ACA Blog

Karen Bates
Jul 06, 2010

Meeting the Client Where They’re At

You’ve heard of the game of curling, haven’t you? If you watched the 2010 Winter Olympics you may have seen it. It is a sport in which players slide stones across a sheet of ice towards a target area. The team uses brooms to maneuver the stone by altering the ice either by sweeping quickly and producing a smoother surface with less friction or sweeping lightly so the stone slows down or goes in a curved path caused by the friction on the ice. At first glance, the game looks sort of silly. You wonder just what the heck is going on. That is the analogy I tell some of my clients when they come into therapy. You may not quite understand exactly what is going on but the therapy process is going to take you to that target as slowly or as quickly as you prefer. I’ll slow down the sweeping or I’ll speed it up so we can get to that target together.

In my previous blog, I mentioned that I don’t tell someone that they have a problem with drugs or alcohol. On the other hand, clients have a right to know their diagnosis. Informed treatment is a right of every client. I collaboratively develop their treatment plan. They receive a copy of it with their diagnosis and a description of their “problem” stated on the plan. They look it over before they sign it. I still don’t tell them that they have a problem. Why? Because the client has to tell me and it is called readiness to change.
When I first starting using this theoretical approach developed by Drs. Proschaska and DiClemente, called the Stages of Change, I thought it was interesting but really didn’t get it. What happened to telling a client that they’re in denial? Now, I’m supposed to say, well, nothing I guess. It was really confusing. But the more I researched about it and understood it, it was about the client. To repeat a catch phrase, it is “meeting the client where they’re at.”

Here is a summarization of the stages:
1) Precontemplation: The person has no intention of changing. It usually is expressed to others as “I don’t think my weight, my drug use, my alcohol use, etc., is a problem.”
2)Contemplation: The person recognizes that he or she has a problem but still has no intention of changing in the next month or so. This is the client that is still on the fence. Most markedly, the client is ambivalent.
3)Preparation: The person recognizes a problem and is in the planning stages of change. This person has some experience with changing but may have failed in the past. For example, “I know I need to lose weight, quit drinking, stop smoking, etc., and I’ve tried this or that.” They usually want to try again.
4)Action: The person is actively executing strategies for change. This is most markedly shown by a modification of a person’s environment, experiences, and behavior. They are practicing new behavior and this requires the most effort. The client has an increased sense of self-efficacy.
5)Maintenance: The person has sustained changes. It is most markedly indicated by a commitment to the changes.

So, there you have it. It is a lot less confrontational and it takes some practice to reach a comfort level but since I was a clean slate when I started as a substance abuse treatment counselor, I really had no other reference to fall back on. I was ready to learn, so I guess you would say, I was in the preparation stage of change when I began and am now in maintenance as a counselor. And every once in a while, I still practice a little curling.



Karen Bates is a counselor, addiction specialist, and a doctoral student at Walden University.

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