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Approaches to Counseling – Approaches to counseling have been developed and tested in academic and clinical settings. These approaches underlie and support the methods we use when interacting with our clients (see below).
- Behavior Modification – Since we recognize that tobacco addiction has a behavioral component, the behavior modification techniques help a client recognize his patterns of and reasons for using tobacco and help him anticipate and avoid events, situations and feelings that trigger tobacco use. This technique is founded on the assumption that recognizing behavior is the first step in changing it.
- Solution-Focused Brief Therapy – change in emphasis from focusing on the problem to constructing workable solutions for that client and developing self-resourcefulness.
- Recovery-Oriented Therapies – focusing on the tobacco-free life and the client’s “relationship” with tobacco – facing fears, exploring ambivalence, and investing in the future
Treatment modalities or frameworks can be used when talking with clients to deliver the counseling approaches outlined above. These modalities can be combined or modified, depending on the setting, allowable time, receptivity of the client and other circumstances:
- Motivational interviewing
- Express empathy (incorporating reflective listening)
- Develop discrepancy (give them insight into what they are doing now vs what they would like to be doing)
- Roll with resistance (avoid argumentation; recognize client’s counter-motivations)
- Support self-efficacy (helping them to recognize and develop their own self-confidence to accomplish their goal)
F.R.A.M.E.S. (Brief Motivational Interviewing): This acronym is explained in depth at the Brief Motivational Interviewing page.
Five A’s and the Five R’s - These refer to tailored messages useful for brief interventions that are easy to remember. (Fiore, et al., 2000). These are explained in depth at the following links:
Printable version of the 5 As and 5 R s for brief interventions can be found in the Tools & Materials Section of the Library Reference Desk or here:
Stages of Change: The goal of motivational interviewing is to help clients move toward being ready to change behavior, NOT to get someone to quit using tobacco (Gauvin, 2000). It is important to remember that there are recognizable stages of change. Even if a client is not ready to hear your message, you can still advise them of the risks and provide them with information and literature. The Stages of Change model was addressed in the Basic Tobacco Intervention Skills Certification that you should have completed as a prerequisite to the Treatment Specialist; you may review your Basic Skills Guidebook or view the diagram of the model found at this link:
Further descriptions of the Stages of Change model for tobacco cessation can also be found at this link:
Relapse Prevention / Management: Due to the chronic relapsing nature of tobacco dependence, relapse prevention should be included in any tobacco cessation treatment program
(Fiore et al. 2000). The primary goal of relapse management is to prevent the client's setback from escalating, and to help the client develop competent coping strategies for present and possible future problems.
Social Support: Social support is an effective component of a comprehensive program for tobacco dependence. The increase of social support in the tobacco user's environment can increase long-term cessation by 50 percent (Surgeon General's Report, 2000). Individuals participating in treatment should be educated about and offered both intra-treatment social support and extra-treatment social support. Increasing the unity among members of smoking cessation groups can enhance both types of social support (Fiore et al., 2000).
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