The next phase in motivational interviewing is to consolidate all the issues raised by the client in the first phase, and build on their motivation to change. This works best when the person has moved to the late contemplation or early determination stage of change. Be aware that ambivalence will still be present, and if encountered use Phase 1 strategies as appropriate.
Ask a transitional question
Communicate free choice
Provide information and advice
Ask a transitional questionShift the focus from reasons to change to negotiating a plan for change. After summarising above, use the following questions:
"I wonder where this leaves you now?"
"Where do we go from here?"
"What does this mean about your speed use?"
"How would your life be different if..."
"What can you think of that might go wrong with your plans?"
Communicate free choiceAlthough abstinence is one possible goal, some people may not be ready to stop completely and may opt for reduced or controlled use. In a motivational enhancement paradigm, the client has the ultimate responsibility for change and total freedom of choice to determine their goal for intervention. The therapist's role is to assist the client to determine an initial intervention goal (see Setting Goals below). Be aware that such goals are likely to alter during the course of the intervention, and an initial goal of cutting down may become a goal of abstinence as the client's confidence increases. Top of page
Address fears"You've told me that (refer to grid) ... are the less good things about reducing your speed use. What is your biggest fear if you do decide to cut down or quit?"
Explore any fears that are identified and assist the client with problem solving for each fear raised. Explore concerns with the management of withdrawal symptoms if this is raised. For example, withdrawal symptoms can include irritability, insomnia, mood disturbances, lethargy and cravings to use. Symptoms are time limited; however, in severe cases, medications can be prescribed for a short period to assist clients during the acute phase. Education and support are essential components of getting through withdrawal.
Provide information and adviceProvide accurate, specific information when it is requested. When clients seek advice, provide qualifiers and permission to disagree.
"If you want my opinion I can certainly give it to you, but you're the one who has to make up your mind in the end".
It may be useful to ask for the client's response to the information provided:
"Does that surprise/make sense to you?"
Setting goalsThe client needs to choose his or her own goal(s) for therapy. In assisting the client to reach a goal, consider the degree of dependence, recent patterns of speed use, and previous attempts to control use, and discuss these issues with the client. Keep in mind the experience from cannabis intervention trials, which suggests that restricting use to weekends or social occasions leads to a slow but steady increase in use over time. Clients must have a firm, personal rule for recreational use (e.g. only use a designated amount (maximum) only once per week, or to never buy speed).
Talk through the characteristics of good, realistic goals with the client. Make sure you cover the following points:
- Goals will help regardless of whether you achieve them. Goals the client reaches can be celebrated/rewarded, but others that aren't achieved can be used as learning experiences for future goal setting.
- Goals need to be short term, concrete, specific, measurable and realistically achievable. For example, the goal of "quitting speed" is not as specific or concrete as "I will stop using completely by ... date." Top of page
"Successful abstinence is a safe choice. If you don't use you can be sure that you won't have problems related to your use. There are good reasons to at least try a period of abstinence (e.g., to find out what it's like to live without speed, and how you feel, to learn how you have become dependent on speed, to break your old habits, to experience a change and build some confidence, to please your partner)."
If the assessment information indicates the need to advise a goal of abstinence and they are not considering this (ie. previous episode of amphetamine-induced psychosis, current mental health disorder etc):
"It's your choice of course. I want to tell you, however, that I'm worried about the choice you're considering, and if you're willing to listen, I'd like to tell you why I'm concerned."