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CORE SKILLS

❝ there are two skills that every therapist will find indispensible ❞

It is useful to work within a structured treatment framework, however, the framework is less important than the use of particular skills.

1. Keeping a momentum for change

Broadly speaking therapy sessions are primarily about motivational change or behaviour change. Motivational change is a process starting with with thinking about changing substance use progressing through to maintaining stable recovery. The important principle is that once your client decides that they want to take a step forward the therapist should focus on the benefits and challenges of change. It is unhelpful, actually detrimental, to talk about the reasons for a decision already reached whereas going forward, talking about belief in the ability to make a change and the benefits it will bring, increases the likelihood of a good outcome.

The essential task is to understand your client’s readiness to change and what kind of change is expected. This can be challenging because clients often want to change the consequences of their substance use rather than the substance use itself. Accurately identifying stage of change is fundamental to determining which intervention skills to use.

The stages of change model (21.08) Carlo DiClemente, Professor in the Department of Psychology at the University of Maryland, talks to Gillian Tober about the thinking behind the universally popular model.

2. Using motivational interviewing

Whatever therapeutic approach that practitioners choose to adopt, its delivery will be more effective if done in a style consistent with the practice of motivational interviewing. We have called this motivational dialogue in order to distinguish the style from the intervention.

What do SBNT & MET therapists do in common?
Key point :: therapists do similar things in different treatment modalities
This study looked at video recordings of treatment sessions in the UK Alcohol Treatment Trial. There were two treatment modalities, Social Behaviour & Network Tharapy and Motivational Enhancement Therapy, with different theoretical underpinnings. It turns out that when therapists in both modalities practised high quality MET, they were more likely to have good outcomes.

Motivational interviewing (14.52) Bill Miller, Emeritus Distinguished Professor of Psychology and Psychiatry, University of New Mexico, talks to Gillian Tober about his early thoughts on motivational interviewing.

Added to this there are specific motivational interviewing skills that have a more important role than others. Asking open questions is a way the practitioner communicates interest, concern and the idea that only the recipient can describe what their substance use means to them. Thus it has been found that the use of open questions followed by complex reflections is likely to elicit thoughts about change, the benefits and the possibility of change.

The terms ‘change talk’ and ‘commitment talk’ have been coined in order to help researchers and practitioners identify what needs to happen in order to be able to be more sure that change will occur. Researchers have been able to show that change talk of itself does not predict behaviour change, but does make it more likely that a commitment will be articulated and the phrase ‘commitment talk’ was coined to distinguish this category of speech. Commitment talk has been shown to predict greater likelihood of subsequent behaviour change. So this is what the practitioner is trying to achieve.