Psychosocial Concepts and Support Systems
Biopsychosocial framing
Health and recovery are shaped by biological, psychological, and social factors. Assess adjustment to illness and disability, coping style, family systems, caregiver burden, and social support. Support has several types: emotional, instrumental, informational, and appraisal. Strengthen resilience and empowerment rather than doing for the client what the client can do.
Change, crisis, and grief
Know the stages of change: precontemplation, contemplation, preparation, action, maintenance, with relapse as an expected part of the cycle. Interventions should match the stage; arguing for change with a client in precontemplation typically increases resistance. Motivational interviewing uses open questions, affirmations, reflective listening, and summaries, and rolls with resistance. Crisis theory addresses disequilibrium and the need for immediate stabilization. Grief is individual and not a mandatory sequence; grief is not the same as depression.
Screening and planning
Screen for depression, substance use, and suicide risk. Asking directly about suicidal thoughts does not increase risk and is the appropriate response to warning signs. Use trauma-informed principles of safety, trustworthiness, choice, and collaboration. Address advance care planning, palliative care, caregiver support, and community resources and support groups.
Traps to watch
Treating grief stages as a required progression; assuming all older adults are depressed or that grief is depression; pushing action before readiness; bypassing family dynamics.
Worked example
A client who smokes says, "I know I should quit, but I'm not sure I can." This reflects contemplation. The correct approach is to affirm ambivalence and explore pros and cons, not to hand over a quit plan as though the client were in the action stage.