Fundamentals of Case Management Practice:
Skills for the Human Services, Third Edition
Chapter Twenty
Facilitating a Meaningful Change and Recovery
By
Nancy Summers
Published by
Brooks Cole
Cengage Learning
2009
WORKING TOWARD RECOVERY
Working toward recovery and a positive change involves:
 Seeing problems and illness as only a part of who the individual is.
 Seeing the client as a competent partner in planning.
 Developing a relationship that is trustworthy.
 Collaborating on goals that are important to the client.
 Giving support and encouragement when needed.
 Workers who believe people can change and recover.
 Services that the client can use to make changes and sustain them.
DISCOURAGING RECOVERYAND CHANGE
People do not recover or make meaningful changes when workers:
 Make decisions with out consulting them.
 Set goals without the client’s input.
 Demean or denigrate clients.
 Act as if clients are incompetent or less capable than they really are.
WHAT IS CHANGE?
Change means different things to different people.
 Change usually takes commitment and hard work.
For some change means
 Immediate improvements.
 Long-term alterations that will have far reaching effects on wellbeing and sense of self worth.
 Giving up an old habit.
 Accepting a diagnosis.
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WHAT KEEPS PEOPLE FROM MAKING
THE CHANGES THEY SAY THEY NEED?
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Fear
Uncertainty
Stubbornness
Denial there is a problem or that change is needed
Lack of confidence
Lack of hope
An inability to envision the future after change is accomplished
TEN FUNDMENTAL COMPONENTS OF
RECOVERY
FROM U.S. DEPT OF HEALTH AND HUMAN SERVICES, OFFICE OF SUBSTANCE
ABUSE, AND MENTAL HEALTH SERVICES ADMINISTRATION
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Self-Directed - The consumer
takes the lead.
Empowerment - Consumers
have authority to choose.
Non-Linear - There will be
setbacks.
Individualized and Person
Centered - Consumers
recover using their unique
strengths and resources.
Holistic - The plan addresses
the whole person.
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Strengths-based - recovery is
built on the person’s strengths.
Peer Support/Mutual
Support - clients encourage
each other and provide
knowledge to one another.
Responsibility - Clients take
personal responsibility for their
own recovery.
Respect - inclusion, full
participation, acceptance and
appreciation.
Hope - the message of a
better future.
BEYOND IMMEDIATE PROBLEMS AND
ILLNESS
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It is important to help clients plan for the future.
Help client visualize and articulate their goals and ideas for
themselves.
Encourage self-determination in where the client would like to go
from here.
Collaborate with clients on finding pathways to their goals and ideas.
Consider the physical health of clients and assist clients in obtaining
the health care they need, including physicals.
PEER SUPPORT
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Peer support is given by peers who have had similar problems and
recovered.
Peer support can diminish the sense of being alone for clients.
Peer support counselors often have tips that workers do not have.
DISCOURAGED
When clients are discouraged:
 The situation seems to overwhelm them.
 They have low regard for their capabilities.
 They are unwilling or unable to take responsibility.
 They describe their circumstances or other people as totally
domineering.
 They are unable to focus on solutions.
 Their goals seem unrealistic or impossible to them.
 They set impossible standards for themselves.
 They use global statements, such as “nobody likes me” or “I never
get invited” or “I have no friends”.
HOW CASE MANAGERS MOTIVATE AND
ENCOURAGE
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Begin where the client is - Use reflective listening to listen to
where the client is now before going for solutions.
See the client’s strengths - clients have strengths and capabilities
that will help them change.
Accurately assess the client’s ambivalence - Not all reluctance to
follow through is resistance. The client may be afraid or
overwhelmed.
Appreciate every effort - When working toward changes some
efforts may fail. Appreciate the effort.
Never lose sight of potential - focus on what clients can do and
talk about past accomplishments and experiences
STAGES OF CHANGE
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Stage One: Precontemplation - The client is not ready for change
and probably not even thinking about it.
Stage Two: Contemplation - The client is ready to explore change
but not ready to commit to it.
Stage Three: Developing a Plan - The client is ready to change but
needs a plan
Stage Four: Implementing the Plan - the client may be uncertain
but will actually change her habits, behaviors, or thinking.
Stage Five: Maintaining Changes - The client wants the changes
to be permanent. Sometimes there are still obstacles.
Relapse - the client is unable to sustain the change over a long
period of time and may return to the old ways.
AMBIVALENCE AND RELUCTANCE
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People move toward recovery at different rates.
Some people are more ambivalent about changing than others.
Ambivalence and reluctance are a normal part of changing.
Case managers need to accept the ambivalence and reluctance as
a normal part of moving toward change and recovery.
Some people stay with their ambivalence longer than others and
some people never move beyond it.
ROLLING WITH RESISTANCE
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We sometimes view reluctance and ambivalence as resistant.
There may be other reasons a person is not moving quickly
You may hear excuses or the person may ignore the plan you
constructed together. The client may avoid you or procrastinate.
We should see resistance as a signal to do things differently.
Resistance tells us that what we have constructed and the support
we are giving for change needs to be done differently.
Respect where the client is and make it clear that:
1. You want to listen
2. The decision is theirs
3. Ambivalence about change is normal