Section 1: An Introduction to Brief Interventions

The stages of change model, originally developed by Prochaska and DiClemente, has informed the development of brief intervention strategies because it provides a framework for understanding how people change their behaviours and what interventions/strategies are useful for particular individuals. By understanding which ‘stage of change’ a person is in, the counsellor can select the most appropriate strategy for the individual client.

The Stages of Change Model

This video explains the Stages of Change model.

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The following extract provides a good overview of the stages of change model:

There is also a sixth stage not explored in the stages of change (Heather & Honekopp) extract – this stage is called relapse. Relapse is a stage in which the individual returns back to the previous behaviour. This could be due to insufficient reinforcement and support for change, the impact of intervening life events, or the result of an overriding temptation to return to the previous behaviour.

The following World Health Organization diagram depicts the cyclical nature of behavioural change in which individuals typically move from pre-contemplation to contemplation, then preparation followed by action and maintenance, and, when relapse occurs, begin the process again but learn from their prior experiences.

^{(World Health Organization, 2017)}

Counsellors (and other professionals conducting brief interventions) can use the stages of change model to help determine the most appropriate interventions and strategies to support the client. For example, it is easy to understand that the information and support that should be provided to someone in the maintenance stage would be entirely different to that provided to an individual in the pre-contemplation stage. The following table provides a brief overview of the different goals brief intervention supports should have for each stage of change.

The Stages of Change

Stage & Goal	Example	Treatment Needs
Stage: Pre-contemplation The user is not considering change, is aware of a few negative consequences, and is unlikely to take action soon. Goal: Encourage clients to consider that they might have a problem/issue.	A functional yet alcohol-dependent individual who drinks himself into a stupor every night but goes to work every day performs his job, has no substance abuse-related legal problems, has no health problems, and is still married.	This client needs information linking his problems and potential problems with his substance abuse. A brief intervention might be to educate him about the negative consequences of substance abuse. For example, if depressed, he might be told how his alcohol abuse may cause or exacerbate the depression.
Stage: Contemplation The user is aware of some pros and cons of substance abuse but feels ambivalent about change. This user has not yet decided to commit to change. Goal: Raise the client’s awareness of the problem/issue and desire to change by encouraging them to consider their behaviour and its consequences.	An individual who has received a fine for driving while intoxicated and vows that next time she will not drive when drinking. She is aware of the consequences but makes no commitment to stop drinking, just to not drive after drinking.	This client should explore feelings of ambivalence and the conflicts between her substance abuse and personal values. The brief intervention might seek to increase the client’s awareness of the consequences of continued abuse and the benefits of decreasing or stopping use.
Stage: Preparation This stage begins once the user has decided to change and begins to plan steps toward recovery. Goal: Encourage the client to plan for change and take the first steps towards change. Encourage the client to commit to making the change a top priority.	An individual who decides to stop abusing substances plans to attend counselling, AA or a formal treatment program.	This client needs to work on strengthening commitment. A brief intervention might give the client a list of options for treatment (for example, inpatient/outpatient treatment, 12-Step meetings) from which to choose, then help the client plan how to seek the best treatment for him.
Stage: Action The user tries new behaviours, but these are not yet stable. This stage involves the first active steps toward change. Goal: Assist the client in making specific action plans, taking appropriate steps, reinforcing changes, and providing support and guidance in the change process.	An individual who goes to counselling and attends meetings but often thinks of using again or may even relapse.	This client needs help executing an action plan and may have to work on skills to maintain sobriety. The counsellor should acknowledge the client’s feelings and experiences as a normal part of recovery. Brief interventions could be applied throughout this stage to prevent relapse.
Stage: Maintenance The user establishes new behaviours on a long-term basis. Goal: Support the continued change and help with relapse prevention.	An individual who attends counselling regularly is actively involved in AA or NA, has a sponsor, may be taking disulfiram (Antabuse), has made new sober friends, and has found new substance-free recreational activities.	This client needs help with relapse prevention. A brief intervention could reassure, evaluate present actions, and redefine long-term sobriety maintenance plans.

Improve Your Life Using the Stages of Change Model (Transtheoretical)

This video addresses key elements of making personal, professional, emotional, physical, mental, and social changes.

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Before any intervention can be implemented, it is crucial for the counsellor to undertake some form of assessment to determine the client's stage of change. This 'assessment' may be in the form of a formal screening tool/questionnaire or may be in the form of a more informal conversation and information gathering/observation of the client. The goal is to assess the client's concern and where they are in the continuum of change. To do this, use all of the communication skills that you have been learning about throughout your Diploma.

Some key points to keep in mind to ensure effective assessment include:

Establishing rapport

While brief interventions are brief by their very nature, it is still important to develop some level of rapport with the client before engaging in them. By demonstrating to the client that you are interested in them and that you understand their frame of reference, the client is more likely to open up and be interested in any information you provide. Always treat the client with respect, express genuine/congruent concern, and seek to mirror the client's language and pace.

Engaging with active listening

For the most part, assessment involves engaging with the client, asking appropriate questions, and listening actively to their responses. It is important to utilise a full range of active listening techniques throughout this process (e.g., maintain appropriate eye contact and an open body posture and use minimal encouragers, paraphrasing, clarifying questions, and summarising to help assess the client's stage of change).

Taking a supportive and nonjudgmental approach

This is an important part of brief interventions. The client must feel supported by the counsellor’s non-judgemental attitude toward their issues. In many cases, clients can fear judgement, so counsellors need to set aside their own beliefs and engage in non-judgemental practice. Statements and expressions of disapproval, shock, judgement, and counterarguments are inappropriate. Instead, it is important to commend clients for their strengths and highlight the steps that they are taking/can take towards change.

Allowing the client to lead the exploration of their issue

Brief interventions should be client-led. The counsellor should avoid imposing their beliefs or forcing a client to change. Instead, the focus needs to be on developing the client's desire for change. If the client is having trouble discussing their issue/concern or they are resistant to the idea of talking about their problem behaviour, it can be helpful to normalise the issue and help reduce shame and isolation by saying something to the effect of “Often people see me because they want some help quitting a behaviour that they or significant people in their life identify as a problem. Change is usually easier to maintain when you have support around you. I’m wondering if that has happened with you.”

Motivational Interviewing_Stages of Change

This video explores Precontemplation and Contemplation, what we will see from clients in these stages and how to help move clients along at the speed they are ready for towards making lifestyle changes.

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The overall goal of the assessment process is to determine which stage of change the client is in. Depending upon the context in which you are working, the assessment process may be structured around a specific screening tool (often used in the context of drug and alcohol counselling), or 'assessment' may simply involve a simple opportunistic conversation with the client regarding a problematic behaviour. In either case, counsellors are typically interested in gathering critical information about the client's need/area of concern, their current behaviour, any steps taken towards change, and their attitudes/intentions towards change.

Information Needed	Questions
Need/areas of concern	What brings you here today? What issues have you been having lately?
Current behaviour	Are you still [engaged in behaviour - e.g., smoking, drinking, unemployment etc.]? How frequently do you [engage in this behaviour, changing jobs constantly]?
Previous solutions tried	Have you tried making any changes to [this behaviour, finding jobs, attending a minimum of one interview to not be unemployed]? How long were you able to sustain that change?
Attitudes, perceptions, and intentions towards change	Do you feel as though [behaviour] is having any negative consequences in your life? Are you considering making a change to [this behaviour]? Is it likely that you will [change behaviour] within the next month?

Brief Intervention (First Sessions) on Alcohol

This video demonstrates building rapport and engagement with a first time female client by an Aboriginal Torres Strait Islander Remote Alcohol & Other Drugs Worker. Answer the questions that follow.

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By asking appropriate questions and monitoring how the client talks about their behaviour, the counsellor can determine what stage of change the client is in.

For example, a client in the pre-contemplative stage will say things like, ‘Being unemployed is really no big deal at all’ and ‘Drinking is not affecting my life adversely in any way’.

A client in the contemplative stage may admit, ‘Unemployment is affecting my life more than I like and I think I want to change’ and ‘I can’t continue drinking like this’.

A client in the preparation stage is already aware of a problem and has started making changes. They may say something like, ‘I want to earn some money so that I do not have to sleep in community centres’, and ‘I intend to stop visiting bars from this month. I've already told my friends that I'm going to stop coming out with them on Saturday nights’.

A client in the action stage has not only recognised their issue but has already taken solid steps to make the changes, and this will be evidenced by statements such as, ‘I have not had a smoke for over a week now’ or ‘I have not had more than a drink a day for a month now'.

A client in the maintenance stage has already changed or quit the harmful behaviour for over six months and can say things like, ‘I have managed to gain an offer for a job’ or 'I don't drink anymore. I haven't had a drink since last year'.

A note on understanding the client’s individual context

To be able to appropriately provide brief interventions, it is best practice for the counsellor to have an understanding of the broader context that impacts the client’s behaviour. While individuals will have their own motivations and intentions surrounding their behaviour, their culture, family, and community also influence behaviours. If counsellors remain unaware of the underlying context of a behaviour, it may be hard to respond to clients appropriately.

For example, imagine working with a client who is displaying problematic drinking behaviour. If heavy drinking is ingrained in the social culture of the individual’s family or community, it may be very hard for the client to make changes in their behaviour without taking into consideration the reality of their daily lives. In such a situation, the counsellor would need to work with the client to find ways of dealing with this reality while on the path to change.

To understand unhealthy behaviours of clients within the context of culture, family, and community, the crucial factors to consider include the following:

• The attitudes held within the family unit, community, and culture on change (Do they approve of change or shun change?)
• Attitudes and perceptions surrounding the behaviour (Do they see it as a problem?)
• The embedded reinforcement (If someone wants to give up drinking, but their social interactions with their family depend on joining in for a drink, that will reinforce the need to keep drinking?)
• The imposed identity upon the individual (Does the family/culture/community have a fixed view of this person? Would they resist changes in their identity?)
• The support of the environment (Will there be sufficient positive reinforcement and support for the individual to recognise and maintain changes?)

Because humans are social creatures, the people a client is surrounded by will inevitably impact their life. Therefore, to select appropriate support for the client, the counsellor should consider these factors and the role that they have in the client’s current behaviour and future change-related behaviours.

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Brief interventions are based on the fact that change can be promoted by providing people with the right information at the right time. The purpose of brief interventions is to raise client awareness of or readiness to change regarding a particular issue and then share relevant knowledge/resources that will support the client to make beneficial changes in their life, hence why it is usually a one-to-one approach. There are three broad reasons for using brief interventions. These are outlined as follows. 

1. To raise the client’s awareness of an issue or problematic behaviour

Using brief interventions to raise awareness involves short and targeted interventions to increase knowledge, understanding, and consciousness about specific health or behavioural issues. Here are some critical reasons for using brief interventions to raise awareness.

Education and information dissemination

Brief interventions can serve as a means to provide concise and focused educational materials, resources, and information to individuals or communities. By delivering key messages and facts about a particular issue, these interventions aim to increase awareness and knowledge about the risks, consequences, and potential solutions related to the topic.

Prevention and risk reduction

Raising awareness through brief interventions can help prevent the onset or progression of health problems. By providing individuals with information about risk factors, early signs, and preventive measures, brief interventions empower people to make informed decisions and adopt healthier behaviours, reducing their risk of developing a particular health condition.

Behaviour change promotion

Brief interventions can effectively promote behaviour change by enhancing individuals' understanding of the consequences of their actions. By highlighting the potential negative impact of unhealthy behaviours or the benefits of adopting healthier habits, these interventions can motivate individuals to modify their behaviour and make positive choices.

Stigma reduction

Raising awareness through brief interventions can reduce the stigma associated with specific health issues, such as mental health or substance abuse. Providing accurate information and dispelling misconceptions, brief interventions help challenge stereotypes and promote a more empathetic and supportive attitude towards those facing such challenges.

Empowerment and self-efficacy

Brief interventions that raise awareness often aim to empower individuals by providing them with knowledge and resources to take control of their health. By increasing awareness of available support systems, treatment options, and self-help strategies, these interventions foster a sense of self-efficacy and empowerment, enabling individuals to seek help and make positive changes.

Community mobilisation

Brief interventions can play a role in mobilising communities and generating collective action around specific health or social issues. By raising awareness, these interventions encourage community members to come together, advocate for change, and engage in collaborative efforts to address shared concerns effectively.

Early detection and intervention

Raising awareness through brief interventions can lead to early detection and intervention for specific health conditions. Educating individuals about the signs and symptoms of particular diseases or disorders, these interventions prompt individuals to seek timely medical or professional help, improving the chances of successful treatment outcomes.

Normative change

Brief interventions that raise awareness can help challenge and reshape social norms related to health behaviours. By promoting healthier and more positive standards, these interventions influence individuals' attitudes, beliefs, and behaviours, creating a ripple effect within communities and driving widespread behaviour change.

Utilising brief interventions to raise awareness is valuable for educating, informing, and empowering individuals and communities. By increasing awareness about specific health issues, risks, and potential solutions, these interventions can facilitate behaviour change, reduce stigma, promote early intervention, and foster healthier communities.

2. To share knowledge about the impact of the issue/behaviour and alternatives that the client can consider

Using brief interventions to share knowledge involves brief and targeted interventions to disseminate information, expertise, and insights about specific topics or subjects. Here are some key reasons for using brief interventions to share knowledge.

Efficiency and accessibility

Brief interventions provide a time-efficient and accessible platform to share knowledge. They are designed to convey information concisely and focus, making it easier for individuals to grasp and retain key concepts. The brevity of these interventions also allows for greater accessibility, as they can be delivered in various settings and formats, reaching a wider audience.

Targeted communication

Brief interventions deliver specific and targeted knowledge to address particular issues or concerns. These interventions can enhance engagement and relevance by tailoring the information shared to the audience's needs, interests, and contexts. They can be customised to address individuals' unique challenges or questions, fostering better understanding and application of shared knowledge.

Increased awareness and understanding

Sharing knowledge through brief interventions helps to raise awareness and deepen understanding about specific topics. By providing accurate and relevant information, these interventions expand individuals' knowledge base, ensuring they have a solid foundation to make informed decisions, take appropriate actions, or engage in meaningful discussions related to the subject matter.

Empowerment and informed decision-making

Brief interventions that share knowledge empower individuals by equipping them with the information they need to make informed decisions. By providing insights, evidence-based findings, and practical guidance, these interventions enable individuals to evaluate options, weigh pros and cons, and make choices aligned with their goals, values, and preferences.

Skill development

Brief interventions can be used to share knowledge related to skill development or behaviour change. These interventions enable individuals to acquire new or enhanced skills by imparting practical techniques, strategies, or step-by-step instructions. The shared knowledge can equip individuals with the necessary tools to address challenges, overcome obstacles, or improve their performance in a particular area.

Professional development and capacity building

Brief interventions can be utilised in professional contexts to share knowledge and foster ongoing learning and growth. They can be used in workshops, training sessions, or continuing education programs to update professionals on emerging research, best practices, or industry trends. Sharing knowledge in these settings enhances professional competence, promotes innovation, and supports delivering high-quality services.

Collaboration and knowledge exchange

Brief interventions can facilitate knowledge exchange and collaboration among individuals or groups. These interventions foster the exchange of ideas, perspectives, and insights by creating opportunities for dialogue, discussion, and sharing of experiences. They make a platform for individuals to learn from one another, build networks, and collectively contribute to developing and disseminating knowledge.

Dissemination of research findings

Brief interventions can be used to share research findings in an accessible and engaging way. Researchers can distill complex information into easily digestible formats, such as infographics, videos, or summary reports, making their findings more accessible to a broader audience. This enables the translation of research into practice and facilitates evidence-based decision-making.

In summary, utilising brief interventions to share knowledge offers an efficient and targeted approach to disseminating information, promoting understanding, empowering individuals, and fostering collaboration. By sharing knowledge effectively, these interventions contribute to informed decision-making, skill development, professional growth, and the advancement of knowledge in various domains.

3. To help the client think about and change their behaviour to improve health/wellbeing

Using brief interventions to help individuals think about making changes to improve their health involves guiding them in considering and contemplating behavioural modifications that can lead to better overall well-being. Here are some key reasons for using brief interventions for this purpose.

Increased self-awareness

Brief interventions can help individuals gain insight into their current health behaviours and the potential impact these behaviours have on their well-being. By exploring their habits, choices, and patterns, individuals can become more aware of areas where changes may be beneficial.

Motivation enhancement

Brief interventions aim to enhance motivation by exploring the individual's ambivalence or readiness for change. These interventions help individuals weigh the pros and cons of their current behaviours, examine the benefits of change, and identify personal reasons for making positive health changes.

Goal setting

Brief interventions allow individuals to set specific, measurable, attainable, relevant, and time-bound (SMART) goals related to their health. By collaboratively identifying meaningful and achievable goals, individuals can clarify their intentions and establish a roadmap for action.

Problem-solving

Brief interventions can facilitate problem-solving by helping individuals identify barriers and obstacles to behaviour change. Through guided discussions, individuals can explore potential solutions, develop strategies, and consider alternatives to overcome challenges that may arise during the change process.

Providing information and resources

Brief interventions offer individuals the necessary information, resources, and support to make informed decisions about improving their health. This may involve sharing evidence-based practices and educational materials or connecting individuals to relevant community resources or support networks.

Self-efficacy enhancement

Brief interventions aim to strengthen individuals' belief in their ability to make positive changes. By highlighting their past successes and strengths, individuals can develop a sense of self-efficacy, which increases their confidence in their ability to implement and sustain health-enhancing behaviours.

Emphasising benefits and consequences

Brief interventions help individuals explore the potential benefits of positive health changes and the consequences of maintaining unhealthy behaviours. By considering the short-term and long-term implications, individuals can better understand the importance and urgency of making changes to improve their health.

Facilitating readiness for action

Brief interventions work towards helping individuals move from contemplation to the action stage in the behaviour change process. By discussing the potential steps, resources, and support available, individuals can begin formulating a plan to implement the desired changes in their lives.

Building support networks

Brief interventions may involve connecting individuals to support networks, such as family, friends, or community groups, who can provide encouragement, accountability, and assistance during the behaviour change journey. Supportive relationships can significantly contribute to individuals' motivation and success in making positive health changes.

Overall, brief interventions designed to help individuals think about making changes to improve their health focus on enhancing self-awareness, motivation, goal setting, problem-solving skills, and self-efficacy. By providing information, support, and guidance, these interventions empower individuals to take ownership of their health and actively engage in the process of making positive behavioural changes.

Brief intervention for possibly dependent marijuana use

Brief intervention demonstration with a patient for possibly dependent marijuana use and/or major consequences of use, utilising motivational interviewing. Answer the questions that follow.

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The Purpose and Role of a public health strategy in brief interventions

The role of public health strategy in brief interventions is to promote and facilitate the widespread implementation of effective interventions that address various health and behavioural concerns. Public health strategies aim to improve population health outcomes by targeting specific issues through brief interventions, such as substance abuse, mental health, or unhealthy behaviours. The focus is on prevention and supporting recovery rather than cure.

Here are vital aspects of the role of public health strategy in brief interventions:

• Prevention and early intervention: Public health strategies focus on preventing the development or escalation of health problems by providing brief interventions early in the process. Public health initiatives can intervene promptly by identifying at-risk individuals or displaying early signs of a particular issue, reducing the potential for more severe consequences.
• Accessibility and reach: Public health strategies aim to make brief interventions accessible and reach a broad population. This involves implementing interventions in various settings, such as healthcare facilities, schools, workplaces, and community centres, to ensure that individuals from diverse backgrounds and demographics can access the necessary support.
• Awareness and education: Public health initiatives are vital in raising awareness about the benefits of brief interventions and providing education about specific health concerns. This includes disseminating information about the effectiveness of brief interventions, the available resources, and the potential impact on individuals and communities.
• Training and capacity building: Public health strategies involve training healthcare providers, counsellors, and other professionals in delivering brief interventions. This helps build the workforce's capacity to effectively and competently provide these interventions, ensuring consistent quality and adherence to evidence-based practices.
• Integration into healthcare systems: Public health efforts work towards integrating brief interventions into existing healthcare systems and practices. This involves collaborating with healthcare providers, policymakers, and administrators to incorporate brief interventions as a standard of routine care, screening processes, and treatment protocols.
• Monitoring and evaluation: Public health strategies emphasise the importance of monitoring and evaluating the impact and effectiveness of brief interventions. This includes measuring outcomes, collecting data on intervention delivery, and assessing population-level changes in behaviour, health outcomes, and resource utilisation. Evaluation findings can inform adjustments and improvements to intervention approaches.
• Collaboration and partnerships: Public health initiatives foster collaboration and partnerships among various stakeholders, including healthcare providers, community organisations, government agencies, and advocacy groups. This collective effort helps mobilise resources, share best practices, and coordinate efforts to implement and sustain brief interventions effectively.

By incorporating public health strategies, brief interventions can have a broader reach, improve population health outcomes, and proactively address health concerns. Public health efforts provide the framework and support to implement and scale brief interventions across diverse settings and populations.

Brief interventions (BI) for substance abuse problems have been used for many years by alcohol and drug counsellors, social workers, psychologists, physicians, and nurses, and by social service agencies, hospital emergency departments, court-ordered educational groups, and vocational rehabilitation programs. Primary care providers find many brief intervention techniques effective in addressing the substance abuse issues of clients unable or unwilling to access specialty care.

Examples of brief interventions include asking clients to try non-use to see if they can stop on their own, encouraging interventions directed toward attending a self-help group (e.g., Alcoholics Anonymous [AA] or Narcotics Anonymous [NA]), and engaging in brief, structured, time-limited efforts to help pregnant clients stop using.

While brief interventions are most commonly used concerning issues of addiction, research has found that brief interventions can be effective when working with a range of other specific behavioural issues (for example, addressing poor diet/nutrition, poor exercise habits, poor environmental health factors, risky sexual health behaviours, improving self-care and improving health-related behaviours).

Recently it was known that older adults are at a high risk of malnutrition and dehydration due to various psychological and social factors, such as memory impairment and older adults forgetting or refusing to eat or stay hydrated. Those suffering from loneliness or social isolation have greater risks of eating alone or not staying hydrated (Starr, McDonald & Bales, 2015).

A recent study that was designed to address malnutrition and fall-related risk in adults over 65 years of age found that through screening and the use of brief intervention, they were able to identify baseline malnutrition risks, which may have gone unrecognised and unaddressed (Mathew et al., 2020). They also claimed that brief interventions have a role in the evidence-based movement to introduce these older adults in informative sessions and link the most at-risk participants to subsequent fall prevention workshops.

Various professionals can offer brief interventions in counselling, depending on their training, expertise, and the specific context.  The specific qualifications and credentials required for providing brief interventions may vary depending on the jurisdiction and the regulations governing mental health professions in that area.

Some of the professionals who may provide brief interventions include the following.

Who can offer brief interventions in counselling?

The Stigma of Addiction

In this TEDx Talk, the presenter Tony, discusses how his first time smoking marijuana led to his eventual drug addiction, homelessness, prison, and finally redemption. This talk provides us with an understanding of the stigma around addiction and the cultural contexts around addiction. 

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When providing brief interventions in counselling, it is crucial to consider a client's problematic behaviour within broader contexts, such as cultural, family, and community factors. It's also essential to clarify the client's view of these factors.

Consider the client's context

Cultural Context Cultural sensitivity

Australia is a multicultural society with a diverse population. Cultural backgrounds influence beliefs, values, norms, and behaviours. Considering a client's cultural context helps counsellors understand their worldview, expectations, and how their cultural background might impact their behaviour.

Communication styles

Different cultures have varying communication styles and preferences. Understanding these nuances can enhance the effectiveness of counselling sessions by ensuring effective communication between the counsellor and the client. Stigma and discrimination: Some cultural groups may face discrimination or stigma related to mental health issues or specific behaviours. Acknowledging these challenges is essential for addressing the client's concerns and potential barriers to seeking help.

Cultural norms

Cultural norms may shape the client's perceptions of problematic behaviour. What is seen as acceptable or unacceptable can vary significantly across cultures.

Family Context Family dynamics

Family plays a significant role in an individual's life. Understanding family dynamics, relationships, and functions within the family unit can provide insights into the origins and perpetuation of problematic behaviours.

Interpersonal conflicts

Family conflicts or dysfunctional relationships can contribute to or exacerbate problematic behaviours. Addressing these issues may be crucial for the client's well-being and progress.

Support systems

Family members can serve as both sources of support and stress. Identifying the level of support available to the client can help counsellors develop intervention strategies that leverage positive family dynamics and address negative influences.

Community Context Social networks

The client's community, including friends, acquaintances, and social networks, can support or enable problematic behaviours. Examining the client's social connections can reveal potential triggers or sources of support.

Environmental factors

The client's physical environment, neighbourhood, and resource access can influence their behaviour. Identifying these factors can help in developing strategies to mitigate environmental stressors.

Community resources

Communities often have resources such as mental health services, support groups, and community organisations. Connecting clients to these resources can be integral to their recovery and addressing problematic behaviours.

Client's perception of cultural, family, and community context

It is vital in counselling to avoid making assumptions based on any one factor. A client may identify as belonging to one culture but may not necessarily adhere to all its teachings, values and beliefs of that culture, impacting their behaviour.

In summary, considering cultural, family, and community contexts when providing brief interventions in counselling allows for a more holistic and practical approach to addressing problematic behaviours. It helps counsellors understand the client's unique circumstances, challenges, and sources of support, leading to more tailored and culturally competent interventions that can yield better outcomes.

Brief intervention alcohol, no concerns

This video provides a demonstration of a client in a Brief Intervention session. Answer the questions that follow.

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There are six elements that are critical for effective brief interventions. The acronym FRAMES was coined to summarise these six components:

• Feedback is given to the individual about personal risk or impairment.
• Responsibility for change is placed on the participant.
• Advice to change is given by the counsellor.
• Menu of alternative self-help or treatment options is offered to the participant.
• Empathic style is used by the counsellor.
• Self-efficacy or optimistic empowerment is engendered in the participant.

A brief intervention consists of five basic steps that incorporate FRAMES and remain consistent regardless of the number of sessions or the length of the intervention:

1. Introducing the issues in the context of the client’s health.
2. Screening, evaluating, and assessing.
3. Providing feedback.
4. Talking about change and setting goals.
5. Summarising and reaching closure.

Providers may not have to use all five of the components in every session. It is more important to use the components that reflect the needs of the client and their personal style. Before eliminating steps in the brief intervention process, however, there should be a well-defined reason for doing so. Moreover, a vital part of the intervention process is monitoring to determine how the client is progressing after the initial intervention has been completed. Monitoring allows the counsellor and client to determine gains and challenges and to redirect the longer-term plan when necessary.

Clients make changes for different reasons, and an intervention that works well for one client may not work for another. These components of the journey toward recovery can be integral steps in the process. For some clients, assistance with the decision to make the change will be enough to motivate them to start changing the behaviour, whereas others may need more intensive clinical involvement throughout the change process.

Brief interventions using a client-led process

While the use of brief interventions is often promoted as part of public health strategies, individual brief interventions are ultimately a one-on-one, client-led process in which a counsellor (or other health professional) meets privately with the client, assesses their current level of desire to change, and provides them with specifically tailored information or strategies to support the client.

Depending upon the client’s needs and desire to change, counsellors (or other health professionals working with the client) may seek to:

• Raise client awareness
• Share information and resources
• Explore the client’s concerns and strategies
• Help the client express their feelings, make decisions, and set goals
• Highlight the benefits of change
• Provide positive feedback and encouragement
• Offer time and support
• Refer the client to other sources of assistance.

The selection of these strategies, as well as the entire process of brief interventions, is informed by a particular theoretical approach which is the stages of change model, introduced in the beginning of this section.

Remember we need to understand our client’s process of behavioural changes – where are they currently and where do they want to be after the sessions; will this work out positively or not? These questions within the initial stage of change leads us to think about how we can use BI to support our client’s change.

Features of a client-led process in Brief Interventions

Collaborative approach

The client-led process emphasises collaboration between the counsellor and the client. The counsellor supports and guides the client while respecting their autonomy and self-determination. The client takes an active role in defining goals, identifying issues, and determining the direction of the intervention.

Client-centred focus

The interventions prioritise the client's needs, preferences, and values. The counsellor creates a safe, non-judgmental space where the client feels heard, understood, and validated. The client's unique perspectives and experiences are acknowledged and respected throughout the process.

Goal-oriented

Brief interventions with a client-led process typically have specific goals the client wishes to achieve. The counsellor assists the client in clarifying their goals and collaboratively develops strategies to work towards them. The focus is on addressing the client's immediate concerns and facilitating change within a limited timeframe.

Strengths-based approach

The counsellor recognises and builds upon the client's strengths, resources, and capabilities. The intervention emphasises empowering clients to leverage their existing skills and abilities to overcome challenges and achieve their desired outcomes.

Solution-focused

Brief interventions with a client-led process often adopt a solution-focused approach. The emphasis is on exploring solutions, identifying exceptions to the problem, and amplifying positive aspects of the client's life. The counsellor helps the client generate ideas and strategies that can lead to practical and achievable solutions.

Flexibility and adaptability

The client-led process allows flexibility and adaptation based on the client's changing needs and preferences. The counsellor adjusts their approach, techniques, and interventions to align with the client's evolving goals and circumstances.

Empathic listening and validation

The counsellor actively listens to the client, demonstrating empathy, understanding, and verification. They create a supportive and non-judgmental environment where clients feel comfortable expressing their thoughts, emotions, and concerns.

Time-limited

Brief interventions using a client-led process typically operate within a defined timeframe. The counsellor and client work together to make the most efficient use of the available time, focusing on addressing the client's concerns and achieving their goals within the allotted sessions.

Overall, brief interventions using a client-led process in counselling prioritise collaboration, client empowerment, goal-setting, and flexibility. They aim to assist clients in identifying and implementing practical solutions to their challenges, all while honouring the client's autonomy and individuality.

Motivational Interviewing

This video provides a good example of the Counsellor using MI in a client led process.

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Brief interventions: Opportunistic

Brief interventions: opportunistic refers to a specific approach where interventions are offered opportunistically in situations where individuals may not have sought help explicitly for their presenting issue.

Features of opportunistic brief interventions:

1. Timely and unplanned: Opportunistic brief interventions are delivered when an opportunity arises spontaneously, often outside a formal therapeutic setting. These interventions may occur during routine encounters or interactions, such as primary healthcare visits, workplace settings, or community events.
2. Targeted and focused: Brief interventions: opportunistic are typically aimed at addressing specific behavioural or psychological concerns identified during the encounter. The focus is on addressing immediate needs or risks rather than delving deeply into complex issues.
3. Brief and concise: Given the impromptu nature of these interventions, they are designed to be straightforward. The intervention provider aims to deliver relevant information, advice, or guidance within a limited time.
4. Psychoeducation and advice: Brief interventions: opportunistic often involve providing psychoeducation and advice to individuals regarding their concerns or issues. This may include information about risks, consequences, coping strategies, or resources available to support behavioural change or problem resolution.
5. Motivational and goal-oriented: These interventions motivate individuals to consider change and take action. The intervention provider may use motivational interviewing techniques to explore the person's readiness for change, enhance motivation, and set achievable goals.
6. Collaborative and person-centred: Despite being brief and unplanned, opportunistic interventions emphasise collaboration between the provider and the individual. The provider partners with the person, considering their preferences, values, and goals while offering support and guidance.
7. Seamless integration into existing encounters: Opportunistic brief interventions are seamlessly integrated into existing meetings or interactions, taking advantage of the natural setting. They may occur within a broader context, such as a healthcare visit, where the provider recognises an opportunity to address a related issue.
8. Follow-up and referral: In some cases, brief interventions: opportunistic may involve providing appropriate referrals or recommendations for further support or treatment. The intervention provider may assist the individual in connecting with relevant resources or professionals to continue addressing their needs.

Overall, brief interventions: opportunistic are characterised by their spontaneous, targeted, and time-limited nature. They focus on addressing specific concerns, providing relevant information or advice, and motivating individuals to take steps toward positive change within unplanned encounters or interactions.

Providing effective brief interventions requires the counsellor to possess specific knowledge, skills and abilities. The following are four essential skills:

1. An overall attitude of understanding and acceptance
2. Counselling skills such as active listening and helping clients explore and resolve ambivalence
3. A focus on intermediate goals
4. A working knowledge of the stages of change through which a client moves when thinking about, beginning, and trying to maintain new behaviour

Motivational Interviewing Role-Play - Doubts about Substance Use after DUI

This video features a motivational interviewing (MI) counselling role-play session in which MI techniques are used to identify and explore ambivalence. Answer the questions that follow.

watch

The demand for brief interventions and therapies

The impetus for shorter forms of interventions and treatments for a range of substance abuse problems comes from several sources:

• Historical developments in the field that encourage a comprehensive, community-based continuum of care—with treatment and prevention components to serve clients who have a wide range of substance abuse-related problems.
• A growing body of evidence that consistently demonstrates the efficacy of brief interventions.
• An increasing demand for the most cost-effective types of treatment, especially in this era of health care inflation and cost containment policies in the private and public sectors.
• Client interest in shorter term treatments.

The increasing demand for treatment of some sort — arising from the identification of more at-risk consumers of substances through EAPs, substance-testing programs, health screening efforts, and drunk driving arrests — coupled with decreased public funding and cost containment policies of managed care leave only two options: provide diluted treatment in traditional models for a few or develop a system in which different levels and types of interventions are provided to clients based on their identified needs and characteristics (Wagner et al., 2017).

Goals of Brief Intervention

The key to a successful brief intervention is to extract a single, measurable behavioural change from the broad process of recovery that will allow the client to experience a small, incremental success. Clients who succeed at making small changes generally return for more successes.

The counsellor should temporarily set aside the final goal (for example, accepting responsibility for one's own recovery) to focus on a single behavioural objective. Once this objective is established, a brief intervention can be used to reach it. Objectives vary according to the client's stage of recovery and readiness to change, but brief interventions can be useful at any stage of recovery.

Resources for brief interventions

To identify the resources required to support a brief intervention, the counsellor can take the following steps:

1. Assess client needs: Conduct a thorough assessment of the client's presenting concerns, goals, and specific needs related to the intervention. This assessment will help identify the resources necessary to support the intervention effectively.
2. Conduct a comprehensive evaluation: Evaluate the client's strengths, limitations, and support systems. Determine what internal and external resources are already available to the client, such as personal skills, social support, or community resources.
3. Stay updated on available resources: Keep abreast of community resources, services, and programs that can support the client's needs. Stay connected with local organisations, healthcare providers, and social service agencies to be aware of the range of resources available.
4. Consult with colleagues and experts: Consult with colleagues, other professionals, or experts in relevant fields. Discuss the client's needs and seek their input on appropriate resources to complement the brief intervention.
5. Collaborate with interdisciplinary teams: If working in a multidisciplinary setting, collaborate with other professionals involved in the client's care, such as psychologists, social workers, or medical practitioners. Engage in team meetings or case conferences to identify and utilise the available resources within the team.
6. Utilise professional networks: Tap into professional networks and organisations related to the client's needs. Attend conferences, workshops, or seminars to learn about new resources, research, and best practices that can enhance the effectiveness of the brief intervention.
7. Conduct resource mapping: Create a resource map specific to the client's needs and location. This map should include local community organisations, support groups, counselling centres, healthcare facilities, helplines, or online resources that align with the client's requirements.
8. Establish partnerships and collaborations: Build relationships and partnerships with community organisations, non-profits, or government agencies that provide relevant services. Collaborate with these entities to access and utilise their resources for supporting the brief intervention.
9. Document and maintain a resource database: Maintain a database or directory of resources relevant to different client needs. Include information on contact details, eligibility criteria, services offered, and any associated costs. Regularly update this database to ensure its accuracy and relevance.
10.  Regularly review and evaluate resource effectiveness: Continuously assess the effectiveness and appropriateness of the resources utilised. Seek client feedback about their experiences with the help and make adjustments as needed.

By actively identifying and utilising appropriate resources, counsellors can enhance the support and effectiveness of their brief interventions, ultimately benefiting their clients' well-being and progress.

Why it is essential to use a one-on-one approach

Goal setting can only be effectively achieved using a one-to-one approach. The features of a private one-to-one approach in brief intervention include:

Confidentiality

The interaction between the intervention provider and the individual seeking help is kept private and confidential, ensuring that personal information and issues discussed are protected.

Individual focus

The intervention is tailored to the individual's needs, concerns, and circumstances. The provider can address the person's unique challenges and work collaboratively with them to set goals and develop strategies for change.

Personalised attention

The one-to-one format allows a deeper exploration of the individual's situation, feelings, and motivations. The provider can offer personalised guidance, support, and feedback to enhance the individual's understanding and motivation for change.

Trust and rapport

Building a trusting relationship is crucial in one-to-one. The private setting allows for open and honest communication, enabling the individual to feel heard, understood, and supported by the intervention provider.

Flexibility and adaptability

A private one-to-one approach allows flexibility in scheduling and adapting the intervention to meet the individual's changing needs. The provider can modify their approach, techniques, and strategies based on the person's progress and feedback.

Personal empowerment

Through the one-to-one approach, individuals can take ownership of their choices and actions. The provider helps them develop skills, resources, and strategies to overcome challenges, make positive changes, and achieve their goals.

Overall, a private one-to-one approach in brief intervention provides a focused, personalised, and confidential setting that fosters trust, collaboration, and empowerment to support individuals in addressing their concerns and making positive changes in their lives.

Embracing a holistic approach to counselling is essential in providing the best outcomes for the client. Fostering well-being on multiple levels involves considering the following. 

Environmental Health

In counselling, environmental health is important for promoting overall well-being and addressing potential factors that may impact a person's mental, emotional, and physical health. Here are some key health and well-being considerations related to environmental health in the counselling process.

Safety and physical well-being

Environmental health involves creating a safe and secure space for counselling sessions. Counsellors should ensure that the physical environment, such as the office or therapy room, is free from hazards and provides a comfortable setting for clients. Attention should be given to factors like lighting, ventilation, temperature, and cleanliness to promote a conducive environment for therapeutic work.

Privacy and confidentiality

Environmental health considerations include safeguarding client privacy and confidentiality. Counsellors should establish policies and practices that protect client confidentiality within the counselling setting. This may involve maintaining private meeting spaces, secure record-keeping systems, and ensuring that others cannot overhear conversations.

Accessibility and inclusivity

Counselors should consider the accessibility of the counselling environment to ensure that it is inclusive and accommodating for individuals with diverse needs. This may involve addressing physical accessibility, such as ramps or elevators for individuals with mobility challenges, and providing accommodations for clients with sensory, cognitive, or other disabilities.

Noise and distractions

The counselling environment should be conducive to open and focused communication. Minimising external noise and distractions, such as loud noises from adjacent rooms or busy areas, can enhance the therapeutic experience and help clients feel more comfortable and heard.

Nature and natural elements

Incorporating nature and natural elements into the counselling environment can positively affect well-being. Access to natural light, plants, or outdoor spaces can provide a calming and soothing atmosphere, promoting relaxation, stress reduction, and a sense of connection to the natural world.

Cultural sensitivity and diversity

Environmental health considerations include acknowledging and respecting cultural diversity in counselling. Counsellors should create an environment that is culturally sensitive, inclusive, and welcoming to individuals from different backgrounds. This may involve displaying culturally relevant artwork, literature, or other materials that reflect the diversity of the clients served.

Psychological comfort

Environmental factors such as comfortable seating, appropriate temperature, and appropriate lighting can contribute to psychological comfort during counselling sessions. A relaxed environment can help clients feel at ease and more open to discussing their thoughts, emotions, and concerns.

Sustainability and eco-consciousness

Environmental health considerations can extend to sustainability and eco-conscious practices within the counselling environment. Counsellors can adopt practices that minimise waste, conserve resources, and promote eco-friendly behaviours. This aligns with the broader goal of promoting health and well-being at both individual and societal levels.

By considering environmental health in counselling, counsellors can create a supportive and nurturing environment that promotes well-being, ensures privacy and safety, and feels clients' diverse needs. These considerations contribute to a holistic approach to counselling, recognising the interconnectedness between individuals and their physical surroundings.

Nutrition

In counselling, nutrition is crucial in promoting overall health and well-being. Considerations related to nutrition include the following.

Assessment and education

Counselors can assess clients' current dietary habits and nutritional knowledge to identify areas for improvement. They can provide education on the importance of balanced nutrition, the impact of diet on mental and physical health, and strategies for making healthier food choices.

Emotional eating and disordered eating

Nutrition counselling may involve addressing emotional eating patterns or behaviours. Counsellors can help clients develop a healthy relationship with food, identify triggers for emotional eating, and explore alternative coping strategies.

Meal planning and goal setting

Collaboratively developing meal plans and setting nutrition-related goals can be beneficial. Counsellors can assist clients in setting realistic and achievable goals, incorporating healthy food choices, and establishing sustainable eating patterns.

Mindful eating

Encouraging mindful eating practices can help clients develop a more conscious and attuned approach to their eating habits. Counsellors can guide clients in paying attention to hunger and fullness cues, savouring food, and cultivating a greater awareness of the eating experience.

Nutrition and mental health

Recognising the connection between nutrition and mental health is important. Counsellors can explore how certain nutrients, such as omega-3 fatty acids or B vitamins, impact mood and cognitive functioning. They can also collaborate with clients to develop nutritional strategies that support mental well-being.

Alcohol

Alcohol consumption can have significant implications for mental and physical health. Considerations related to alcohol in the counselling process include the following.

Assessment and screening

Counsellors can assess clients' alcohol consumption patterns and screen for potential alcohol-related problems or disorders. This assessment helps identify clients who may need further support or intervention.

Education and harm reduction

Providing education about the effects of alcohol on physical and mental health is important. Counsellors can share information about safe drinking guidelines, the risks associated with excessive alcohol consumption, and strategies for harm reduction.

Motivational interviewing

Counsellors can utilise motivational interviewing techniques to explore clients' motivations, ambivalence, and readiness to change their alcohol use. This approach helps clients evaluate the pros and cons of their drinking behaviour and consider healthier alternatives.

Referral and support

Counsellors can refer clients to specialised services or support groups for alcohol-related issues if necessary. Collaboration with other healthcare professionals, such as addiction specialists or medical providers, may be essential in providing comprehensive care.

Other Drugs

Counselling may also address using other drugs, such as illicit or prescription medications. Considerations related to other drugs in the counselling process include the following.

Substance use assessment

Counsellors can assess clients' drug use patterns, history, and potential risks associated with their drug use. This assessment helps inform treatment planning and intervention strategies.

Harm reduction and safety

Counsellors can provide information on harm reduction strategies for individuals who continue to use drugs. This may involve discussing safer use practices, overdose prevention, and ways to minimise associated risks.

Motivational enhancement

Using motivational interviewing techniques, counsellors can help clients explore their motivations and goals regarding drug use. By examining the impact of drug use on their lives, clients can consider making changes and explore alternatives to drug use.

Referral and support

Counsellors can refer clients to specialised substance abuse treatment programs or community resources that provide comprehensive support for drug-related issues. Collaboration with addiction specialists or medical providers may be necessary for holistic care.

• It is important to note that counselling for nutrition, alcohol, and other drugs should be delivered by qualified professionals with expertise in these areas. Collaboration with other healthcare providers, such as registered dietitians, addiction specialists, or medical professionals, may be necessary to ensure comprehensive care and address clients' needs.

Various obstacles and difficulties can hinder positive intervention outcomes in counselling. It is essential to address these obstacles to optimise the effectiveness of counselling interventions. Here are some common barriers and suggested strategies for addressing them.

Resistance or lack of motivation

Clients may exhibit resistance or have low motivation to engage in counselling or make changes. This can be addressed by:

• Building rapport and trust: Establish a solid therapeutic alliance by demonstrating empathy, understanding, and genuine care for the client's well-being.
• Eliciting and exploring ambivalence: Use motivational interviewing techniques to help clients explore their conflicting feelings and motivations, enhancing their readiness for change.
• Clarifying goals and values: Collaboratively identify meaningful and personally relevant goals that align with the client's values and aspirations, increasing motivation and commitment.

Limited self-awareness or insight

Some clients may have limited self-awareness or struggle with gaining insights into their thoughts, emotions, or behaviours. Address this challenge by:

• Thoughtful exploration: Encourage clients to reflect on their experiences, thoughts, and emotions, facilitating deeperself-awareness.
• Active listening and questioning: Use active listening skills and ask open-ended questions to help clients explore their internal processes and gain insights.
• Psychoeducation: Provide relevant information and psychoeducational materials to increase clients' understanding of their emotions, behaviours, and patterns.

Stigma and social pressures

Stigma surrounding mental health or seeking counselling can be a barrier for some individuals. Strategies to address this barrier include:

• Normalising and validating experiences: Help clients understand that seeking counselling is a sign of strength and self-care, normalising their experiences and reducing self-stigma.
• Education on mental health: Provide psychoeducation to increase clients' understanding of mental health conditions, emphasising that seeking help is a positive step toward well-being.
• Encouraging social support: Facilitate the development of social support networks for clients, helping them connect with individuals who can provide understanding and encouragement.

Cultural and linguistic barriers

Cultural backgrounds and language differences can impact counselling. To address this, consider the following strategies:

• Cultural competence: Enhance cultural competence by educating yourself on different cultures, customs, and beliefs and incorporating this knowledge into your counselling approach.
• Language support: Provide language support through interpreters or bilingual counsellors to ensure effective communication and understanding.
• Collaboration and consultation: Seek consultation with professionals from the same cultural background or expertise to gain insights and develop culturally sensitive interventions.

External stressors and life circumstances

External stressors, such as financial difficulties, relationship problems, or traumatic events, can affect the counselling process. Address these challenges by:

• Psychoeducation on stress management: Provide clients with strategies to manage stress, such as relaxation techniques, time management, or problem-solving skills.
• Referral and collaboration: If necessary, collaborate with other professionals or refer clients to appropriate resources, such as financial counsellors, legal services, or support groups.
• Trauma-informed care: Incorporate trauma-informed principles into the counselling approach, ensuring safety, trust, and empowerment for clients who have experienced trauma.

Limited resources or access to support

Clients may face challenges related to limited resources or access to ongoing support outside the counselling sessions. Consider these strategies:

• Resource exploration: Assist clients in identifying and accessing community resources, support groups, or organisations that can provide ongoing support.
• Advocacy: Advocate for clients' needs and rights by connecting them with appropriate services or working with relevant agencies or organisations.
• Collaborative care: Collaborate with other professionals involved in the client's care, such as medical providers, social workers, or educators, to ensure a comprehensive and coordinated support system.

By proactively addressing these barriers and challenges, counsellors can create a more supportive and effective.

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By asking the appropriate questions, being aware of a client’s context, and being observant of how the client explains their issues, a counsellor will be able to identify which stage of change the client is in and what interventions would be most appropriate for the client based upon their stage and context. While you will learn more about intervention in the next section of this module, the following extract provides a good summary of what you have learned so far – it is a ‘practice sheet’ that provides a summary overview of the brief intervention process used by one organisation. It outlines the process of ASSESS, ASK and ASSIST. Under this framework, the worker will first ASSESS the client and share the assessment results with them. Then they will ASK the client questions to increase the client’s awareness of their own behaviour and the impact their behaviour could have on their health. Finally, the worker will ASSIST the client to change their health-related behaviour by selecting and using the most appropriate intervention for the client.

• ASSESS: ‘Your results indicate that you could benefit from changing some of your health-related habits.’
• ASK and increase AWARENESS: ‘Do you know…?’ ‘Have you thought about…?’ ‘How important…?’ ‘How confident…?’
• ASSIST them to CHANGE HEALTH-RELATED HABITS: By giving an appropriate response and supporting them to make a personal SMART goal.

Note: Use alongside an appropriate tool/leaflet.

Client’s Response (How do they feel about the results?)	Stage (The stage the client is in regarding wanting to change related habits)	Assist (Appropriate response, information and level of support. Listen, reflect, clarify and listen again. The client is the expert about themselves.)
I am OK. ‘I’m not sure it’s right. Anyway, I feel fine. It’s never really bothered me'.	Not interested in changing and may not want information	Highlight the benefits of changing Talk about it and suggest simple possible changes or relate to the relevant leaflet, but do not push it Inform if support is available
Do I want to do something? ‘I am a little concerned and I really ought to tackle it, but I’ve always found it so difficult to change what I do.'	Thinking about changing and may want more specific information and a chat about the blocks/barriers	Explore what might be difficult about changing – discuss the barriers Increase motivation by listening and encouraging the patient to talk; reflect on importance by exploring concerns, benefits and ‘confidence’ by allowing reflection on past experience and building on this; ‘Visualise the future benefits if you make this change’ Refer to the relevant leaflet
What can I do to get started? ‘Yes, I have been worried and thought about what I could do, and I am going to make a start.'	Preparing to change or planning to make changes soon	Refer to the relevant leaflet and highlight specific tips Discuss support options available (for example, do it alone or join other people) Support the client to make one agreed SMART (specific, measurable, achievable, realistic, timed) goal Support with action planning – SMART
I’ve already made a few changes.	Making changes Staying stopped	Listen and reflect on successes and lessons learned Praise and encourage Give information about other opportunities to gain support
How can I keep going? ‘I have been doing this for a while, but it’s getting difficult.'	Maintaining changes Staying stopped	Congratulate the client; reflect on lessons learned - How will they maintain these lifestyle changes through difficult times? What other support is out there? Reinforce the benefits and importance of change and encourage them to talk personally about how much better they feel
I want to give up. ‘I’ve struggled to keep going. It’s difficult, and I miss all the nice things'.	Relapse	Reassure the client that relapse is a normal part of the process Reflect on triggers leading to relapse; review the action plan, identifying coping strategies to take account of these triggers; also, build on past successes Cognitively replace negative thoughts with positive ones Highlight support available for the next attempt

^{(Adapted from Raihan & Cogburn, 2021)}

The extract refers to providing clients with appropriate leaflets and tools. These sorts of resources are a central component of brief interventions. Because brief interventions are very short-term, there is often no time for the counsellor to engage in psycho-education or provide lengthy interventions in session. Instead, the focus is on providing the client with resources they can review or access after the session.

Some commonly used resources in brief interventions include:

• Brochures or pamphlets: Most organisations that provide brief interventions will have a selection of brochures and pamphlets that counsellors (or other professionals) can supply to clients. There are usually different types of brochures or pamphlets, and the counsellor will select the most appropriate for the client’s stage of change. For example, if the counsellor meets with a client with problematic drinking behaviours and the client is in the pre-contemplation or contemplation stage, the counsellor may supply them with a pamphlet on dangerous drinking behaviours and tips for reducing drinking. However, if the client is in the action or maintenance stage, the counsellor may supply them with brochures for local support groups such as Alcoholics Anonymous. Brochures and pamphlets are ideal for brief interventions because the counsellor can review the information with the client in session, and then the client can take this with them when they leave.
• Books and publications: Many organisations may also have newsletters, reading lists, or support publications that the counsellor can use to support brief interventions with clients. For example, when working with a client in the action or maintenance stage, the counsellor may provide the client with a list of useful books and publications to support the client in their change efforts. Similarly, some organisations provide clients with support kits containing useful resources and ‘hints and tips’ for clients in the preparation phase to help encourage them to progress to the action phase.
• Displays: Many organisations that provide brief interventions make use of displays. You may have often noticed displays in schools, hospitals, and health centres advertising the impact of harmful behaviours. For example, an anti-drug display may prominently display the slogan ‘Drugs Kill’ and then list the harmful effects of drug use and some sources for support. These displays are designed to help clients in the pre-contemplation and contemplation stages increase their desire to change.
• Referral directories: In some cases, the counsellor may identify that the client could benefit from a referral to a specialised service so that they will make a referral following their organisation’s referral policies and processes. An example might be an unemployed client who ended up homeless but is now leaning on the action stage. They would benefit from a referral to the job seeker services centre or a career advisor.

Ultimately, counsellors should ensure that they use the most appropriate resources for each client and plan appropriate brief intervention strategies to match the individual client’s needs. The following table summarises just a few of the approaches a counsellor might take and how they could communicate this to the client.

Approach	Communicating with the client
Raising client awareness	‘I am wondering if you have noticed…’ or ‘Have you considered…?’
Highlighting benefits of change	‘If you were to be making this change now, how would your life look in five years?’ or ‘Often when people make changes to unhealthy behaviour it can result in a lot of positive changes in their health, wellbeing, relationships, and overall life. What do you think about that?’
Exploring concerns and strategies	‘So, you’ve mentioned that you want to quit smoking. A useful strategy for us to consider might be finding a replacement activity for you to do instead of smoking. What do you think?’
Sharing information and resources	‘In the past, some of my clients have found it useful to engage with an Alcoholics Anonymous support group to help them maintain their abstinence. If you are interested in that, I could give you some information on how to find a group near you.’
Helping the client express their feelings, make decisions and set goals	Feelings: ‘How do you feel about…?’ or ‘When that happens, how do you react to it?’ Decisions: ‘What do you see as the best course of action for you going forward?’ or ‘It sounds like you have a few choices. What choice most closely aligns with where you want to be?’ Goals: ‘What will help you get where you want to be?’ or ‘What are the first steps we need to take in order to get you to your final destination?’
Giving positive feedback and encouragement	‘That’s great that you’ve made the decision to come here today!’ or ‘You’ve made such great progress already. You’re showing great commitment to making that change!’
Offering time and support	‘This is your time and space to focus on yourself and how making changes positively benefits your life.’ or ‘My role here is to support you while you take those positive steps to make changes. This is a supportive platform from which you can launch yourself.’
Referring to other sources of assistance	‘Withdrawing from Valium on your own can be dangerous. Since you are ready to make this change, I can refer you to a detoxification centre to help you through this process.”

Substance Use and Alcohol Use Assessment

In this video, the presenter outlines how to assess and screen clients to provide appropriate interventions.

watch

check your understanding of the content so far!

You were provided with an introduction to brief interventions in this module section. In the next section of the module, you will learn more about implementing effective brief interventions with clients in different stages of change. Always bear in mind that, depending on the organisation you work for and/or your specific role as a community worker (for example, Alcohol and other drugs (AOD) worker, social worker or mental health worker), you may come across situations of risky/harmful behaviour that you are not familiar with, including specific drug information and their interaction with other substances. As emphasised, it is extremely important you understand that different substances can interact with each other, including prescribed mental health medications your client may be using. Hence you should not hesitate to consult with specialist services/organisations (if you do not work for one) or a specialist (if you are not a trained and qualified specialist) to obtain more specific and detailed information about those drugs and, if appropriate, interactions with other substances that your client may be using.

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