appendix d: motivational interviewing - National Drug and Alcohol ...

Appendices
• Express optimism about change.
• Express intent to change.
These strategies include:
Typical day
Often a client deems certain aspects of his/her life irrelevant to treatment or they are
insignificant to the client and overlooked and therefore not disclosed during therapy. However,
knowing these things can help a worker engage with the client. It can also provide a more
holistic view of the person as well as invaluable information concerning daily habits, significant
environments, important relationships and people in the client’s life. Furthermore, this can
highlight to the client aspects of his/her life that he/she had not been aware of (e.g., “I hadn’t
realised I was drinking that much”).
In order to attain this information it can be useful to ask the client to explain how he/she spends
an average day. Encourage the client to pick an actual day (e.g., last Wednesday) rather than
what they do “most days”.
Allow the person to continue with as little interruption as possible. If necessary, prompt with
open-ended questions (e.g., “What happened then?” or “How did you feel?”). Review and
summarise back to the client after he/she has finished, and clarify that you have summarised
accurately.
Once you have a reasonably clear picture of how the client’s use (and any co-occurring mental
health symptoms) fits into a typical day and any current concerns, ask the client’s permission to
provide feedback from your assessment (e.g., “I’m getting a feel for what’s going on in your
everyday life at the moment, you’ve mentioned several things that are concerning you”).
Summarise these problem areas briefly, using those issues raised by the client in the “typical
day” discussion (e.g., quality of life, health, mood, drug use).
Decisional balance (good and not so good aspects)
This technique involves a conscious weighing up of the pros and cons of certain behaviours (e.g.,
drug use). Clients are often aware of the negative aspects involved in certain behaviours but
have never consciously assessed them. The decisional balance is a frequently used motivational
strategy, particularly when clients are displaying ambivalence regarding their substance use and
for when you want to determine their stage of change in regard to their substance use.
Begin by asking questions like:
• “What do you like about your use of …?”
• “Tell me about your drug use. What do you like about it? What’s positive about
using for you?”
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