Week 1: Initial Assessment
Defining Objectives
What connections can the client draw between their level of physical activity and the other areas of their life? What benefits would more exercise or daily movement bring that the client will care about?
- Client will begin to make connections between his current level of physical activity and the areas of his life that are most challenging or stressful for him
- Client will be able recognize and talk about moments in his life where physical activity provided an escape, release, sense of accomplishment, sense of joy, or other positive result
- Client will identify specific forms of physical activity that interests him that will also help to improve his quality of life or manage negative symptoms
- Client will consider making an evidence-based decision to change his habits after engaging in learning and research and commit to trying one new form of physical activity to purposefully engage in before the next session
Taking Action
What information can you gather about this client’s attitude towards physical activity?
- Provider will assess the client’s motivation through the stages of change model and work to understand the client’s existing relationship with exercise in order to tailor the psychoeducation provided to best suit the client
- Provider will use motivational interviewing skills like open ended questions, decisional balance and scaling questions to gauge client’s awareness of how their physical activity could contribute to things that he is motivated to achieve (ie: freedom from his parents, improved self image, more motivation/drive, feeling better about self)
- Provider will stay mindful of potentially stressful associations the client may have with physical activity, engage in strengths-based assessment, and offer unconditional positive regard and affirmation when addressing client’s current patterns
- Provider will offer psychoeducation around the benefits of physical activity and guide the client towards forms of physical activity that fit their preferences and lifestyle
- Provider will request that the client identify a particular form of exercise to engage in prior to the next session
- Provider will refrain from offering unsolicited feedback without first asking for permission/invitation to do so
- Provider will refrain from assuming that their own methods of physical activity are superior OR that they are the best option for that client and will be mindful to be client centered in their approach
| Questions to Consider | Resistant Client Corner |
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The more structure a goal has, the more likely it is that the client can follow through. Get specific! Schedule a date and time in addition to identifying a type of exercise. Create reminders, notifications, and other accountability tools. For a very resistant client, consider what existing habits or leisure activities might be supplemented with physical activity. For instance, a client might be more open to a cardio workout if they know that they can watch their favorite show or play a handheld video game free of disruptions during the time in which they are exercising. |
When to Check In
As you dig into the client’s relationship with physical activity, you are likely to encounter other overlapping issues around body image, social status, and self-confidence that are well within the scope of your work. If the client presents any of the following indicators or behaviors in the initial assessment, connect with your supervisor to plan out the next few lessons accordingly:
- A physical limitation such as excessive body weight or poor coordination that may be contributing to avoidance and require a more customized plan
- History of bullying related to his childhood performance in sports or activities
- Poor body image and recurring negative self talk around his appearance
- How to work with resistance, not against it
Week 2: Solidifying Goals
Defining Objectives
How can the client build more positive associations between physical activity and the other facets of his life?
- Client will be identify the behavioral change(s) related to physical activity that made the most difference in the last week
- Client will be able to name a positive emotion or feeling associated with their physical activity of choice
- Client will be open to engaging in physical activity of his choice in the next session with his provider
- Client will continue to draw connections between his improved physical activity and improvements in his symptoms and motivation
Taking Action
What steps can you take to strengthen the burgeoning connections between physical activity and positive outcomes for the client?
- Provider will remain mindful of client’s history and current stage of change when conducting the session
- Provider will use MI to propose community-based physical activity to be conducted in this session or in the following session(s)
- Provider will continue to connect how improved physical activity in a social, supportive context can improve client’s overall experience, reduce negative symptoms, and boost motivation
- Provider will propose a plan of action to complete physical activity in the community over the course of the next session(s)
| Questions to Consider | Resistant Client Corner |
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Don’t beat yourself up if you don’t think the client is ready to take your plan and run with it. Sometimes slower is faster and change can take time. Be patient with the planning phase and don’t rush to judgment nor behavior change. Think about making a plan that changes the power dynamics and puts you in the position of the learner as well. If there is a physical activity that he wants to try that you haven’t tried, that might be a good way to demonstrate humility while trying new things. Work with the client to create a pump-up playlist of motivational songs or YouTube clips that inspire him before his next attempt. Identify a role model or avatar for the client to visualize and embody during their bouts of activity. This could be a historical figure, athlete, or fictional character that can provide the client with extra motivation. If the client resists naming positive emotions, work backwards by having him identify pursuits that do bring positive feelings, then illustrate how physical activity can provide the same benefits. For instance, a gamer might gravitate towards the clear markers of progression in their favorite game. Pursuits like weight training and running can offer similar feelings of measurable progress. |
When to Check In
Consider looping in the client’s care team if the client exhibits:
- Excessive or disproportionate anxiety around participating in a social situation
- An intensely negative or fixed mindset towards exercise that does not seem to shift after multiple sessions
Week 3: Work in Action
Defining Objectives
What activity or pursuit will the client engage in with their provider?
- Client will engage in physical activity with provider; Client will feel that they are a part of the decision making process around choosing an activity
- Client will be open to pushing through resistance with the support and encouragement of their provider
Taking Action
How will you show up for the client during your shared activity?
- Provider will model what it looks like to try new things, including physical activities that the provider has never engaged in before
- Provider will encourage, support, model, affirm and challenge client and themselves to engage in some level of relative difficulty during the physical activity
- (A) Provider will propose physical activity opportunities as a setting for future session(s) if the client is assessed to be in precontemplative, contemplative, or preparation stages of change OR
- (B) Provider will encourage a follow-up summative session when the client has demonstrated he is in the action or maintenance stage of change
| Questions to Consider | Resistant Client Corner |
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Consider starting with an activity the client is already comfortable with before branching out into something new. Then build upon that progress to try a new activity together. Position the client as an “expert” who has something to teach you about the chosen activity. Ask questions and demonstrate a healthy beginner’s mindset. Think about intentionally engaging in activities that are collaborative or that you’re not great at. Modeling how to learn new things is just as important, if not more important, than engaging in the activity in the first place. |
When to Check In
Engaging with the client outside of the office is a great opportunity to observe the client in a less formal environment. With his attention turned towards an activity, the client may let their guard down or exhibit behaviors that they wouldn’t ordinarily display in session. As you observe, consider following up with your supervisor if:
- Client exhibits emotional outbursts or extreme anger upon losing a game or failure to master a new skill
- You feel that the client may have had an experience within the activity that left him feeling unsafe or unsupported, whether due to an unforeseen injury, unexpected event, or heated moment
- You fear that the client is struggling to buy in to what’s being recommended, or that he seems to be doing things to appease you
- Your best laid plans didn’t work out the way you envisioned
Week 4: Future Goals & Lessons Learned
Defining Objectives
What lessons will the client carry forward? How can physical activity fit into their schedule consistently?
- (A) Client will engage in physical activity with provider OR (B) meet with provider in office to review changes throughout the month
- (A) Client will commit to a behavior change and talk about his experience of change with his provider OR (B) reflect on his experience and be able to connect those changes to improvements in his overall motivations or symptoms
Taking Action
What you should consider to help solidify or build on the changes the client has made or plans to make?
- (A) Provider will continue to engage in physical activity with client to support habit formation and build rapport OR (B) Provider will engage the client in a reflective dialogue to review the changes they have made, the obstacles they confronted, and the successes they experienced to solidify learning and assessed for continued change
- Provider will explore continued behavior change around physical activity and assess to see if future work in this domain would be beneficial or helpful to the client
- Provider will collaborate with client around future work based on this dialogue as well as broader assessments
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When to Check In
If the client reaches session 4 having made little meaningful progress, this is a great juncture to re-assess the client’s capacity for self-initiated changes outside of session time. The following indicators may be signs that the client’s overall treatment goals may need to be revisited in concert with your supervisor and any other members of the client’s team:
- If you have yet to engage in an activity together, meet with your supervisor to understand why it hasn’t happened and what roadblocks you are navigating
- If your client continues to struggle to initiate strategies dedicated to getting more exercise, consult with your supervisor and be ready to provide your conceptualization as to why that might be the case
- Think more holistically as to what the client is motivated to achieve: did your aim to improve physical activity miss the mark because you thought it was more important than the client did? How well were you able to tie this intervention to the client’s motivations? Consult with your supervisor if you feel like you’re striking out in this domain.