Principle 1: Express empathy

The goal is to listen with the purpose of understanding the problem, the person and the emotions behind the resistance. Listening is more than just paying attention. It is how practitioners engage with clients. When clients are listened to, they often feel:

It is important to engage clients in discussing change. Practitioners must always watch for roadblocks to communication. Although some roadblocks are self-evident, many seem to be the right way to engage clients, when in fact they tend to block conversation. These include:

The practitioner must convey the desire to get a clear idea of what the client is going through. A conversation that includes good reflections and open-ended questions can be guided in such a way that everyone involved understands the problem, obstacles and motivators for change in the same way.

Principle 2: Develop discrepancy

The client rather than the practitioner should present the arguments for change. Change is motivated by a perceived discrepancy between present behaviour and important goals and values. Several techniques are used to create a decisional balance that weighs in favour of change. A good way to engage this conversation is to examine the decisional matrix. For example, ask the client:

  • What are the benefits of keeping things just the way they are?

  • Tell me what you love about drugs.

  • What could be some of the drawbacks?

  • How does not losing weight and being tired all the time conflict with being an active dad?

Principle 3: Roll with resistance

Creating an alliance with clients is a necessary element of engagement. Have 

strategies in place to decrease resistance. Recognize that ambivalence is normal, not pathological; it is a symptom of denial. Helping clients resolve ambivalence will help propel them toward change. In the spirit of collaboration, it is clients who are the primary resource for solutions. When clients are resistant, take it as a sign to respond differently.

Sample script


Principle 4: Support self-efficacy

Clients' belief in the possibility of change is an important motivator. If clients are skeptical, the practitioner's role is to either support them, align with them or engage resources to propel them toward change. The client, not the practitioner, is responsible for choosing and carrying out the change. The practitioner's own belief in clients' abilities to change becomes a self-fulfilling prophecy; therefore, it is important to set aside biases. Clients with mental illness or substance use problems are particularly sensitive to stigma and discrimination.

Sample script: