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

Appendices
counsellors make the mistake of assuming that just because the client acknowledges a not-sogood
thing about AOD use, this automatically presents a direct concern for them.
Now give a double-sided, selective summary. For example:
• “You said some of the things you like about using were … and then you said that
there was another side to it … you said some of the not so good things about using
were …”
Skill is required here in order to emphasise the not-so-good things. It can be useful to give the
client a chance to come to his/her own conclusions, for example:
• “Now that you’ve gone through both sides, where does this leave you? “
• “How do you feel about your drug use now?”
If, despite appropriate emphasis on the not-so-good aspects, the perceived benefits of using still
outweigh the perceived costs), continue MI and try to tip the balance in the other direction. If
ambivalence is evident, attempt to explore the reasons that underlie this imbalance and reestablish
the initial reasons for wishing to quit/cut down. Incorporate information on health and
psychological effects of continued use. Guide the client through a rational discussion of issues
involved, and carefully challenge faulty logic or irrational beliefs about the process of quitting.
Positive reinforcement and encouragement are crucial, but if you encounter resistance from the
client, do not push them.
NOTE: Use this strategy with caution for clients with high levels of anxiety or those who are not
ready to deal with the pressure of increased ambivalence. In addition, do not leave a depressed
client in psychological distress for too long after using the decisional balance strategy 330 . Avoid
using this strategy with a client who is currently tempted to use. Distraction is a better strategy
to use with someone who is currently tempted rather than to discuss the things they like about
using 118 .
Elaboration
Once a motivational topic has been raised, it is useful to ask the client to elaborate. This helps to
reinforce the theme and to elicit further self-motivational statements. One good way of doing
this is to ask for specific examples and for clarification as to why (how much, in what way) this is
a concern.
Querying extremes
Clients can also be asked to describe the extremes of their concerns, to imagine worst
consequences. For instance you may ask:
• “What concerns you the most?”
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