"It's Just Wine": Motivational Interviewing With a Client Who Is Not Sure She Has a Drinking Problem
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Psychology Program, Aspen University
PSY530: Advanced Helping Skills
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Month Day, Year
"It's Just Wine": Motivational Interviewing With a Client Who Is Not Sure She Has a Drinking Problem
Some clients arrive ready to change; many do not. Motivational interviewing was developed for the second group: people who are ambivalent, who see reasons both to change and to stay the same. This paper explains the approach's spirit, core skills, and central processes, applies them to the evening drinking of Teresa, the course's composite client, and considers what the evidence suggests about how much to expect.
Why Teresa's Drinking Matters
Since the layoff, Teresa says, she finishes most days with four or five glasses of wine. The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking for women as four or more drinks on any day or eight or more in a week (National Institute on Alcohol Abuse and Alcoholism [NIAAA], n.d.), and a restaurant pour of wine is often larger than a standard drink. By that definition she is drinking heavily every week, and the pattern began as a way to quiet shame and sleeplessness. Yet she does not see a problem. "It's just wine," she says. "I'm not an alcoholic. I just need to switch off." Confronting her with the label would likely produce resistance and could damage the alliance built in earlier sessions.
The Spirit and Skills of Motivational Interviewing
Miller and Rollnick (2013) described motivational interviewing as a collaborative conversation style for strengthening a person's own motivation and commitment to change. Its spirit has four elements: partnership, working with the client rather than on her; acceptance, including respect for her autonomy; compassion, putting her welfare first; and evocation, drawing out her own reasons for change rather than supplying them. The core skills are summarized as OARS: open questions, affirmations, reflections, and summaries. Its central aim is to elicit and strengthen change talk, statements of desire, ability, reasons, and need to change, while responding to sustain talk, the arguments for staying the same, without arguing back.
Four Processes Over Time
Miller and Rollnick (2013) organized the method into four overlapping processes. Engaging builds the working relationship; with Teresa, this was done in earlier sessions through empathy for her loss. Focusing agrees on what to talk about; here the counselor asked permission to discuss the evenings rather than raising the drinking uninvited. Evoking draws out her own motivation, the work shown in the exchange below. Planning develops a specific commitment, but only once she is ready. Moving to planning too early, for example by proposing a drinking limit before she has expressed any wish to change, is one of the most common ways counselors undo the progress they have made.
An Annotated Exchange
Counselor: "You've said the wine helps you switch off. What does it do for you in the evenings?" [Open question that respects her view.]
Teresa: "It stops the loop. I stop thinking about what I should have done differently."
Counselor: "So it gives you a break from a mind that won't let go of the layoff." [Reflection of meaning.]
Teresa: "Exactly. Though I'm not sleeping any better. I wake up at three."
Counselor: "The wine helps you get to sleep, and then you're awake at three." [Double-sided reflection that holds both sides of the ambivalence.]
Teresa: "And then I'm useless in the morning. That's when I'm supposed to be applying for jobs." [Change talk: a reason.]
Counselor: "Mornings matter to you because that's your best time for the search." [Reflecting the change talk to strengthen it.]
Teresa: "I guess if I cut back I might actually get something done before noon." [Change talk: ability and desire.]
Counselor: "You've been carrying so much and still trying to find a way forward; that takes persistence." [Affirmation.]
The counselor never says the word alcoholic and never argues that she drinks too much; Teresa connects the wine to the mornings herself. Near the end of the session, the counselor summarizes her reasons and asks, "What, if anything, would you want to try this week?" She chooses to stop at two glasses on weeknights and to note how she sleeps.
What the Evidence Suggests
A meta-analysis of 119 studies by Lundahl et al. (2010) found that motivational interviewing produced statistically significant, durable effects in the small range, an average g of 0.28, when compared with weak comparison groups, and effects that were not significantly different from other specific treatments, with an average g of 0.09. Effects appeared across substance use, health behaviors, gambling, and engagement in treatment. For Teresa, this suggests realistic expectations: motivational interviewing is well suited to resolving her ambivalence and increasing her engagement, but it is unlikely to be enough on its own if heavy drinking continues. It works best as a way into change, combined with the behavioral and cognitive strategies from the previous module.
Ethical and Clinical Safeguards
Respecting autonomy does not mean ignoring risk. The counselor will ask about symptoms of dependence, such as morning drinking, tremors, or failed attempts to cut down, and will screen for any thoughts of self-harm, since heavy drinking and depression together raise that risk. If signs of physical dependence appear, a sudden stop could be dangerous, and Teresa should be referred to her physician before reducing further. The counselor will also share information about heavy drinking levels, with her permission, because informed choice requires information.
The Following Session
In the next session, the counselor begins by asking what Teresa noticed during the week rather than whether she met her goal. She reports stopping at two glasses on three of five weeknights and sleeping through twice. The counselor reflects the gain and asks what made those nights different; she mentions that on those evenings she had called her sister. That observation connects her drinking goal to the behavioral activation plan from the previous module, and the two now reinforce each other.
Conclusion
Motivational interviewing offers a way to address Teresa's drinking without confrontation. By using open questions, reflections, affirmations, and summaries in a spirit of partnership and evocation, the counselor helps her voice her own reasons for change, as she did when she linked evening wine to lost mornings. The evidence supports modest but real effects, which makes the approach a good entry point for change rather than a complete treatment.
References
Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20(2), 137-160. https://doi.org/10.1177/1049731509347850
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). Guilford Press.
National Institute on Alcohol Abuse and Alcoholism. (n.d.). Drinking levels and patterns defined. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
How this PSY 530 Module 4 example is structured
Aspen's catalog describes PSY530 as analyzing theories' techniques and principles and evaluating their use for client outcomes. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example establishes the clinical concern, defines the approach from its source, demonstrates it in an annotated exchange, reports evidence honestly and addresses safeguards.
PSY530 Module 4 questions, answered
What does PSY530 Module 4 usually ask for?
Work in this part of PSY530 often asks you to apply a specific counseling approach, such as motivational interviewing, to a client case and evaluate its fit. Aspen does not publish module deliverables, so your classroom's instructions govern.
What are the OARS skills?
Open questions, affirmations, reflections and summaries, the core communication skills of motivational interviewing.
How effective is motivational interviewing?
A meta-analysis of 119 studies found small but durable effects, an average g of 0.28, against weak comparison groups, and effects similar to other specific treatments.
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