Clinical Engagement and Therapeutic Alliance

BMDC fosters the development of a strong working alliance between counselor and client to explore marijuana-related problems, identify realistic goals, and initiate change strategies. From the outset of treatment, the counselor focuses on engaging the client in the treatment process by establishing trust and showing an accurate reflection of the client’s concerns. Throughout treatment, the counselor demonstrates respect, warmth, and empathy and shows concern for the client’s needs. Any disruptions to the therapeutic relationship are handled carefully and respectfully.

Meeting Clients “Where They Are”

The counselor develops a clear picture of the client’s past and current marijuana use upon admission to treatment, the problems that have been created through continued use, the reasons the client has identified for making lifestyle changes related to marijuana, and the goals the client wants to achieve. An understanding of where the client is on his or her particular path to abstinence helps the counselor guide growth and change. The counselor listens to the client’s core concerns about marijuana and his or her treatment goals and provides an environment that motivates the client to take steps toward recovery. The counselor does not impose goals or values during the treatment process, nor does he or she communicate disapproval or judgment about the client’s objectives or readiness to change. Rather, the counselor encourages the client to express his or her goals and to participate in developing objectives. This approach presents an apparent conundrum: the client’s goal of abstinence will be served by the therapist’s not demanding abstinence of the client immediately upon entering treatment. It is important to note that meeting clients “where they are” is a therapeutic necessity that is consistent with a goal of abstinence.

The client-centered aspects of MET and case management allow the counselor to adjust session content to a client’s background and culture (Steinberg et al. 2002). Focusing on the individual is not meant to preclude the client’s participating in mutual-help or 12-Step programs between sessions. If the client shows an interest in attending such groups, the counselor should make available a list of local meetings.

Supporting Client Efficacy and Pointing Out Discrepancies

As the BMDC counselor engages the client in treatment and establishes a positive working relationship with him or her, the counselor looks for opportunities to refine goals and examine motivation levels. The counselor achieves this in a variety of ways, including supporting the client’s efficacy and pointing out discrepancies. Supporting client efficacy is essential because it communicates belief in the client’s inherent wisdom and ability to solve problems effectively. The counselor conveys the message that, although treatment entails learning new techniques or skills for handling difficult problems, the client possesses the ability to learn, process information, and carry out his or her plans. Discrepancies may exist between goals and behaviors, previously stated and currently stated concerns, or perceived benefits and actual consequences of marijuana use. By pointing out these discrepancies or inconsistencies to the client the counselor can enhance the client’s motivation and determination.

Learning About Marijuana Use Patterns

The BMDC model is based on the principle that substance use disorders result from learned behavior patterns rather than basic character defects. The counselor presents this framework to the client as a way of both understanding how the client’s problems developed and thinking about how to ameliorate the situation. For example, marijuana dependence can result from repeated use to relieve painful emotions or to self-medicate. Therefore, recovery from marijuana dependence requires making new choices involving healthier lifestyle patterns.