This section presents the content of sessions 1 and 2. It also presents information on motivational interviewing and the stages-of-change concept. The counselor uses this concept throughout the remaining sessions to measure the client’s readiness for change and to adjust the sessions to accommodate the client’s stage. The section provides examples of motivational interviewing strategies, highlighting how to use these techniques in treatment sessions. Finally, it presents sessions 1 and 2; these sessions are based primarily on principles of motivational enhancement and secondarily on cognitive behavioral skills.
After completing the initial assessment session, the counselor introduces the client to more targeted motivational strategies. Session 1 focuses on
• Reviewing the completed Personal Feedback Report (PFR)
• Exploring the client’s experiences with marijuana
• Eliciting, acknowledging, and reinforcing the client’s expressions of motivation to change
• Building the alliance between the client and counselor
• Integrating the client’s feedback about marijuana use and associated problems
• Setting goals
• Planning treatment.
The protocol for session 2 guides the counselor in
• Reinforcing successful efforts the client has made at initiating change
• Discussing how and when assistance may be offered by the friend or relative invited to the session by the client
• Refining goals
• Reviewing change strategies
• Assessing the client’s social support for initiating changes.
Key Concepts: Motivational Interviewing Skills
Identifying the Individual’s Stage of Change
The stages-of-change model (Prochaska and DiClemente 1982) describes a sequence of stages through which individuals progress as they think about and change their behaviors. It gives the counselor insight into the client’s thinking so that the counselor can select strategies specific to the client’s stage. This model was adapted for the Marijuana Treatment Project and assumes
• Progress in overcoming marijuana dependence (e.g., getting ready for the first day of abstinence, getting through the first 3 months) depends on the client’s readiness for change.
• Client readiness may shift and evolve and may be influenced by the therapist.
The model comprises five stages: precontemplation, contemplation, preparation, action, and maintenance (exhibit V-1). Individuals move back and forth between the stages and progress through the stages at different rates. For example, in the assessment session the client may be committed to maintaining abstinence, but in session 2 he or she may be ambivalent. The Center for Substance Abuse Treatment’s Treatment Improvement Protocol (TIP) 35, Enhancing Motivation for Change in Substance Abuse Treatment (CSAT 1999b), as well as the KAP Keys (CSAT 2001c) and the Quick Guide (CSAT 2001d) that accompany TIP 35, provides detailed information about this model.
Stages – Characteristics
Precontemplation
• Is not considering change
• May be unwilling to change behaviors
• Is unaware of adverse consequences from marijuana use, although others may believe problems exist
Contemplation
• Becomes aware that problems exist
• Recognizes causes for concern and reasons to change
• Typically is ambivalent and continues to use marijuana
• May seek information and reevaluate marijuana use behavior
• Weighs the pros and cons of making a change
• Could remain in this stage for years
Preparation
• Commits to changing
• Recognizes that advantages of changing outweigh benefits of not changing
• Thinks about capabilities of success (i.e., self-efficacy)
• Continues using marijuana but intends to stop or cut back soon
• May have attempted to reduce or stop use
• Sets goals and may tell others about them
Action
• Chooses and begins to pursue a goal
• Modifies habits
• Can last months following termination of marijuana use
Maintenance
• Makes efforts to sustain gains achieved during the action phase
• Works to prevent recurrence of use
• Learns how to detect and guard against risky situations
• Requires prolonged behavior change and continued vigilance for 6 months to several years