Who should decide on the goals of treatment?
On the t-shirt you will find the motion for the debate, and below it, arguments for and against.
Are you for or against or not sure?
For... A non-directive approach allows the client to set the agenda and determine the content of the intervention and, therefore, address the issues that are important to them rather than those decided by the practitioner. Clients will feel relaxed and listened to which will give them confidence that they are getting the help they need.
Against... A directive approach ensures that the client and practitioner are both focussed on dealing with the problem that the client has brought. Having agreed goals is crucial. The use of strategic questioning and reframing of the client's talk enables the client to re-imagine themselves as capable of making the changes needed for a better life.
Here is something to inform your thinking…
Read the summary of this chapter from the book Motivational Dialogue: Motivational dialogue is a style of psychological intervention and is in contrast to overt confrontation, particularly in group and family settings, once considered a key ingredient of successful psychotherapy. This was particularly so in the United States where 12-step approaches were dominant. Motivational approaches have become popularised and gained widespread support as a key psychotherapeutic intervention in the addictions field and beyond. The study on which this chapter is based was the first randomised controlled trial in which a motivational approach was adopted in the intervention called Motivational Enhancement Therapy (MET), and compared with a non-directive counselling.
At six month follow-up, the results showed a significantly lower rate of heavy drinking in the MET group: 42% of people in that group remained heavy drinkers, compared with 63% in the non-directive counselling group, and 65% in the group that had no counselling.
This chapter provides a selective review of the literature available at the time and explores issues related to therapist training. There are reflections on the experience of delivering the two contrasting therapies from both training and therapist perspectives. The chapter proposes a protocol for integrating motivational dialogue into routine treatment of alcohol and drug dependence. It suggests a further integration whereby all interventions are delivered using a stepped care framework starting with assessment and simple advice and working up through increasingly intensive interventions.
The chapter illustrates motivational dialogue applied to the delivery of four interventions of different intensities: Assessment, Simple Advice, Motivational Enhancement Therapy (MET), Social Behaviour and Network Therapy (SBNT). It demonstrates how treatments with different theoretical underpinning can be delivered in a motivational dialogue style. The intervention is based upon MET as practised in the UK Alcohol Treatment Trial (UKATT) in three sessions: the first session consisted in the giving of feedback from assessments; second session is to establish commitment for change in the light of change plans and for this purpose a change plan worksheet might be used; third session concentrates on building motivation for changed behaviour.
Get the full text of the article
Sellman D, et al (2007) 'A comparison of motivational interviewing with non-directive counselling', in G Tober and D Raistrick (eds.) Motivational Dialogue, Hove, UK: Routledge pp. 137-150
If your library does not have a copy of Motivational Dialogue you can refer to the original research that the chapter is based on: Sellman JD et al (2001) A Randomized Controlled Trial of Motivational Enhancement Therapy (MET) for Mild to Moderate Alcohol Dependence. Journal of Studies on Alcohol 62: 389-396
Have you looked at the Motivational Dialogue and Motivational Dialogue Research pages?