Counseling
Match the intervention to the stage
Most counseling items reduce to one question: does the clinician's behavior fit where the client actually is? Use the stages of change - precontemplation, contemplation, preparation, action, maintenance (and relapse as a stage, not a verdict). With a precontemplative client, the work is raising doubt and building Alliance, not assembling a relapse-prevention plan.
Core models to know
- Motivational interviewing: spirit of partnership, acceptance, compassion, evocation. Microskills - open questions, affirmations, reflections, summaries (OARS). Evoke and reinforce change talk (desire, ability, reasons, need, commitment, activation, taking steps); reflect rather than argue with sustain talk. MI is a way of being with people, not a technique for tricking them into compliance.
- CBT and MET: identify and restructure thoughts and behaviors that maintain use; enhance self-efficacy.
- Relapse prevention: high-risk situations, apparently irrelevant decisions, coping skills, and the distinction between a lapse and a relapse - a slip is information, not a discharge criterion.
- Contingency management: tangible, structured reinforcement of verified abstinence. Twelve-step facilitation: active, structured introduction to mutual-help.
- Group and family work: stage-matched, confidential, with clear ground rules.
Traps
Confronting a client who is not yet ambivalent; giving advice instead of eliciting the client's own reasons; labeling ambivalence as 'denial' and treating it as a character trait; the counselor talking more than the client; treating a lapse as proof the plan failed.
Rule of thumb
When you notice yourself arguing for change, you have stopped doing MI - roll with it: reflect, summarize, and ask.