Counselling / Lifestyle

Counselling

1. When counselling a patient:

   • Set clear therapeutic goals with the patient

   • Allow adequate time

   • Evaluate your own skills (e.g., Does the problem exceed the limits of your abilities? Are you the right person and is this the right time to unpack the patient’s concerns?)

   • Recognize when you are approaching or exceeding boundaries (e.g., transference, counter-transference)

   • Recognize when your beliefs or biases may interfere with counselling

   • Remain aware of the risks of offering advice versus providing options

   • Pay close attention to the quality of the therapeutic relationship and alliance

2. For a patient who is considering or requesting referral for counselling/psychotherapy, clarify concerns and provide realistic information about the process and available resources (e.g., expectations, timing, frequency, costs, duration, homework, starting/ending the relationship if ineffective).

See also: Crisis

Lifestyle

1. In the ongoing care of patients, ask about behaviours that, if changed, can improve health (e.g., diet, exercise, alcohol use, substance use, safer sex, injury prevention (e.g., seatbelts and helmets).

2. Before making recommendations about lifestyle modification, explore a patient’s readiness to change, as it may alter advice.

3. Explore a person’s context (e.g., poverty) before making recommendations about lifestyle modification (e.g., healthy eating choices, exercise suggestions) so as to avoid making recommendations incompatible with the patient’s context.

4. In the ongoing care of patients, periodically review their behaviours, recognizing that these may change.

5. In the ongoing care of a patient, regularly reinforce advice about lifestyle modification, whether or not the patient has instituted a change in behaviour.

See Periodic Screening

Counselling

• Explore context (eg. Financial, social, culture, etc...) to make appropriate recommendations

• Remain aware about

  • Transference

    • Patient redirects feelings for others onto therapist

  • Counter-transference

    • Redirection of a psychotherapist's feelings toward a client (eg. emotional entanglement with a client)

Strategies

• Readiness to change

  • Precontemplation (Not ready)

    • Highlight advantages for change and problems with current behaviour,

    • Harm reduction

  • Contemplation (Getting ready)

    • Weigh pros and cons, explore ambilance/alternatives, identify reasons for change/challenges, increase confidence

  • Preparation - Action (Ready)

    • Goal setting, start date and strategy for change, as well as address challenges

    • Support and praise, stress that episodes of relapse are normal

  • Maintenance (Sticking to it)

    • Help identify and use strategies to prevent relapse

  • Relapse (Learning)

    • Help renew process of contemplation and action without becoming demoralized

• Five A's (Health risk behaviour):

  • Ask "Would you mind if I talked to you about your smoking? How often do you smoke/exercise/wear a seatbelt?"

  • Advise "As your doctor, I strongly recommend that you ____. It is one of the most important things you can do for your health."

  • Assess "Are you ready to quit smoking in the next 30 days?"

  • Assist "Quitting smoking can be a real challenge. I can help you with this change, as well as pharmacotherapy/community resources/spousal support may help.”

  • Arrange 'I'd like to see you again/call you next week to see how the plan is going."

• BATHE (Psychosocial problem)

  • Background "What's going on in your life?"

  • Affect "How do you feel about this situation?"

  • Troubles "What bothers you most about the situation?"

  • Handling "How are you coping with the situation?"

  • Empathy "It sounds very difficult."

• RULE (Motivational interviewing for behaviour change)

  • Resist the righting reflex

  • Understand the patient’s own motivations

  • Listen with empathy

  • Empower the patient

Generic Lifestyle Advice

• Decrease

  • Smoking, alcohol, marijuana, drugs

  • Salt, fat, sugar, calories

  • Screentime/TV

  • Stressful activities/work

  • Exposure to triggers (allergies)

• Increase

  • Exercise

  • Healthy eating choices

  • Relaxation strategies (breathing)

• Injury prevention (helmets/belts)