The change process

Clients affected by problem gambling may not be ready or able to accept that they have a problem.

Your ability to help your client change their gambling behaviour will be greater if you:

  • understand your client's current stage of change
  • match your support and professional responses to the stage that they are currently in.

Any life change is likely to be a process rather than event. The change process in addiction was best described in the Motivational Interview (MI) and its derivative Motivational Enhancement Therapy (MET) developed by Miller, Zweben, Di Clemente and Rychtarik in the mid 1990s who described a more or less cyclic process of change in people making both self directed changes and change assisted by formal counselling.

Some key messages for professionals from this approach are:

  • change comes from the client rather from outside forces
  • the client (as opposed to the counsellor/professional) has to recognise, frame and resolve the ambivalence that will ultimately drive change
  • direct persuasion may not be effective in resolving change and may actually increase the clients' resistance to change
  • the client will be helped where a counsellor elicits information that helps them to examine and resolve their ambivalence to the behaviour they want to change
  • readiness to change is not an internal or fixed state but a fluctuating result of environmental and interpersonal interactions.
  • the therapeutic relationship resembles a partnership or companionship

For professionals working with people affected by problem gambling this therapy suggests helping clients to change requires recognising their current stage of change.

Movement between steps can be rapid and in both directions in the cycle. Having recognised where the client is in terms of stages of change, the professional must then use targeted strategies to enhance change and help the client move to the next stage.

Stages of change

Young plant growing in the morning light and green bokeh background

Find out about the different stages of change and what you can do for your client if they're transitioning through any of the following.

  • Pre-contemplation 'I don't have a problem'

    Pre-contemplation is the stage where a person hasn't connected their gambling to the problems it may be causing in their lives. 

    For example, track gamblers typically associate gambling with big wins and periods of abstinence and the consequences of gambling - financial hardship, marital discontent and alienation from their children and family as just 'normal life'.

    What can you do?

    • Build a rapport with your client
    • Explore the issues presented but do not label them 'a gambling problem'
    • Emphasise the client's ability to make decisions, their responsibility for those decisions and their consequences
    • Make it easy for the client to raise the issue again: keep the door open and keep it low key
    • Explore the surrounding issues
    • Be willing to follow up
    • Use motivational interviewing techniques

    What can Gambler's Help do?

    By definition a pre-contemplative client will not accept a referral to a Gamblers Help organisation – why would they?

    If you have rapport and an ongoing relationship with this client, it is better for you to continue working with the client but don't ever collaborate with their gambling, always be prepared to bring it up and factor it into any other interventions you are doing. 

    For example when setting a budget or managing time you may want to, incorporate their gambling in a matter of fact way.

    Gambler's Help services can provide support for family members of pre-contemplative clients and provide you with advice and information, through:

  • Contemplation 'I know I have a problem and need to change. I will do something about it, one day'

    The contemplative client is thinking about their gambling as a problem but is not committed to change and may not even believe this change is possible for them. 

    What can you do?

    Your goal should be to help tip the balance in favour of changing their behaviours and provide hope that is that change is possible:

    • Help your client self-reflect
    • Act as a sounding board for your client
    • Use motivational interviewing strategies
    • Provide your client with information about
    • Gambler's Help services
    • Try to direct your client to visit the Reducing Harm pages of this website
    • Keep it "low key"
    • Highlight the discrepancy between your client's goals and their behaviour
    • Prompt self-motivational statements

    What can Gambler's Help do?

    At this stage, your client may want more information about treatment services. It's important that you represent Gamblers Help services as credible and effective help services. 

    Gamblers Help services can help the contemplative client and will also help the family members/affected others.

    If your client is in the contemplation stage, Gambler's Help can provide you with advice and information, through:

  • Determination 'Yes I have a problem and I need to do something to change - now'

    What can you do?

    If your client is in the determination stage, they recognise the need to change and resolved to do something about it. You have a valuable window of opportunity to help your client move into action.

    At this stage, you need to:

    • Help your client find an accessible, appropriate, acceptable and effective strategy for change
    • Reinforce and support their decision to change – help plan activities for change
    • Explore your client's goals
    • Recommend the 'Getting Help' section of this website for information on:
    • self exclusion,
    • self assessment,
    • resources for gambling change,
    • the phone Apps that can identify when the client enters a gambling venue and give self help options to use at that time
    • a self help workbook for changing gambling
    • numerous resources for changing gambling and gambling information
    • Facilitate an 'assisted referral' to Gambler's Help services
    • Directly link your client with their local Gambler's Help service
    • If you are a Primary Care Partnerships member, you may consider using the Service Coordination Tool Templates to support this process.
    • Follow up on the assisted referral

    What can Gambler's Help do?

    During the determination stage, your client needs to work with Gambler's Help services. These services are free and confidential, will see Affected Others/Family members and can provide services:

    • Face to face
    • By phone
    • Online through text or email

    At this stage, YOU can engage with Gambler's Help for information on:

  • Action 'I am doing something to change my behaviour now'

    What can you do?

    If your client is in the action stage, they are not only determined to change their behaviours but are doing something about it.

    This is the time to encourage your client to change by focusing on the three key aspects of gambling change known as the gambling triangle; time, money and mood.

    During this stage, it is important that you support your client by providing them with effective strategies for changing their behaviours:

    • Set goals
    • Identify people, friends or mentors who can help and contact these people
    • Deal with other related and underlying issues
    • Prepare for possible relapses and relapse prevention
    • Help develop new skills: stress management, anxiety management, stimulus (avoiding dangerous situations) and coping with the urge to gamble
    • Teach your client to delay, distract and desist from gambling
    • Encourage your client to get involved in alternative activities
    • Focus on building resilience
    • Help your client to identify and reinforce "what's working"
    • Direct your client to visit the Reducing Harm pages of this website
    • Facilitate a cold referral - Provide your client with information about the nature and types of services offered by Gambler's Help and direct them to their local service

    What can Gambler's Help do?

    During the action stage, Gambler's Help can offer your client a range of services, including:

    • Self Exclusion Program

    Gambler's Help can also provide you with the following services:

    • Provider Education
    • Specialist portfolio services
    • Secondary consultation
    • Supported assessment
  • Maintenance 'I've changed'

    Your client has found all the things they need to do to change their behaviour and started to put this into practice.

    Working with the maintaining client.

    What can you do?

    If your client is in the maintenance stage, they are actively working on their changed behaviours. At this stage, it is important that you support your client to maintain the changes they have made:

    • Encourage and foster personal development
    • Help your client to avoid feeling discouraged
    • Help your client to continue contemplating change, renewing their determination and resuming action
    • Explore lifestyle issues not directly related to gambling, such as parenting, budgeting, relationships, education and employment
    • Help your client to build self protective behaviours
    • Reinforce and encourage "what works" for your client
    • Help your client to identify possible triggers for lapse

    However it is also helpful to warn your client that lapses into gambling are normal and have a plan to deal with this if it happens.

    What can Gambler's Help do?

    During the maintenance stage, Gambler's Help can offer your client a range of services including:

    • Peer Connection program
    • Chinese Peer Connection program
    • Gambler's Help Line (1800 858 858)

    Gamblers Help can also provide you with the following services:

    • Provider Education
    • Specialist portfolio services
  • Lapse/Relapse 'I have started gambling again'

    What can you do?

    Sometimes during the change process when clients have started to recover, they will start gambling again.

    This happens so often that it can be considered a normal part of the change process. It can be a difficult time for the gambler and their Affected Others particularly if they set a target of total and enduring abstinence. 

    Where the gambler has made absolute promises - "I will never gamble again" and where Affected Others have made threats – "If you ever gamble again I will leave you" - both can feel disempowered by the gambling and emotionally devastated.

    In this stage the client is likely to feel confused about what went wrong and what led to the gambling. Identifying the triggers for gambling can be a help.

    Your primary role at this time is instilling hope. The client has gambled but they are not back at square one, the time and effort they have spent not gambling still means something and can make getting back control over their gambling easier, and perhaps more realistic than it was the last time.

    During relapse, you should help your client to explore ways to avoid future relapses and encourage them to learn from their relapse behaviour to prevent future occurrences:

    • Identify a relapse when it occurs
    • Re-establish your client's commitment and ability to change
    • Provide crisis intervention
    • Avoid blame
    • "Name and normalise" your client's relapse behaviour
    • Help your client understand that lapse is a common part of the process of change
    • Help your client to understand the triggers for lapse
    • Develop strategies to avoid relapse
    • Recognise and reinforce your client's ability to successfully maintain change
    • Encourage your client to re-engage with the Gambler's Help services

    What can Gambler's Help do?

    At this stage, your client may need to re-engage with their local Gambler's Help service. For some clients, this may be a brief intervention while for others; it may mark a new episode of care.

    Gambler's Help can also provide you with information on strategies to deal with lapse and relapse through:

    Gamblers Help can also provide you with the following services:

    • Provider Education
    • Specialist portfolio services

Contact your local Gambler's Help service

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http://responsiblegambling.vic.gov.au/for-professionals/health-and-community-professionals/screening-and-supporting-patients/change-process/
Last updated: 13 October 2022
Printed on: 23 September 2023