Monday, October 5, 2009

I Love TIP 35

All of the TIPS I have reviewed have contained good information, but TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment is my favorite so far. I have not read much of it, but I noticed that it is a very thorough, step-by-step guide to engaging clients and encouraging change at all the different stages. I read the part about dealing with precontemplators and I was impressed with how it not only explains what needs to be done but gives lots of examples of actual things you could say to someone who doesn’t think they have a problem. It even explains how the client often thinks that other people do not see the situation correctly, and how the counselor can seek to find the client’s viewpoint in a non-judgemental way.

In my presentation that I was going to give in class today, I was going to talk about an involuntary client, and I was going to quote from TIP 35 about how client motivation is influenced by the counselor’s style. The way the counselor relates to the client has a powerful effect on how they react to treatment and whether they achieve the intended results. I noted that “establishing a helping alliance and good interpersonal skills” were found to be “more important than professional training or experience.” It is interesting because I know someone who just did an alcohol assessment (involuntarily) and I casually interviewed him about it on the phone (because I’m taking the class) and while it can certainly be said that he is in denial about his problem, he was not persuaded in the least to become more contemplative by the way his assessor spoke to him. Apparently she did not make any effort to establish a rapport and came across in a very demanding and demeaning manner. TIP 35 says:

“A direct comparison of counselor styles suggested that a confrontational and directive approach may precipitate more immediate client resistance and, ultimately, poorer outcomes than a client-centered, supportive, and empathic style that uses reflective listening and gentle persuasion (Miller et al., 1993).”

I also read about this Johnston Intervention. It is a scenario in which friends and family rehearse what they are going to say to the client about how the substance abuse is affecting them and then, with some element of surprise all of these people confront the client in the counselor’s presence. Apparently is has been revised into a fairly successful way to get uninterested clients to come around to the idea that they need some help.

Some of the writing was repetitive and like I said, I haven't even read much of this yet, but I am happy to be introduced to this material. Thank you