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Co-Occurring Schizophrenia and Substance Dependence/Abuse

Applying MI: Avoid Argument
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Assessment of Co-occurring Disorders
Motivational Interviewing
Applying MI: Express Empathy
Applying MI: Develop Discrepancy
Applying MI: Avoid Argument
Applying MI: Roll With Resistance
Applying MI: Support Self-Efficacy
Evidence Based for Motivational Interviewing
Future Research and Barriers to Service
Web sites of Interest
Bibliography

Avoid argument and direct confrontation:

Temptation to argue with a client may arise for the therapist when the client is unsure about changing or unwilling to change, especially if the client is hostile, defiant, or provocative.  More resistance may arise if the client feels they are trying to be convinced that a problem exists or that a change needs to be made.  If the therapist tries to prove a point, the client could take the opposite side.  This can lead to a power struggle between the therapist and the client and would not enhance motivation for a beneficial change.  Only when it is the client, not the therapist who voices arguments for change, progress can be made.  The goal is to “walk” with the clients (i.e., accompany clients through treatment) not “drag” them along (i.e., direct clients’ treatment).

 

A common area of argument is the client’s unwillingness to accept a label, such as “alcoholic” or “drug abuser.”

 

“There is no particular reason why the therapist should badger clients to accept a label, or exert great persuasive effort in this direction.  Accusing clients of being in denial or resistant or addicted is more likely to increase their resistance than to instill motivation for change.  We advocate starting with clients wherever they are, and altering their self-perceptions, not by arguing about labels, but through substantially more effective means.”

                                                                                    (Miller and Rollnick, 1991)

 

Nicole & Colleen