TPC-Journal-V3-Issue3

146 The Professional Counselor \Volume 3, Issue 3 Once goals are generated, it is imperative to assess the client’s readiness to pursue goals so that the appropri- ate treatment approach can be tailored to meet the client’s stage of change (Hettema & Hendricks, 2010; Lun- dahl, Kunz, Brownell, Tollefson, & Burke, 2010). One way to assess a client’s readiness is to ask the client: Sabine, we are all at various stages of change in our lives depending upon a number of factors. I’m curi- ous, with the goals you have mentioned, on a scale of 1–10 with 1 being not ready and 10 being very ready, where would you say you are in terms of making changes in your life? The counselor then processes the responses; if the client is ready, the counselor helps the client tailor small objectives to reach goals. If the client expresses reluctance toward making change, the counselor can proceed as follows: It seems you are frustrated being here, and it doesn’t sound like you feel you need to work on anything at this time. I respect your ability and power to choose what is right for you. So, if this needs to be the end of the session, please let me know. However, given we have 20 minutes left in this session, what would be most helpful for you? Step 3: Treatment Planning Assuming the client is ready to make changes, the counselor can proceed with the treatment planning phase of the model. To begin this phase the counselor draws from solution-focused brief therapy (DeShazer, 1991; Metcalf, 1998; O’Hanlon, 1999) and asks, “What is a small step you would be willing to take between now and next session that may move you closer to your goals?” It is important to note at this point that goals do not have to be established for each model domain. The idea is to have clients choose their goals and take small steps to ensure forward progress and success, which will hopefully lead to further goal attainment and eventually in- creased confidence and symptom relief, all based on appropriate treatment fit (see Table 2). Table 2 Completed Treatment Fit Model Behaviors Cognitions Assessment: Avoids driving Assessment: Believes she is out-of-control Goals: Gradually begin driving places other than work (i.e., running errands and visiting with friends and family) Goals: Believe she has tools to cope with and reduce emotional and physiological reactions (i.e., “I can cope with this. I can overcome this.”) Treatment Plan: Daily practice of breathing and mindfulness exercises learned in session Treatment Plan: Keep a journal of thoughts, which will be used in session to restructure unproductive thinking Physiology Emotions Assessment: Shortness of breath; tight chest; sweating hands; racing heart Assessment: Feels anxious and afraid Goals: Reduce and become more tolerant of physiological symptoms Goals: Reduce and become more tolerant of anxious feelings Treatment Plan: Limit caffeine and sugar, engage in daily aerobic exercise, and practice good sleep hygiene Treatment Plan: Increase awareness of symptoms of anxiety and implement grounding exercises learned in session to reduce symptoms