The impact of addictions counselors' interactional style (confrontational vs. motivational), recovery status (recovering vs. nonrecovering), and nonverbal behavior (facilitative vs. neutral) on 116 clients' perceptions of addictions counselor credibility was examined in a fully crossed factorial design. Significant results were found, and implications are discussed.
Addictions counselors practicing in the 21st century face many challenges as they manage the care and quality of their services to clients. Some of the most serious of these challenges are presented by such factors as session and/or funding limits, mandatory "check-ins" with insurance companies, and requirements to measure intervention outcomes (Gabbard, 1997; Magura, Horgan, Mertens, & Shepard, 2002). These care and quality issues are accompanied by documentation requirements that account for a considerable portion of addictions counselors' time. The result is that addictions counselors have less time to spend with clients (Alexander & Lemak, 1997) and, thus, may perceive pressure to expedite the counseling process. As a result, their interactional style with clients may take on a rather direct, "get down to business" tone (Lemak, Alexander, & D'Aunno, 2001; Rohrer, Rohland, Westermann, Knott, & Zwick, 1999). One critical factor for addictions counselors working in such an environment is the ability to be effective when clients are resistant to or ambivalent about changing their substance-abusing behaviors. In these circumstances, clients may be asked to implement changes before they are ready or willing to make such changes. Thus, the extent to which clients perceive their addictions counselors as a valid source of counseling input (i.e., credible) would seem to be of even greater importance than normal, given that they have less time to spend with clients and experience pressure to produce rapid, positive outcomes. Moreover, credibility of addictions counselors is also at a premium because influencing clients to enter and remain in counseling is one of the more salient challenges that these counselors face. For example, 50% to 64% of individuals who begin
Paul }. Toriello and Douglas C. Strohmer, Department of Rehabilitation Counseling, Louisiana State University Health Sciences Center-New Orleans. Douglas C. Strohmer is now at the Department of Counseling, Educational Psychology and Research, University of Memphis. Correspondence concerning this article should be addressed to Paul ]. Torielto, Department of Rehabilitation Counseling, 1900 Gravier Street, Box G6-2, New Orleans, LA 70112 (e-mail: email@example.com).
journal of Addictions & Offender Counseling • October 2004 • Volume 25
addictions counseling do not complete it (Center for Substance Abuse Treatment, 2000b, 2000c). In addition, the literature suggests that the most frequently specified reason for leaving counseling prematurely was "client's choice" (Center for Substance Abuse Treatment, 2000a). Thus, in the addictions counseling milieu, where time with clients is limited, the credibility of addictions counselors and their ability to influence clients to willingly engage in the counseling process are critical. Given these pressures, addictions counselors have often adopted Confrontational Interviewing (CI), which is a very direct manner for dealing with client issues (Schneider, Casey, & Kohn, 2000). This approach attempts to break through the resistance of clients to promote a quick change in behavior. However, recent research and theory suggest that this confrontational approach may be counterproductive. For example. Miller and Rollnick (2002) have advocated adopting a counseling style that they call Motivational Interviewing (MI). This approach advocates that addictions counselors allow clients to set their own pace of change....