Getting Them to Say ItEncouraging Pre-Health Students to Develop Realistic Expectations

Julie R. Nelson, Kate Karacay and Emily BrunnerAcademic Advising CenterThe University of Iowa

For Today• Counseling and Advising• How Counseling Theories Inform

Advising• Intentional Advising Interventions

Counseling and Advising

The Same, But Different

Counseling and AdvisingON THE ONE HAND

• Advising is NOT Counseling

• Different Purpose• Ethical Practice

ON THE OTHER HAND

Advisors are First to Know

Advising as Problem Solving

Affective Nature of Advising

See Crookston, B. B. (1972). A developmental view of academic advising as teaching. Journal of College Student Personnel, 13, 12-17.

Four Main Benefits• Counseling:• Teaches Problem Solving• Encourages Communication• Values Process Orientation• Provides Context

Competitive Majors—Unique Student Population

• Pre-Health Challenges• No Guarantee• Highly Competitive• Few Second Chances

• Advising Priorities, Student Realities• Beginning Well = Accurate Assessment

What to Assess? Problem-Solving Ability and Coping Skills• Ask Yourself, Notice:

• Is this a Problem-Focused Problem?• Is this an Emotion-Focused Problem?

D'Zurilla, Nezu, & Maydeu-Olivares, 2002; Dobson, 2010; Cormier & Nurius, 2003.

Problem-Focused Problem

• Problem is Solvable• Problem is a Challenge (apart from

self)• Problems can be Successfully

Resolved• Problems Take Time (and that is okay)

D'Zurilla, Nezu, & Maydeu-Olivares, 2002; Dobson, 2010; Cormier & Nurius, 2003.

Problem-Solving Skills

• Problem Definition• Ability to Generate Alternative

Solutions• Making Decisions• Solution Implementation is Realistic

D'Zurilla, Nezu, & Maydeu-Olivares, 2002; Dobson, 2010; Cormier & Nurius, 2003.

Emotion-Focused Problem

• Student Mindset:• Problems Threaten Well Being or Identity• Create Doubt about Ability to Succeed• Have Low Tolerance for Uncertainty• Problems Take Time (and that is not okay)

D'Zurilla, Nezu, & Maydeu-Olivares, 2002; Dobson, 2010; Cormier & Nurius, 2003.

Emotion-Focused Problem

• Situation or problem is not changeable• Focus on student’s reaction• Advising support = helping student cope

+ helping student respond more effectively

D'Zurilla, Nezu, & Maydeu-Olivares, 2002; Dobson, 2010; Cormier & Nurius, 2003.

What to Ask…

• “How did it feel?” [Affective]• “What did you tell yourself?” [Cognitive]• “What were you doing?” [Behavioral]• “Who supported you?” [Relational]• Describe where you were. [Contextual]

Cormier & Nurius, 2003.

How Counseling Theories Inform Advising

A Light by Which to See

Two Theories• Grief and Loss• Transtheoretical Model of Change

Theories on Grief• Elizabeth Kubler-Ross• J. William Worden

Kubler-Ross (1969); Worden (2009).

Kubler-Ross Stages• Denial• Anger• Bargaining• Depression• Acceptance

Kubler-Ross (1969).

Worden’s Four Tasks• Accept the Reality of the Loss• Process the Pain of Grief• Adjust to a World Without the Deceased• Find an Enduring Connection to the

Deceased in the Midst of New Life

Worden (2009).

Grief in Pre-Health Advising

• Loss of Identity—Personal & Social• Things Are Not What They Seem

Responding to Loss• Making Room for Grieving• Normalizing Uncertainty• Acknowledging Embarrassment• Building Network of Support

TranstheoreticalModel of Change• Prochaska & DiClemente (1982)• Five Stages of Change• Resolving Feelings of Ambiguity

See Prochaska, J. O. & DiClemente, C. C. (1982) Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, Practice, 19, 276-88.

See Prochaska, J. O. & DiClemente, C. C. (1982) Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, Practice, 19, 276-88.

Motivational Interviewing• Motivational Interviewing Aims to

Stimulate Intrinsic Motivation to Change by Exploring and Resolving Ambivalence.

• Effective with Advisees Who Contemplate Change but Feel Hindered by Uncertainty.

Miller, W. R. & Rollnick, S. (2013). Motivational interviewing: Helping people change. 3rd Ed. New York: Guilford.

Position on Change

• How Does the Student Feel about Change?

• Would the Student Give You Permission to Explore Options?

Resistance in MI• Ambivalence Hinders Adaptive Behavior• Resistance Likely w/ Loss of Freedom or Choice• Resistance is a Product of Interaction• Resistance is a Barrier to Change Talk• Advisor Allows Resistance• Reduce Resistance to Avoid Rupture w/ Advisee

Moyers, T. B. & Rollnick, S. (2002). A motivational interviewing perspective on resistance in psychotherapy. JCLP/In Session: Psychotherapy in Practice, Vol. 58(2), 185-193.

With MI:• Establish a Relationship• Set an Agenda• Determine Multiple Behaviors in Need of

Change• Student Decides on Single Behavior to Change

• Importance + Confidence + Readiness Scaling• Explore Importance/Build Confidence

See Miller, W. R. & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviors. New York: Guilford. See also Rollnick, S., Mason, P., & Butler, C. (1999). Health behavior change: A guide for practitioners. London: Churchill Livingstone.

Intentional Advising Interventions

Getting Them to Say It

“Life can only be understood backward,but it must be lived forward.”

-Soren Kierkegaard

Getting Started• Beginning the Advising Relationship

with Acknowledgement of Challenges

• Frontloading Information without Overwhelming Students

• Reflecting in Real Time: Advising as Collaboration

What to Say…• Getting the Conversation Started• Using Open-Ended Questions• Helping Students Develop Insight• Empowering Students to Change

Cormier & Nurius, 2003.

Thank You!

Questions?