A nurse is reinforcing teaching with a client about avoiding foods with tyramine. The client states, "Thank you for all of this information, but it's just not for me. I eat what I want when I want it." Which of the following stages of change is the client demonstrating?

A. Although you have mentioned wanting to talk today about your past abuse, let's discuss this handout I have with new coping skills. Redirecting the client away from their chosen topic disregards their needs and autonomy. Patient-centered care involves respecting the client’s concerns and prioritizing what is most meaningful to them.
B. I am going to have to change our meeting time because I need to go get lunch. Changing the meeting time based on the nurse’s personal needs rather than the client’s schedule does not align with patient-centered care. The focus should remain on the client's well-being and therapeutic relationship.
C. Let's review the goals you set today and see what your priority is this week. Reviewing client-established goals and prioritizing their needs aligns with patient-centered care. This approach fosters collaboration and empowers the client to take an active role in their recovery.
D. I would like to focus on what I believe are the best goals for you to work on. Imposing the nurse’s priorities over the client’s goals does not support patient-centered care. Instead, care should be tailored to the client's preferences, values, and recovery journey.

A. "When attending dialectical behavior therapy." Dialectical behavior therapy (DBT) is specifically designed to help individuals with borderline personality disorder (BPD) manage emotions and reduce self-harming behaviors. While therapy can bring up distressing emotions, it provides structured support and coping strategies. The risk of self-harm is lower when clients are actively engaged in treatment and receiving professional guidance.
B. "When getting married." Major life changes, including marriage, can be stressful for individuals with BPD, but they do not inherently pose the highest risk for self-harm. Support from a partner and structured therapy can help navigate emotional challenges. While instability in relationships can trigger distress, the protective factors of marriage may reduce immediate risk. Self-harm risk is typically higher in periods of transition without support.
C. "When discharged from the hospital." Clients with BPD often struggle with emotional regulation, and discharge represents a significant transition with decreased support. The sudden loss of a structured inpatient setting can increase feelings of abandonment and distress, leading to a heightened risk of self-harm. Ensuring a follow-up care plan and support system is crucial to reducing this risk after hospitalization.
D. "When attending narrative therapy." Narrative therapy helps clients reframe their experiences and build a stronger sense of identity. Although deep emotional topics may be explored, structured therapy provides a safe space for expression. Therapeutic interventions aim to reduce distress and teach coping mechanisms, decreasing the likelihood of self-harm. The highest risk occurs when structured support is suddenly removed.