Discuss Ambivalence

The client may be reluctant to disclose ambivalence for fear of disapproval. However, strong ambivalence may be manifested in nonverbal behavior and possibly in an impaired therapeutic alliance (e.g., missed sessions, reluctance to establish treatment goals). The counselor needs to be vigilant about maintaining the client’s level of motivation for change and engagement in treatment.

Establish a Change Plan

The counselor helps the client establish a long-term plan for behavior change, focusing particularly on the next 12 months. The counselor summarizes indications of motivation that the client has made. If the client has given no indications of a desire to change, he or she may not be ready to commit to change, and the counselor points this out.

The counselor explains that articulating goals increases the likelihood that the counseling will be meaningful and useful. For clients whose goal is immediate and permanent abstinence, articulating goals is straightforward. However, many clients are not at this stage of change early in treatment. If clients say they are not ready to give up marijuana, the counselor suggests setting other interim goals such as learning more about the skills that will help them quit or reduce marijuana use in the future. Goals may be general, such as quitting marijuana use within the next 2 weeks or reducing marijuana use to no more than four joints per week. Other goals may be more specific. For example, the client may set goals of figuring out how to stay away from substance use opportunities, identifying ways to get past cravings, learning new social skills, and participating in activities that are incompatible with marijuana use. Although the program’s goal is to help clients achieve abstinence, the counselor needs to meet the clients where they are to avoid alienating them and to keep the door open for improvement and possible future abstinence.