This session has two major purposes: first, to establish rapport with the client, and second, to introduce the client to the reasoning behind coping skills training.

By doing this, clients can have very clear expectations about how treatment will proceed and about what behaviors may be expected of them.

The time shown for each topic area is only suggested, and some areas (e.g., building rapport) may take longer than the time shown, while others may require less.

Building Rapport (45 minutes)

This is an extremely important part of the treatment, where the therapist first gets to know the client. Therapists should begin by introducing themselves and by explaining who they are (e.g., a private practitioner in the area, a VA psychologist).

The therapist should then explain the purpose of this first meeting: to get to know the client, to get an idea of the client’s drinking patterns and motivation, and to discuss the rationale for treatment and what the sessions will be like.

The initial interview should be informal, but it is desirable to obtain some key information in the first session.

Questions to be asked of the client include the following (not necessarily in this order):

Tell me a bit about yourself. What do you do for a living? Married?

How do you spend your free time?

What is your living situation like (lives alone, apartment, own house, children, extended family)?

How serious do you think your drinking problem is?

Why are you seeking treatment now?

Why did you seek treatment here? How did you hear about this treatment program?

Have you been treated before for alcoholism or drug abuse? (If yes: What were your experiences like?)

Have you ever tried to quit on your own? (If yes: How did you do?)

When you think about alcoholism treatment, what do you think about? That is, what is your idea of what treatment should be like?

What do you want out of treatment? How will you get it?

How confident are you that you can succeed, that is, remain abstinent?

Conceptualizing Treatment: What Is Alcoholism? (5 minutes)

Having begun to establish rapport with the client, therapists may begin to explain the rationale for coping-skills training. This begins with a social learning explanation of alcohol abuse. As therapists go through this explanation, they may illustrate the various points by drawing on what the client has already described. The explanation may run as follows:

In thinking about alcoholism, we view excessive drinking as harmful behavior. Once people start to drink alcohol a lot, they sometimes learn that it changes the way they feel.

For example, some people use it like a tranquilizer to help them deal with stressful situations. Other people expect that it will make good times seem even better. Some people think it will make them more confident. Some people use it just to keep from thinking about things.

After a while, drinking can be triggered by things in the environment, sometimes without the person even realizing it. Often, things in the environment can trigger feelings of craving, but that does not happen with everyone.

Things in the environment that often trigger drinking may include seeing alcoholic drinks, being in the presence of people who are drinking, or being in situations that are stressful.

Finally, people often develop beliefs about alcohol and about their own drinking (e.g., “Drinking is not a problem for me. I can stop whenever I want.” “I need to change, but it’s not worth the effort.” “Stopping drinking is not possible for me.”).

Alcohol can change the way a person feels, thinks, and acts. This can make substance abuse very easy to start and very difficult to stop. The purpose of this treatment is to help you avoid or cope better with those situations in which you tend to drink and to help you find behaviors that you can do instead of drinking.

The therapist should probe for understanding.

Assessing High-Risk Situations (15 minutes)

The therapist should give a brief explanation of how treatment works, again capitalizing on the client’s experiences to make points more clearly.

If drinking changes the way a person acts, thinks, and feels, we need to begin by finding out what situations you are most likely to drink in and what you are thinking and feeling in those situations.

We call these high-risk situations. What we want to find out is what kinds of things are triggering or maintaining your drinking. Then we can try to develop other ways you can deal with high-risk situations without drinking. This involves learning specific skills and strategies to use.

The main point is that once we know about the situations and problems that contribute to your drinking, we can look for other ways to deal with those situations.

The therapist should again probe for understanding or resistance.

Having given the client a rationale for treatment, the therapist should begin an informal assessment of high-risk situations. Among the questions the therapist might ask are—

In what kinds of situations do you drink? What are your triggers for drinking?

Can you give a specific example (e.g., a relapse story)?

Can you remember your thoughts and feelings at the time?

What were the positive consequences of drinking?

What were the negative consequences of drinking?

The therapist should show the client the self-monitoring record handout and demonstrate its use by recording the above responses on it. The therapist should summarize with the client the apparent determinants of drinking in this episode and follow up by asking for other examples.

Motivation (5 minutes)

At this point, if clients are sufficiently engaged, the therapist can try to boost motivation by expressing confidence in their ability to do well in treatment. The therapist may also help the client review reasons to stop drinking and may elicit examples of the client’s successes in the past (e.g., longest period of abstinence or controlled drinking to date). The therapist should commend the patient for making this effort now.

Contract and Ground Rules (10 minutes)

The therapist needs to stress at this point that treatment can help but that it will require certain commitments on the part of the client. The therapist will be there to help the client figure out how to deal with alcohol problems, but the client will have to work at it. That work will include certain ground rules:

Attendance. The client must attend without fail. Cancellations must be made in advance, and the client must have a good reason to cancel. The client may withdraw from treatment but must discuss this decision with the therapist first (i.e., not just fail to show up).

Promptness. The client must be on time for sessions. If for some reason clients cannot be on time on a given day, they must contact the therapist to that effect.

Alcohol and drug use. This treatment is intended for people who want to abstain from alcohol. Although clients may not want to have total abstinence as the goal, they must work on remaining abstinent for the program to be most effective.

Completion of homework. One of the ways in which this treatment works is that therapist and client decide the appropriate skills to learn and how best to learn them. This may include homework assignments, such as practicing specific skills, that clients must do if they are to benefit from treatment. The client, therefore, must agree to complete homework assignments.

These ground rules are set out in a contract that the therapist asks the client to read and sign. Included in the contract is a statement of the short-term goals that the client agrees to work on.

Homework (5 minutes)

The therapist sends the client home with the self-monitoring record, gives instructions in its use, and requests that the patient take time once a day to record episodes of craving or desire for alcohol. The therapist then sets the next appointment.

Treatment Contract, and Self-Monitoring Record : see source page
http://pubs.niaaa.nih.gov/publications/MATCHSeries3/core.htm#1