Curriculum for Addiction Professionals > Competency 3: Treatment Strategies for Working with Clients with an FASD > 5l. Motivational Coaching

Please Select One 1. Competency Description 2. Pretest 3. Learning Objectives 4. Introduction 5. Adults 5a. Assessment and Treatment Plan Development 5b. Chronological Age Compared to Developmental Age 5c. Ways To Modify Facility Treatment Plans and Staff Expectations 5d. Counseling Strategies 5e. Counseling Strategies: Boundaries 5f. Counseling Strategies: Strengths 5g. Counseling Strategies: History of Abuse 5h. Counseling Strategies: Loss and Grieving 5i. Counseling Strategies: Stigma 5j. Counseling Strategies: Self-Esteem and Personal Issues 5k. Counseling Strategies: Resistance, Denial, and Acceptance 5l. Motivational Coaching 5m. Education, Direction, and Support for Families 5n. Appropriate Birth Control and Referral for Pharmaceutical Assessment 5o. Ongoing Assessment for Comprehension of Information 5p. Transitional Planning and Case Management 6. Adolescents 6a. Treatment Plan Development 6b. Treatment Plan Development: Points to Consider 6c. Medical and Mental Health Assessments 6d. Ongoing Assessment for Comprehension of Information 6e. Educational Support (IDEA and FAPE) 6f. Transitional Planning and Case Management 7. Children 7a. Medical and Mental Health Assessments 7b. Educational Support 7c. Case Management 8. Issues Related to Professional Values and Ethics 9. Matching Activity 10. Posttest 11. References

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Competency 3: Treatment Strategies for Working with Clients with an FASD

Adults

Motivational Coaching

Motivational coaching, or motivational interviewing, is based on stages of change theory. It involves helping people make decisions for themselves along the stages of change.¹⁰ Because of their cognitive deficits, women with an FASD may take longer to go through the stages and may need to repeat stages. Multiple conversations at each stage may be needed to reinforce important points.

The diagram shows the stages of readiness for change, which are described below.

Source: Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C. 1992. In search of how people change: Applications to addictive behaviors. American Psychologist 47(9):1102-1114.

• Precontemplation. The person is not considering change. He or she does not see the need and may be surprised to find that others think a problem exists.
• Contemplation. The person is ambivalent. Part of the person wants to change and part does not. The characteristic response of the contemplator is “Yes, but...”
• Preparation. The person feels ready to change. He or she may express feelings such as “Something’s got to change. I can’t go on like this.” If determination does not lead to action, the individual may temporarily return to the precontemplation stage.
• Action. The person has begun doing something about his or her behavior. This is usually when treatment starts.
• Maintenance. This is the hardest part of change. The challenge is to maintain the gains and avoid relapse.
• Relapse. Approximately 90 percent of problem drinkers will drink again after treatment¹¹. They need to recover from the lapse as quickly as possible and reenter the change process. Relapse is not formally considered a stage. It is included because many individuals relapse and repeat stages.

Motivational interviewing is a way to help people recognize their problems and increase their motivation to change. It is especially useful in resolving ambivalence. It is a supportive, respectful approach that is persuasive but not coercive. One useful model for understanding motivation is FRAMES.¹²

FRAMES stands for six key elements that are effective in assisting persons with at-risk or problem drinking to change their drinking behavior:

• Feedback: Provide useful feedback based on screening.
• Responsibility: Emphasize personal responsibility and freedom to choose.
• Advice: Give specific advice about how to change drinking patterns.
• Menu: Provide the person with options.
• Empathy: Show an understanding of the person’s situation and be supportive.
• Self-efficacy: Convey the message that the person is capable of change.

Motivational interviewing strategies can help people stay focused and avoid getting sidetracked. It is important to reinforce statements that indicate a willingness to consider change. Resistance may indicate a different stage of change than previously thought. The goal is to understand where the person is and guide the process accordingly.

Motivational interviewing has been shown to be effective with pregnant women and women of childbearing age.¹³ However, it has not been tested at length with these groups and has not been specifically tested with women with an FASD.

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