Discuss Implementation Issues

The client may be ambivalent about addressing psychosocial problems that are barriers to abstinence. He or she may question whether he or she has the skills needed, wonder whether change may bring on new challenges, and question changing the status quo. The counselor remains alert to signs of client ambivalence.

The stages-of-change model is applicable to acquiring psychosocial support (see sessions 1 and 2). For example, some clients may be precontemplators, unaware of barriers affecting their life; others may be contemplators, aware of barriers but not sure they are ready to overcome them; and others may be ready to engage with resource providers.

The counselor uses the following motivational strategies to encourage the client to address psychosocial problems other than marijuana:

Elicit self-motivational statements

C: Tell me how not having a job has affected you.

C: You’ve said it’s tough not having a safe place to live and that it makes it harder to stop smoking, but you haven’t convinced me that you’re ready to do something about it. Should we go ahead with our plans?

Listen with empathy

C: It sounds as if you’re worried about taking all this on at once.

C: You feel not seeing Jerry as much would be an important step forward, but you worry about not seeing a friend you’ve been close to for a long time.

Roll with resistance

C: You’re not sure you’re ready to spend time finding a new place to live.

C: I think you’re jumping ahead. We’re not talking about moving right now; we’re just looking at how living in your current neighborhood may be interfering with your goal of quitting marijuana use.

Communicate free choice

C: It’s up to you what to do about this.

C: You can take this on now or wait for another time.

Review consequences of action and inaction

C: What do you see happening if you don’t see a doctor?

C: It sounds as if you’re concerned about calling your probation officer right now; what do you think will happen if you don’t?

Throughout the sessions, the counselor praises all the client’s efforts to carry out the Support Plan, even small steps. The counselor conveys confidence that the client has the resources and skills to carry out the plan and obtain services, during treatment and after treatment:

C: I’m impressed that you arranged a place at Transitional Housing. You questioned whether you could handle the steps, but you hung in there. You were persistent when you were put on hold several times, and you kept rescheduling those interviews until you got them. It wasn’t easy, but you made it happen. How do you feel about how you handled it?

B: It wasn’t easy, and once or twice I felt like telling them off, but I just kept telling myself I need a drug-free place to live and that I could do it.

C: You sound proud of yourself, and your pride is well deserved. Knowing how to contact the social service system is an important skill, and you’re getting better at it. Have you thought about your next step?

The counselor encourages the client who lacks confidence and communication skills to make initial phone calls during the sessions; the counselor provides support and coaching if necessary.

After each call, the counselor and client talk about the call, and the counselor praises the client’s efforts, offers constructive criticism, and reviews the next steps in the client’s change plan. A key strategy in this session is exploring the relationship between other life problems and marijuana use. What are their roles in the client’s marijuana use, and how are they frustrating his or her efforts to become involved in treatment?

C: You’ve told me your concerns about problems you’re having, including not having a place of your own or a job, and your probation officer is concerned about these problems, too. How do you see these problems making it harder for you to stop smoking?

B: Well, I’m staying at Jerry’s, and he’s always smoking. I don’t have anything to do all day, and time moves when you’re partying. I wasn’t smoking as much when I was working. The thing is, I don’t know anybody who doesn’t smoke.

C: So it sounds as if finding a place to live where you won’t be with people who smoke and getting a job will help you reach your goal of stopping smoking. Meeting some new people who don’t smoke might help also. These are important goals. Let’s talk about how you might tackle these problems. Are you concerned about other problems that might make it hard to stop?

If the client lacks assertiveness skills, the counselor engages the client in role plays of contacts with agency representatives. To break the ice, the counselor plays the person seeking service and the client plays the agency representative. After the initial role play, the counselor comments on the skills that were demonstrated (e.g., assertiveness, asking for a specific service, eliciting information, avoiding arguments). Then the counselor plays the agency representative and the client plays the person requesting service. Afterward, the counselor points out effective behavior and provides constructive criticism:

C: [A person requesting services] Hello. My name is Shirley, and I’m calling because I would like information about your center and how I might set up an appointment with a family counselor for me, my husband, and our children.

S: [As agency representative] Well, we have a long waiting list. You might want to call back next month.

C: Okay, I understand that your program is filled, but could you direct me to another family counseling center that might have a shorter wait?