COMMON TREATMENT ISSUES
This section highlights problems that may arise when working with people who are dependent on marijuana. Clients in Brief Marijuana Dependence Counseling (BMDC) may differ from clients with mental disorders and from clients who abuse other substances. For example, this may be the client’s first experience in any type of treatment setting. Clients may be uncertain about what they are supposed to do in therapy. To alleviate feelings of uncertainty, a counselor can provide clients with general information about the client–counselor relationship and treatment expectations and parameters.
In BMDC the client–counselor relationship is at the core of the change process; a positive relationship is the foundation of treatment. Even though BMDC treatment is brief, the quality of the relationship is important.
A strong relationship positively affects compliance and retention. The counselor can promote the therapeutic relationship through listening empathically, providing support and encouragement, displaying genuine concern, responding to client concerns, addressing disagreements promptly, and providing clarifications and explanations.
The counselor should avoid strategies that may elicit resistance, including aggressive confrontation of denial, excessive questioning, interrupting the client, or arguing with the client. The counselor should respond to client concerns and complaints while providing a consistent structure for the sessions. Clients who have never participated in psychotherapy or psychosocial treatment may need extra guidance about the process of treatment to foster therapeutic engagement.
Orienting the Client and Confidentiality
As part of the assessment session, the counselor spends time describing the treatment and session format and answering questions. The counselor provides an overview at the beginning of each session and spends a few minutes at the end summarizing the topics addressed to help the client develop a framework for the sessions and retain the material that was discussed.
The counselor also should discuss confidentiality issues during the assessment session. The client may be unfamiliar with the confidentiality of information disclosed in therapy and the limits to confidentiality. He or she may need updated information on new rules such as the Health Insurance Portability and Accountability Act. Although the client may have signed an informed consent or other admissions forms, the counselor should not assume that the client understands the issues surrounding confidentiality; it is good clinical practice to discuss them.