Motion: 'a non-directive approach is the only way to maintain client autonomy and agency'

For...

You need to establish rapport before you can talk about the substance use and its treatment. If there is no rapport then there is no point to any kind of intervention; service users will not take in anything that is said to them, they will probably dislike their practitioner, and are likely to drop out.

Against...

Establishing rapport is important and needs to be part of dealing with the problem the service user wants help with. It is no good wasting time just trying to strike up some rapport. Service users want to know that they are going to get the help they need and that their practitioner has that as their focus.

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 upon 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 has been presented. 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. Motivational dialogue is a style of psychological intervention and is in contrast to overt confrontation, particularly in group and family settings, which was 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 is directly compared with a non-directive psychotherapy. This chapter provides a selective review of the literature available at the time and explores issues related to therapist training. Finally 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. Read the chapter in: 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