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Payoff Matrix Helps Clients Make Changes

A few tried-and-true practices can help clients struggling with addictions or chronic illnesses resolve to take the steps needed to change their behaviors and improve their health.

Participants often wax and wane in their motivation to make changes in their life. They may often feel ambivalent about changes, even ones they want to make. This is understandable. Practitioners can help participants weigh the pros and cons of change through exploratory discussions. For example, they might ask, "What do you think would be the advantages of applying for Social Security benefits?" and "What do you think would be the disadvantages of applying for benefits?" Or practitioners might help participants use a payoff matrix.
The payoff matrix involves prompting the participant to identify the advantages and disadvantages of an action or a behavior as well as the advantages and disadvantages of not performing the action or behavior. For example, the payoff matrix could be used to help a person decide whether to stop smoking marijuana. The practitioner asks the client to explore both the positive and negative effects of smoking marijuana and then to weigh the importance of those effects. The positive effects of smoking marijuana might include having friends to hang out with, feeling temporarily "high" rather than depressed, and being less bored. The negative effects might include financial problems, precipitation of health risks, and interference with achieving employment goals. The practitioner then also asks about the positive and negative effects of stopping smoking marijuana. Examples of positive effects of not smoking might include better control over one's money, less severe symptoms, less conflict with family members, and a better ability to pursue one's vocational goals. Examples of negative effects of not smoking might include having to say "no" to friends who smoke, finding new friends who don't smoke, not having an escape from depressed feelings, and not having anything fun to do when feeling bored. When considering the advantages of changing the behavior in question, it is important for the practitioner to encourage the participant to think of whether such a change could help the person achieve his or her recovery goals.

Sometimes after completing the payoff matrix, especially when the participant clearly sees how the behavior change may help him or her achieve his or her goal, the person becomes motivated to work on changing the behavior. However, at other times, despite the evident advantages of changing the behavior, the participant may continue to feel ambivalent about changing the behavior. In this situation, the key to shifting the decisional balance toward change often lies in further exploring and addressing concerns the participant has about the anticipated change--specifically, addressing the participant's perceptions of the negative effects or disadvantages of change.

Using the previous example of a participant deciding whether to quit smoking marijuana, the practitioner could explore with the participant strategies for reducing the disadvantages of not smoking, such as dealing with friends who smoke, feeling depressed much of the time, and having nothing fun to do. Examples of strategies for addressing such problems could include learning to say "no" to friends when they invite the person to smoke marijuana, identifying new places or activities where the person could meet people who do not smoke, learning new ways of coping more effectively with depressed feelings, and developing new and rewarding things to do with one's spare time.

Considering these strategies and making a plan to learn and implement them can motivate participants to make important lifestyle changes that will help them better manage their psychiatric disorder and achieve their recovery goals.

Excerpted and adapted from the Implementation Guide to Illness Management and Recovery IMR: Personalized Skills and Strategies for those with Mental Illness. by Susan Gingerich and Kim T. Mueser. Hazelden, 2011

Evidence-based treatment models

The Hazelden Co-occurring Disorders Program helps treatment programs implement effective, integrated services for people with non-severe mental health disorders that co-occur with substance use disorders.

Integrated Combined TherapiesIntegrating Combined Therapies utilizes a combination of motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), and Twelve Step facilitation (TSF) therapy. Each of these models of therapy has been proven successful when used in community addiction treatment programs.

Cognitive-Behavioral TherapyCognitive-Behavioral Therapy, utilizes cognitive-behavioral therapy (CBT) principles to address the most common psychiatric problems in both mental health and addiction treatment settings.

Read more about the Hazelden Co-occurring Disorders Program

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