2. Embrace a nonjudgmental and empathic stance. Empathy is a key component to delivering the highest level of care to patients. It is our job to have the willingness to listen and to understand patients in the fullest way possible, which on a concrete level means using active listening skills as a deliberate and meaningful part of the clinical experience. Providing information, for instance, has a much greater chance of enhancing someone’s motivation when it is specifically tied to the personal attributes and statements of the patient in front of you. Suspending judgment can serve to build the therapeutic bond and allow the clinician to connect with the part of the patient that seeks change.
Dr. Michael S. Ascher
3. Avoid stigmatizing language. It is key to pay attention to the words we use in our clinical practice in order to have the most effective conversations about behavioral change. Words such as enabling, denial, addict, alcoholic, and codependency should be removed from our lexicon, as they often carry negative meanings, can promote discord between clinician and patient, and can be more confusing than clarifying. If the patient uses these words, then it can be helpful to ask the patient to clarify and explore the meaning of the word to him or her so the underpinnings and individualized meaning for this patient can be understood and explored.
4. Explore ambivalence. Show patients that we understand their perspective and acknowledge the difficulty and various emotions elicited with the dilemma of change. Ambivalence is normal, and one of the key dilemmas we all face when considering health behavior change. The value of acknowledging the function of the substance use for the patient can both help the patient feel heard and understood but also identify an important area in need of change so that the particular function can be replaced with healthier behaviors.
5. Lend hope and optimism to patients. Patients completing detox may feel that there is no hope in getting to a better place. Clinicians should emphasize the importance of patients not judging themselves too harshly. Instead, patients should focus on self-care and minimizing negative self-talk that fuels negative feelings and emotions. Reassure patients by explaining that dysphoria and anxiety can be attributed to protracted withdrawal lasting weeks to months, and that their feelings are normal given the current situation. It also can be affirming and fuel optimism to acknowledge the important and courageous first step taken by engaging in the detoxification process itself, with as much specificity to their current situation as possible.
6. Find the strengths in our patients, and use affirmations judiciously.
Affirmations should only be offered when sincere, genuine, and specific. Eliciting strengths from patients may serve to build the therapeutic bond and help patients have a more accurate self-image. Affirmations must be individualized, and can be verbal or nonverbal. While some appreciate enthusiasm, others may appreciate more subtle acknowledgments.
Dr. Ascher serves as a clinical associate in psychiatry at the University of Pennsylvania, Philadelphia. He is coeditor of “The Behavioral Addictions” (Washington: American Psychiatric Publishing, 2015). Dr. Kosanke is the director of family services at the Center for Motivation and Change in New York City and a coauthor of “Beyond Addiction: How Science and Kindness Help People Change” (New York: Scribner, 2014).