Chapter Three

Motivating heroin users for change

Henck van Bilsen and Andree van Emst

Why do we need motivational interviewing techniques?

Heroin addicts, heroin users, and other people suffering from addictions are often in the stages of precontemplation or contemplation (see Chapter 2 in this book). Before it is worthwhile starting a treatment programme, the clients have to reach the stage of active change, and once they have reached this stage (Prochaska and DiClemente 1984) a fair number of change-directed therapeutic procedures are available (Miller 1980). In other words, in order to benefit from treatment the client has to be motivated. It is possible to support the transition from the stage of contemplation to the stage of active change, if appropriate therapeutic interventions are applied.

A goal of the motivational interviewing approach should therefore be to stimulate and to supervise the contemplation and decisionmaking of the client concerning his ‘problem’ behaviour so that he takes into consideration all the relevant pros and cons of change and non-change. Such a task has consequences for the attitudes of the therapist and for the nature of the therapeutic interventions. In this approach the client himself is seen to be responsible for his behaviour and the problems. The therapist has to accept this and should not have inflexible ideas abut the decisions a client should make. A moralising attitude cannot pass muster. Contact between client and therapist should be directed towards raising the selfefficacy and self-esteem of the client. It is helpful for the therapist to view himself as someone who guides clients through the dangerous land of decision-making. It is his task to stimulate the client into starting an internal re-evaluation of his situation in such a way, that it leads to a ‘wise’ (all pros and cons considered) decision. The therapist tries to create an atmosphere in which the client motivates himself. The client can only motivate himself if he becomes more aware of his behaviour and the nature and seriousness of the consequences of that behaviour. He also has to become more

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