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COUNSELING FOR MOTIVATION

What is Motivation? ➣ helping significant others (relatives, friends, employer) ‘Motivation’ is creating the to intervene change one’s own dysfunctional and ‘motive’ is the energizing condition ➣ examining discrepancies be- that directs the individual to achieve that tween the client’s and others’ . Motivating the addict to accept help of problem behavior thus forms the first phase of treatment. ➠ Express concern and keep the door We can understand motivation as open, ensuring support anytime it is consisting of five stages — pre-contempla- solicited. tion, contemplation, preparation, Contemplation (Stage 2) and maintenance (Prochaska and Diclemente, 1984). The client acknowledges the problem, considers the possibility of change but is Pre-Contemplation (Stage 1) ambivalent and uncertain. The client is not yet considering change Strategies or is unwilling or unable to change. ➠ Help the client realize the need for Strategies for the Clinician/ change by Counselor ➣ eliciting and weighing the pros ➠ Establish rapport and build and cons of substance use and ➠ Raise doubts or concerns in the change client’s mind about substance use by ➣ examining the client’s personal ➣ exploring the nature of events values in relation to change that brought the client to ➣ emphasizing the client’s respon- treatment or the results of sibility for change previous treatments ➣ eliciting the client’s perception ➠ Elicit self-motivational statements of of the problem commitment from the client ➣ offering factual information ➠ Elicit ideas regarding the client’s about the risks of substance use expectations from treatment ➣ providing feedback about ➠ Summarize self-motivational state- assessment findings ments.

COUNSELING FOR MOTIVATION 69 Preparation (Stage 3) ➠ Assist the client in finding new reinforcers (new non-drug taking The client is committed to and planning friends, improved relationships with to make a change in the near future but is family members) of positive change. still considering what to do. Maintenance (Stage 5) Strategies The client has achieved initial such ➠ Clarify the client’s own goals and as abstinence and is now working to strategies for change sustain gains. ➠ Offer a list of options for change or treatment Strategies ➠ If willing, offer expertise and advice ➠ Help the client identify alternative ➠ Negotiate a change or treatment methods of enjoyment (games, plan in detail gardening, rearing pets) ➠ Help the client enlist family and ➠ Support lifestyle changes others’ support ➠ Affirm the client’s resolve and his ➠ Explore treatment expectancies and efforts the client’s role ➠ Help the client practice and use new ➠ Elicit from client what has worked coping strategies to avoid a return in the past either for him or for to use others he knows ➠ Assist the client in dealing with ➠ Maintain supportive contact (self- potential barriers related to entering help programs and contact with treatment — finances, leave etc. clinician) ➠ Have the client openly express to ➠ Review long-term goals with the family and significant others his client. plans to change. Action (Stage 4) KEY COMPONENTS OF The client is actively taking steps to change MOTIVATIONAL COUNSELING but has not yet reached a stable state. The key components of motivational Strategies counseling are a non-paternalistic, non- judgmental attitude on the part of the ➠ Reinforce the importance of remain- counselor, an orientation that accepts ing in treatment patients as they are, and techniques that ➠ Support a realistic view of change encourage and reinforce patient’s self- through small steps responsibility. The five basic principles of ➠ Acknowledge difficulties experienced motivational counseling are as follows. by the client in early stages of change Express Empathy ➠ Help the client identify high-risk situations and develop appropriate In providing counseling for a patient in coping strategies to overcome them recovery from , the counselor

70 COUNSELING FOR MOTIVATION needs to express empathy in order Avoid Arguments to convey of the patient’s cur- rent situation. Acceptance does not mean Arguing with a patient tends to evoke resistance. As a result, both the counselor agreement with, or approval of, the INFORMATION SECTION patient’s behavior. Rather, it is the res- and the patient are likely to come away pectful desire to understand the patient’s feeling dissatisfied and more entrenched frame of reference. It acknowledges that in their own positions. While motivational changing behavior is difficult and involves counseling is confrontational in its goals, feelings of ambivalence. it is not confrontational in style. Resistance by the patient is a signal to Respectful listening and reflection of the counselor to change strategies: feelings are two key skills I can see that you’re just not ready to for this task. For example, the counselor might say the following: try quitting right now. I would ask that you give some thought to what So, it seems like you think you should we have talked about, and let me stop using drugs at some point, but know if and when you’re ready. I’d you’re afraid that quitting would be like to help. too hard. Move Along with Resistance Identify Discrepancy The counselor can also ‘move along with This is accomplished by identifying and resistance’ by using the momentum of the amplifying incongruities between the patient’s resistance to shift his patient’s present behavior and his stated perspective. Turning a question or personal goals. Using skillful questioning problem over to the patient is an excellent to help the patient clarify goals and way to do this. This approach encourages explore consequences, the counselor can the patient to use his own resources to often get the patient to present his own solve the problem. For example, the reasons for needing to change. This counselor might use the following approach can be much more effective than statements: subjecting the patient to another lecture, Taking drugs is the main way that because it allows the patient to think you cope with stress, and you’re about his behavior without feeling worried about giving it up. That’s pressured and coerced. The following understandable. Let us explore other remarks could accomplish this goal: methods to deal with your stress. I know that you are interested in giving Support Self- up drugs. That is why you have come to the treatment center. Your This is the only possible path to change. unwillingness to get admitted as I The concept of self-efficacy can be perceive it, is due to withdrawal difficult, because it requires a shift in symptoms you may experience in giving perception that often seems at odds with up drugs. Would you like to know the professional ethics and values. Most treatment which would be given to counselors understand that they cannot bring down withdrawal symptoms? force patients to change their behavior.

COUNSELING FOR MOTIVATION 71 However, they feel inadequate or You’re not ready to make any plans frustrated when they are unable to to quit right now, but I’m glad we’ve persuade patients to do what is best for had a chance to talk about it. You’ve them. shown good judgment in making an appointment to see a counselor. We The counselors are encouraged to respect both know these things take time. the patient’s right to take decisions about his own behavior. At the same time, counselors are encouraged to define for ❋ ❋ ❋ themselves what they need to do in order to feel as if they have fulfilled their Thus, motivational counseling employs professional responsibilities. Letting go of techniques that encourage and reinforce the responsibility for change often frees the the patient’s self-responsibility. ■ counselor to listen more empathetically and *Reference — Miller. W.R. Enhancing Motivation for to assume a less authoritarian position. Change in Substance Abuse Treatment. Treatment Using this approach, the counselor can Improvement Protocol (TIP) Series 35, U.S. Depart- make statements such as the following: ment of and Services, USA, 1999.

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