lots of people will describe themselves as “in recovery”

2. Recovering.

People who describe themselves as recovering have moved from the point of being hopeless and lost to having hope and seeing their symptoms reduced. The urges and cravings may decrees even if they are never totally gone. People with mental health symptoms, while not fully back on their feet, may find they are able to do more things more days. Symptoms while present are shrinking.

3. Recovered.

Some people are afraid to say this. They are afraid that feeling recovered, they will let down on working on themselves and relapse. The A.A. Big Book uses this language on the title page of Alcoholics Anonymous, “The Story of How Many Thousands of Men and Woman Have Recovered from Alcoholism.”

People who call themselves “recovered” are quick to point out that they are not cured. Just as when someone is diagnosed with diabetes they may get their disease under control but they will never go back to being a non-diabetic. With any chronic, relapsing disease you may recover but you are never really cured.

People who are recovered begin to get their life back. They may go back to work, volunteer or be able to participate fully in everyday life.

4. Life on life’s terms.

Every recovered person will have bumps on their road of life. This is a real life, good happens and bad happens. A person’s recovery is secure when they are able to withstand the things that happen, good or bad, in life without a return to active symptoms.

Doing the maintenance steps helps, so does building a comprehensive support system. The real test of someone’s recovery is – can bad or unexpected things happen in your life without triggering a return of your symptoms.

Best wishes on your recovery and having the happy life you deserve.

Other posts on this topic can be found at: Pre-contemplation, Contemplation, Preparation, Early Action, Late Action, Maintenance, relapse, recovery, triggers, support system, more on support systems, Resiliency

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Stages of change part two – contemplation

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Change

Change.
Photo courtesy of Pixabay.com

Contemplation, thinking about your problem is the second stage of change.

Last time we began our discussion of the stages of change by describing how someone might be confronted with a situation where others think you have a problem, a need to change, even before we recognize that something is a problem. We called that stage of change Pre-contemplation.

Lots of people end up in the therapist office, court, child custody mediation, a Drunk driver program or substance abuse treatment who never thought they had a problem. Sometimes they are sent with an ultimatum, do this treatment or else. Sometimes it is a spouse or a boss who says change or else. Sometimes it is too late and the or else has taken effect.

Often they resist thinking that they have a problem despite being required to go to some type of treatment. An interesting thing happens too many of these people, sooner or later. They see other people confronting their problems and those people’s lives are getting better. This is especially powerful in group settings where a group member gets a new job or relationship, someone gets to see their kids again or gets a license back, or someone loses a lot of weight.

Sometimes this mental change can occur after they read a book on solving a particular problem and they start to consider if they might need to change. Once the willingness to think about change occurs they have reached step two in the process of change model.

Step 2: Contemplation

In this stage, the person who is on the road to change is gathering information. That does not mean they agree they have a problem, they may, they may not, but they are open to looking at the facts. So let me continue my weight loss story from our last episode.

I get home and I ask my roommate “Have I gained any weight?” She giggles politely. Maybe it was more like a hysterical laugh. So I go looking for the scale that used to be in my bathroom. Not there. I check in the closet, under the bed, I find it on a top shelf in the garage. I weigh myself. That can’t be. I don’t weigh that much! Do I?  This scale must be broken, that’s why I put it in the garage right?

The next day at work I weigh myself on the certified scale. It gives me a bigger number than my garage scale. This can’t be right. I go to another department and try their scale. It gives me a bigger number yet. I go back to the first scale and reweigh myself. Now the truth hits me. I have put on weight. Not a little, but a lot. The weight gain is getting harder to deny.

Some people get this moment of truth when the judge sentences them. Some when their spouse leaves them or the family doesn’t want them around. For some people, it may be the DUI. Some people get to this realization the second or third time their parole officer sends them to a drug program. Maybe they realize it after the fiftieth job interview that does not result in a job. Could it be me? Do I lack the skills? Do I have a problem?

Whatever it takes eventually those who change get to this point. I am hoping that for you all you need is a little number on a scale. Whatever it is we both have a choice at this point. Change or go on the same course as before.

I could get off the scale at this point and just ignore or accept the fact I am now heavier, maybe even fat, or I can do something about it. I am no longer contemplating. But what will I do next?

Do you have any stories about changes you have made? Want to share them? You can make a comment if you chose.

Check back next blog for the next installment about how people change.

Other posts on this topic can be found at: Pre-contemplation, Contemplation, Preparation, Early Action, Late Action, Maintenance, relapse, recovery, triggers, support system, more on support systems, Resiliency

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.