Lesson 15: Change Theory

Attention

Disability affects hundreds of millions of families in developing countries. Currently around 10 percent of the total world’s population, or roughly 650 million people live with a disability.
( for more information about world wide statistics see  http://www.disabled-world.com/disability/statistics/  )
 
As community rehabilitation professionals we cannot facilitate individual change in most of these locations, but we can in our own community.  It starts with each client you work with or are responsible to facilitate recovery for.  Facilitating change one person at a time will begin a momentum that can and will send hope to the world eventually.  If we in this country and state begin to set an example of what can be achieved, we can have an impact on this world wide phenomenon.  

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Explore and demonstrate knowledge of various engagement and motivation techniques specific to encouraging the development of vocational goals.

Teaching

How people change        

The key factor in understanding vocational aspects of disability, and all rehabilitation work for that matter, is learning to facilitate change and encouraging motivation in the client by assisting them in moving towards job readiness with a goal of employment in an integrated competitive environment.   Change occurs when people learn new information that moves them to action.  Sometimes they learn new information the hard way like getting arrested, loosing a friend or loved one because of poor choices.  These cause trauma and in most cases they will need more than you can provide as a community rehabilitation professional.

This is a time when referral is important.  However, many of the individuals you work with are simply frozen in time because of ambiguity.  They have no idea what to do or how to do it.  Your job then is to facility their learning.     

Inaction breeds complacency and we can’t do it for them.  We must encourage, teach,  facilitate and hurl belief at them until they have enough information to create hope and belief in their own future to take action.  There is an old adage that says; “sometime we are our own worst enemies”.  This can be particularly true with consumers diagnosed with mental illness who have come to believe they cannot work.  Changing this self belief using the components of recovery combined with vocational profile development and change theory is the overall focus of the work done in community rehabilitation setting.

  • Change is hard for everyone.
  • How we operate, no matter how it appears to others, has meaning and function for us. We are more comfortable with what we know than what we have not tried or experienced.
  • Not only are we ambivalent about changing, we resist harder when others push us in the direction of change before we are ready [have addressed our ambivalence].
  • Ambivalence about change is to be expected; does not reflect “denial” or pathology.
  • Ambivalence is reflected as resistance when change is pushed on people by outside forces/parties, sometimes before counseling begins from family, members, court, employer, etc; sometimes during counseling by counselor and/or program practices.
  • Resistance may be manifested by negative communications (anger, silence, etc) and/or expressions and signs of ambivalence.

Sometimes there is a “right” or “correct” answer that is NOT debatable or negotiable. Mathematical processes are not subject to our opinion or rationale.  One plus One is Two (1+1=2). Period. This is not debatable unless you change the rules of math.   Some laws are administered like that.  If you drink and drive (and get caught) you will lose your license.  This is not debatable.  Other evidence based responses that are based on reality are not negotiable.  This is a change that many of the clients may be very resistant to accept. As long as a response is debatable, no real decision has been made.  We will go with the flow.  This creates ambiguity and promotes a lack of confidence in our daily lives and the lives of the clients we work with.  Sometimes rhetoric suffices in our work and other times finite correct answers are required and expected.  Discerning which professional response has some fudge room and which must be done correctly is a critical skill to learn in the rehab business.  Sometimes you do not get second chances. Helping our clients with this process, discerning what is negotiable and what has clear non negotiable consequences is part of our job as community rehabilitation professionals.
 
The major action that facilitates change is to assist the consumer in Resolving Ambivalence about their work capabilities.

READY, WILLING, AND ABLE  to Change?
ASSESS READINESS:  

What are people’s perspectives toward their PROBLEM,(identified by someone else) and CHANGE?  When you develop an accurate vocational profile that the consumer clearly understands, hope is introduced and clarity of a positive future begins to formulate in the consumers mind.
What is the person’s LEVEL OF MOTIVATION  to change something?

Change begins when individuals recognize that there is significant DISCREPANCY, causing ambivalence between their intrinsic values and important life goals and their current circumstances and/or actions, impeding the pursuit of these values or achievement of their goals.

WILLING:

Address Discrepancy: difference between what one wants and what one has.

-IS THE ISSUE PERCEIVED BY THE PERSON AS AN IMPORTANT ENOUGH PROBLEM TO CHANGE?

- How important?

ABLE:
Facilitate Self-Efficacy: sustained confidence and accomplishment
DO I HAVE CONFIDENCE ENOUGH TO CHANGE THE PROBLEM?
-  How much?

Change occurs when:

1)  people recognize the importance and feasibility of change (ARE MOTIVATED).
2) understand they HAVE THE ASSESTS AND RESOURCES TO CHANGE
3) ARE WILLING TO TAKE CONCRETE STEPS TO CHANGE (ACHIEVE SLEF-EFFICACY)

INTERATION TECHNIQUES: OARS

- OARS is an appropriate metaphor for making, steady, sustained progress- unrushed-, dependent on self-generated initiative and requiring sustained effort.
O: Use open-ended questions.
A: Promote affirmations of strength, resources and accomplishments;
 individual strengths;
explore motivation in their actions
R: Encourage personal reflection; use empathy. [3 to 1 in favor of reflection vs. question. attending especially to change-talk
S: Summarize (at 5-15 minutes intervals)
Reflections and summarizing should be dominant responses. Questions should always be as open-ended as possible.
Suggestions, ok; direct responses to client questions are important.

Six Brief Steps:

Listening and Engaging: Joining Up
Assess Individual Readiness for Change
Examine Barriers to Change.
Decisional Considerations.
Explore Personal Goals.
Emphasize personal  Resiliency, Assets, and Resources.
Offer Options.

Assessment

Lesson 15 Discussion

Discuss personal changes that you have had to make and analyze them using the change model and information in the lesson.