> Competency 3: Treatment Strategies for Working with Clients with an FASD > 5l. Motivational Coaching
Competency 3: Treatment Strategies for Working with Clients with an FASD
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
The diagram shows the stages of readiness for change, which are described below.
Stages of Readiness for Change (read from bottom to top)
Source: Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C. 1992.
In search of how people change: Applications to addictive behaviors. American Psychologist
- 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
- 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.
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
problem drinking to change their drinking behavior:
- Feedback: Provide useful feedback based on screening.
- Responsibility: Emphasize personal responsibility and freedom to
- 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
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.