Step 4: Assess Readiness

Recommend abstinence without respecting autonomy

PROVIDER: Drinking at your age is illegal and the best choice for your health is to quit. Do you think you could try it out?
TEEN: Um, I don't think so.

COACH: It's important to respect the patient's autonomy. Otherwise, it seems like you're pushing your own agenda. When recommending abstinence, acknowledge that the decision is ultimately theirs.

Bringing up referral too early in the brief intervention
PROVIDER: So you're a five, that means you're somewhat ready to change. I'm glad you're taking this seriously. And I think you should consider seeing a counselor.
TEEN: a counselor?
PROVIDER: You need someone to help you deal with your stress in a real way.
TEEN: It's just a rough spot, okay? I can get through this.

Asking, "What made you choose that and not a higher number?"

PROVIDER: What made you choose a six and not a higher number, like a nine?

TEEN: I mean, maybe I overdid it tonight, but I like drinking with my friends. It's a lot of fun.

COACH: The way you phrased this question ("why not higher?") caused the adolescent to reflect on reasons he should continue drinking (sustain talk). Your goal is to elicit change talk by asking why he didn't pick a lower number.

Affirmations that express judgment PROVIDER: I have to say you seem like you have so much potential it's a shame to see you do this to yourself.
TEEN: (down) I know.

COACH: That affirmation didn't actually reinforce anything the adolescent is doing right or make her feel more empowered. In fact, it did the opposite, by emphasizing her failures with a comment that feels patronizing.