1. FACILITATING CHANGE
A Collaborative Approach
By: Rosie Ford, HFS and Counselor Intern

2. BUILDING RAPPORT
 At the core of a positive collaborative relationship
 Particularly important EARLY in the relationship
 Establish open, trusting, collaborative relationship
 A poor collaborative alliance predicts premature client drop out
 Especially important within a change process
 Strength of collaborative alliance is directly related to the degree of change a
client makes
 Reflects the extent to which client and coach are on the same
wavelength
 Working together
 Collaboration for change

3. BUILDING RAPPORT
COACHES’ QUALITIES
 Genuine - authentic, honest, congruent → builds trust
 Empathetic - enter the client’s worldview and convey understanding
 Non-judgmental
 Respectful - acceptance, unconditional positive regard → may not
agree with everything they do but ALWAYS show acceptance
 Collaborative/team player
 Agreement of goals
 Agreement of tasks that will help achieve goals
 Actively involved in process
 Positive relationship

4. BUILDING RAPPORT
COACHES’ QUALITIES (CONT’D)
 Warm and caring
 Flexible
 High degree of comfort in interpersonal relationships
 Easy to talk to
 Honest and sincere
 Understanding
 Not suspicious
 Not hostile or aggressive

5. SKILLS TO BUILD RAPPORT
 Attending
 Verbal and non-verbal
Examples:
 Eye contact, facial expressions, minimal encouragers (uh huh, I see, yea,
ok), body language, tone of voice
 Reflecting
 Demonstrates understanding
Examples:
 Content – “So what I am hearing you say is….”
“So you would like to learn more ways to prepare your
veggies, is that right?
 Feeling – “You are very excited about this idea!”
“You feel overwhelmed because you don’t have time to
prepare your veggies.”

6. SKILLS TO BUILD RAPPORT (CONT’D)
 Paraphrasing/Summarizing
Examples:
 “What I am hearing you say is you are hungry when you get
home from work and tend to eat whatever is available.”
 “So it sounds like your main concerns are eating out, social
situations and not having time to prepare your meals.”
 Empathetic Understanding
 Ability to accurately understand a client’s perspective in a given
situation
Examples:
 “I can see how you could be confused in that situation.”
 “That must have been very difficult for you.”

7. SKILLS TO BUILD RAPPORT (CONT’D)
 Self-disclosure
 Used very sparingly and ONLY when it will benefit the client
Examples:
 “I know when I don’t plan ahead, things never go well.”
 “Crock pot cooking helps me out a lot.”
 Provide Information
Examples:
 Recipes
 Educate on physiological concepts of program
 Tanita Reads
 Tips on eating out

8. NECESSARY CONDITIONS
 Relationship
 Vulnerability
 Genuineness
 Perception of Genuineness
 The client must FEEL the coach is genuine
 Unconditional Positive Regard
 Accurate Empathy

9. BEGINNING TASKS
 Build alliance or bridge → relationship → FIRST session → will be likely
to come back
 Increase importance of change → move stage of change
 Build self-efficacy for change

10. STAGES OF CHANGE
 Precontemplation
 Unaware of the problem OR lack desire to change
 The cons of change outweigh the pros
 High drop out risk
 Contemplation
 Aware of the problem but are not ready to change it OR do not
understand the problem
 Cons equal the pros
 Wonder if they can change or ambivalent about change
 Will drop out if suggested
 Preparation
 Develop an action plan
 The pros outweigh the cons
 Some problems
 plan is too vague (“I want to be healthier”)
 not supported by others/their network
Preparation

11. STAGES OF CHANGE (CONT’D)
 Action
 Actively changing the behavior and/or modifying environment
 Usually take a few steps forward and a few back – this is OK!
 baby steps
 one day at a time
 Major problems
 changing too many things at once
 lack of support
 Coaches like this stage
 not everyone comes at this stage
 Maintenance
 HARDEST stage
 What you did in the action phase will be different than in the maintenance
phase (ex: Loosing weight)
 Common problems
 streamlining the action plan
 coping with lapses/set backs
 incorporating change into the overall lifestyle
 Can cycle back and forth through stages
 Tailor approach to match stage of change

12. MOTIVATIONAL INTERVIEWING (MI)
 Basic Premise: Individuals become more committed
to what they say to themselves than what they hear
from others
 Effective and necessary at the pre-contemplation
stage of change
 Skills used for building rapport also very
important when using MI
Motivational
Interviewing
Roll With
Resistance
Motivational
Interviewing
Express
Empathy
Create
Discrepancies
Roll With
Resistance
Support
Self-efficacy

13. MOTIVATIONAL INTERVIEWING (CONT’D)
 Express Empathy
 Know that acceptance facilitates change
 Use reflective listening
 Be empathetic to the ambivalence

14. EMPATHY
 Communicates respect for and acceptance of clients and their feelings
 Encourages a nonjudgmental, collaborative relationship
 Allows you to be a supportive and knowledgeable consultant
 Sincerely compliments rather than belittles
 Listens rather than tells
 Gently persuades with the understanding that the decision to change is
the client's
 Provides support throughout the process

15. MOTIVATIONAL INTERVIEWING (CONT’D)
 Create Discrepancies
 Developing awareness of consequences helps clients examine their
behavior
 A discrepancy between present behavior and important goals motivates
change
 The client should present the arguments for change

16. MOTIVATIONAL INTERVIEWING (CONT’D)
 Roll With Resistance
 Avoid Arguments
 Arguments are counterproductive
 Defending breeds defensiveness
 Labeling is unnecessary
 Do not directly oppose resistance
 New perspectives are invited but not imposed
 The client is a valuable resource in finding solutions to problems
 Resistance is a signal to respond differently

17. MOTIVATIONAL INTERVIEWING (CONT’D)
 Build self-efficacy
 Belief in the possibility of change is an important motivator
 The client is responsible for choosing and carrying out personal change
 There is hope in the range of alternative approaches available
 The coach’s belief in client’s ability to change becomes a self-fulfilling
prophecy
You’re awesome!

18. SELF-EFFICACY
 Elicit and support hope, optimism, and the feasibility of accomplishing
change
 Self-efficacy is a critical component of behavior change
 you as the coach must also believe in your client’s capacity to reach their
goals
 Recognize the client's strengths and accomplishments and bring these
to the forefront whenever possible

19. SELF-EFFICACY (CONT’D)
 When client believes change is not possible
 perceived discrepancy between the desire for change and feelings of
hopelessness result in rationalizations or denial in order to reduce discomfort
 Helpful to talk about how persons in similar situations have successfully
changed their behavior → other clients can serve as role models and
offer encouragement
 One day at a time
 Education can increase client’s sense of self-efficacy

20. RESISTANCE
 Unwillingness to work on their problems and initiate change
 Vital to learn how to work through resistance
 Likely to manifest itself in all clients at one point or another
 Thinking about motivation and resistance in a different way…
 As a state – changes
 OR as a trait – unchangeable
 How you think about motivation influences how you deal with it!

21. CHALLENGING
USE ONLY WHEN RAPPORT HAS BEEN ESTABLISHED!
 Confronting
 Point out discrepancies between words, goals and
behaviors
Example:
 “You’ve mentioned that you really want to meet your goal
in time for the wedding yet your recent deviations have
really slowed down your progress. I just wonder what your
thoughts are on that.”
 Interpreting
 Suggesting possible reasons for client behavior
Example:
“I don’t know but I am just wondering if your recent deviations
might be because you are afraid of maintenance. What do
you think?”

22. CHALLENGING (CONT’D)
 Feedback
 Sharing thoughts and impressions
Examples:
 “You know I have noticed that every time you get close to your
goal you deviate. I just wonder what is going on with that.”
 “You get very excited when you talk about being able to play with
your children.”
 Pose it as a question or hunch
 The Columbo Approach
Example:
 “I don’t know, but I’m just wondering
if preparing your food ahead of time
would be helpful. What do you think?”

23. INCREASING COMMITMENT TO CHANGE
 Promote an internal attribution for change
 Makes them more invested/active in the change process
 because you want to vs because you have to
 Provide Choices (menu)
 Input
 The more you get them to participate the more committed → have to ask
themselves…. “I must be very committed if I am participating so much.”

24. INCREASING COMMITMENT TO CHANGE
(CONT’D)
 Minimize outside pressure or force
 May attribute behavior to external force rather than internal
 Reactance → when freedom is impinged upon → uncomfortable feeling
→ will try to restore sense of freedom
 can feel pressured
 can cause opposite effect on behavior
 Be careful how you deliver information
 speak to stage of change
“Success seems to be largely a
matter of hanging on after others
have let go.”
~William Feather

25. QUESTIONS

26. REFERENCES
 Erford, B., Hays, D., & Crockett, S. (2015). Helping Relationships. In Mastering the
national counselor preparation comprehensive examination (2nd ed., Vol. 1, pp. 121-
152). Upper Saddle River: Pearson.
 Facilitating health behavior change. (2014). In G. Liguori (Ed.), ACSM's Resources for
the Health Fitness Specialist (First ed., Vol. 1, pp. 249-263). Philadelphia: Lippincott
Williams & Wilkins.
RESOURCES
 G. Gintner, Ph.D., Associate Professor and Program Leader, Counselor Education,
122C Peabody Hall, Louisiana State University.
 Laura H. Choate, Ed.D., LPC, NCC, Associate Professor, Counselor Education,
Louisiana State University.