Topic: client engagement and motivation

If we want to see any progress, we’ll have to figure out a way to break this apparent impasse.

At its root, treatment is primarily a work relationship– with goals that need to be accomplished, and outcomes that must be kept in mind.

Ambivalence isn’t just a matter of figuring out what we want to do. It’s very much about the ability to make good decisions and feel confident about them.

Really resistant clients are already planning to continue using alcohol or drugs throughout treatment, possibly in secret.

Even when the patient has concluded that continued substance use is no longer the best option, he or she still harbors a number of important doubts about the ability to change.

Most addicts and alcoholics wind up in treatment because they’re experiencing difficulties due to substance use– ranging from the pain of withdrawal to troubles with the law, to threatened loss of job or family.

Even in remission, the client is still an addict. The challenge is to sustain the remission, going forward.

Sending somebody to meetings without some prep work is like making a referral for therapy without bothering to find a therapist.

Instead of becoming inspired to turn his life around, he seems to have figured, “OK, crisis averted. Let’s go get a beer.”

The point of the game is to win. You win by knowing the odds and trying to take advantage of them. Even if that means resisting emotional impulses.