Counseling, Behaviour Change and Goal Setting

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Counseling, Behaviour Change and Goal Setting

• CPAFLA Ch 2 and 3
• ACSM Ch 62 and 65

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Counseling

• Your goal is to effect change and help an
  individual adopt an active and healthy lifestyle
  or to motivate an individual to maintain an
  active lifestyle.
• You need to consider a broad range of factors for
  each individual
• current health status
• background (exercise history, health, etc.)
• desired goals
• mind-set and motivation
• accessibility and availability (facilities,
  costs, time commitment)
• individual interests and abilities
• values and beliefs
• support systems (individual, group, and social)

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Counseling

• You need knowledge and skills in a wide variety
  of areas sociology, psychology, interpersonal
  communication, marketing, public relations,
  kinesiology, etc.
• Two common problems in the health and fitness
  field are
• A lack scientific background combined with
  well-developed marketing and promotional
  abilities (flash but no substance).
• Well-educated individuals who lack the skills to
  communicate information to potential
  clients/customers.

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Functions of Health Counselor

• 1. Develop rapport and convey a sense of empathy
  for challenges they may face in making changes
• 2. Assess health related behaviours and state of
  readiness for change
• Understanding how participant perceives the
  impact of behaviours on health and quality of
  life
• 3. Facilitate change
• Discuss potential benefits and problems
  associated with implementing a lifestyle change

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1. Developing Rapport

• Acceptance - setting tone of openness and
  acceptance during initial conversation
• Refrain from appearing to make judgments
• Unconditional acceptance - Accepting oneself
  without any preset conditions for acceptance
• Important in developing positive self esteem
• Conditional acceptance - Conditions or
  standards have to met to be judged worthy.
• I have to look like that, or play as well as
  so-and-so.
• Behaviours, actions, performance
• Both Verbal and Non-verbal objectives and
  empathic responses from counselor are important

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Expressing Empathy

• Empathy - ability to understand people from their
  frame of reference rather than your own
• Helps create perception of unconditional
  acceptance
• Facilitates disclosure of information important
  in developing effective programs
• Active listening techniques can convey empathy
• Rephrasing - reflects emotional content, develops
  rapport, ensures accurate interpretation and that
  you are listening and understanding
• Questions to clarify or gain more information
• Non verbal Communication
• Eye contact, body movements, voice inflection,
  proximity and interpersonal distance

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Self Esteem

• Refers to how one feels about oneself and ones
  characteristics
• Self esteem is critical for behaviour change and
  adopting more healthy lifestyles.
• High self esteem is positively associated with
  acceptance by (and of) others, greater social
  effectiveness, less deviant behaviour,
  participation in physical activity, and good
  dietary practices.
• It is negatively associated with alcohol, tobacco
  and drug abuse.

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Levels of Self-Esteem (Figure 2-1, page 2-3)
Superordinate
Superordinate
Dimension/Domain
Dimension/Domain
Subdomaine
Subdomaine
Facet
Facet
Subfacet
Subfacet
State (feelings of self-efficacy)
State (feelings of self-efficacy)
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Distorted Perceptions

• Distorted perceptions can affect self-esteem and
  motivation, (e.g. Im fat and overweight).
• Others have problems in the other direction,
  (Im in good shape).
• In may cases a poor self-image is due to
  unrealistic expectations of an ideal self-image
  (e.g. models in society).
• CPAFLA - objective testing and feedback creates
• realistic view of self
• Realistic outlook
• Realistic aspiration and goals

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2. Assessing Health-Related Behaviours

• Behavioural assessment - history, self report,
  self monitoring - family may also provide
  valuable information
• Many tools in CPAFLA
• Motivational Assessment - though we cannot
  motivate individuals directly, we can appeal to
  what motivates them
• Assist them in finding aspect of their history
  that can bring them awareness of the value of
  fitness
• Then help them develop clear goals and a program
  to achieve them

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3. Facilitate Change

• Role of counselor is to facilitate change not
  prescribe it - work with client to discuss,
  develop and agree on a plan for change
• Ultimate goal - participant to accept and
  maintain responsibility for personal behaviour
• Assist participant in identifying all of the
  benefits as well as costs of behaviour change -
  all aspects of health - counselor can help
  broaden scope

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Factors affecting participation

• Three main reasons for approaching counselor
• Gain health benefit
• Strength, weight loss, reduce stress or disease
  risk
• Enjoyment or pleasure
• Self image
• All reasons require the following to be in place
• Beliefs
• That physical activity will produce desired
  benefits
• Their own ability to stay with program
• Attitudes
• Value attached to a belief
• Intentions
• Realistic planned approach - SMART goal setting
• Reinforcement - chosen by client

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• Styles for Helping People Change
• (CPAFLA)
• Each style is effective in certain situations and
  ineffective in others.
• An appraiser should be able to use the most
  appropriate style for particular participants and
  particular needs.
• Appropriate style may shift during interview

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The Preacher

• "Thou Shalt Jog"
• Advantages/Disadvantages
• some people need to be told (Ad)
• some people respond negatively to commands
  (Disad)
• very little discussion or client input (Disad)
• no alternative action plan (Disad)
• Client not a full participant in creating change
  (Disad)
• unfounded assumptions about participant's
  activity preferences (Disad)

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The Expert

• Research shows that jogging at a heart rate of
  70 to 85 of your maximum, 3-5 times per week
  for 20 to 30 minutes continuously will increase
  your aerobic capacity.
• Advantages/Disadvantages
• some people want the facts (Ad)
• this style provides a credible rationale for
  assessment and recommendations (Ad)
• it prevents dialogue about lifestyle preferences
  (Disad)
• people not willing to change because scientific
  information suggests they should (Disad)
• some people feel intimidated by information and
  will not express their opinions or ask questions
  for fear of appearing to lack knowledge (Disad)

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The Counselor

• "I have knowledge about fitness, you know what
  activities you want to do, and now we have your
  test results, so let's talk."
• Advantages Disadvantages
• focuses on the individual (Ad)
• it sets the stage for dialogue (Ad)
• goals are set by participants with guidance from
  the appraiser rather than the reverse (Ad)
• the chances for permanent, beneficial changes are
  increased (Ad)
• the style appeals to nearly all participants (Ad)
• some people just want to be told what to do
  (Disad)

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Strategies for Effective Leadership/Counseling

• 1. Know your clients
• 2. Make your clients feel important
• 3. Help client design a program to meet their
  individual needs
• 4. Provide information (fitness, health,
  nutrition, etc.)
• 5. Help clients understand their own fitness
  goals
• 6. Decrease the "hassle factor"
• 7. Help clients use one another for support and
  encouragement
• 8. Provide opportunities for regular assessment
• 9. Make fitness fun
• 10. Provide a good model of safe and effective
  practices
• 11. Work on your own development as a leader
• 12. Market the "product"

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Behaviour Change

• Transtheoretical Model - Prochaska and DiClimente
  - derived from social learning theory
• CPAFLA Fig 2-3, 2-4
• Progression of behaviour change through a series
  of stages
• 1. Pre-contemplation - no intent, no exercise
• 2. Contemplation - intent, no exercise
• 3. Preparation - intent, occasional exercise
• 4. Action - regular exercise
• 5. Maintenance - exercise for 6 months or more
• Rate of progression relates to use of strategies,
  expected outcomes and self confidence

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Health Behaviour Change Model

• Conceptualized in three stages
• 1. Antecedent - includes pre-contemplation,
  contemplation and preparation phases of
  transtheoretical model
• 2. Adoption - (Action) - early phases of change
• 3. Maintenance - later phases of change
• Antecedents - refers to all conditions that can
  assist, initiate, hinder or support change
• Ask client to rate intention 0-10
• Fig 65.1 - intentions can change and may be
  influenced by many factors

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Antecedents

• Information -often a stimulus for beginning
• Needs to be clear and simple - most effective
  when combined with instructions about how to make
  change
• Emphasize benefits rather than risks
• Test knowledge critical to behaviour change prior
  to program - correct myths and misperceptions
• Instructions should be kind but firm - remove
  ambiguity
• Ask participant to repeat information important
  to behaviour change

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Antecedents (cont)

• Models - family, friends
• Allows participant to see how others make changes
• Ask them to think about people they know or
  admire who have made changes
• Experience - people are more likely to repeat a
  behaviour if it was helpful in the past
• Client should be made to answer question
• How can I make sure that I benefit from this
  program?

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Adoption

• When to intervene or encourage adoption of a new
  behaviour should be guided by experience
• Ask are you ready to.
• Goal setting is an important part of adoption
  phase
• Flexible, individually tailored, achievable
• Include needs and preferences
• Rate confidence 0-100 - 70 more likely to
  succeed
• Early phase most difficult
• praise (immediate and specific), clients active
  ongoing social support 2-3 times as likely ot
  succeed

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SMART GOAL SETTING

• Specific Is the goal specific?
• Do you know how, where, when, with whom, and how
  long you will do this? Action-oriented
• Measurable Is it measurable?
• Will you know when it is done?
• Acceptable Will you feel good about doing this?
• Meaningful -- is this a personal goal or for
  someone else?
• Realistic Are you able to do this?
• Genetic characteristics, personal preferences,
  time, money
• Timely Is there a deadline attached?
• Set short and long term goals
• Create new goals once they are achieved
• Maslow's Theory once a need (or goal) is
  satisfied, it no longer motivates.

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Goal Setting for Athletes

• Review periodically to stay psyched or make
  adjustments
• 1. What is your long-term dream/goal?
• 2. What is your dream/goal for this year?
• 3. What do you feel is a realistic performance
  goal that you can achieve this year?
• 4. Can you make a commitment to accept yourself?
• 5. If you don't meet your desired performance
  goal, to what
• extent will you still be able to accept
  yourself (0-10)?
• 6. Whenever you work out, can you set an on-site
  goal of best effort and be satisfied to get to
  just that goal?
• 7. What do you feel is your most important
  psychological goal this year, to achieve better
  preparation or mental control?
• 8. Describe your personal goal for your next
  session.

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Maintenance

• Behaviour that satisfies or reduces discomfort is
  likely to be maintained
• Four Strategies
• Monitoring and Feedback
• Diary, physiological monitoring
• Making the activity as satisfying as possible
  Reinforcement - very individualistic
• Relapse prevention - and anticipation - decide
  what to do in event of relapse now
• Making a formal commitment - Contract
• Realistic and achievable, revised as necessary
• Problem solving for goals not achieved

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Developing a Program

• Ask client to consider change
• Requires good self esteem, confidence, belief,
  attitude, and intention as well as good client
  counselor rapport
• Provide information, instructions and models for
  change
• Building confidence, reducing disincentives,
  increasing incentives - providing agreeable
  options from large knowledge base
• Request commitment
• SMART goals, relapse prevention, contracts and
  rewards - decide on monitoring and reevaluation
  criteria

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CPAFLA - Seven step approach

• Describes step by step process of working with a
  client to develop an effective program
• Step 1 - Build rapport and structure
• Step 2 - Gather information
• Step 3 - conduct fitness appraisal
• Step 4 - Interpret fitness appraisal results
• Step 5 - Generate alternatives for change
• Step 6 - Develop an action plan
• Step 7 - Follow up
• Our focus today is on steps 1,2, 5 and 6
• Utilize CPAFLA forms to gather information, and
  to generate a plan with the client.

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