For... A non-directive approach allows the client to set the agenda and determine the content of the intervention and, therefore, address the issues that are important to them rather than those decided upon by the practitioner. Clients will feel relaxed and listened to which will give them confidence that they are getting the help they need.

Against... A directive approach ensures that the client and practitioner are both focussed on dealing with the problem that has been presented. The use of strategic questioning and reframing of the client's talk enables the client to re-imagine themselves as capable of making the changes needed for a better life.

Motivational dialogue is a style of psychological intervention and is in contrast to overt confrontation, particularly in group and family settings, which was once considered a key ingredient of successful psychotherapy. This was particularly so in the United States where 12-step approaches were dominant. Motivational approaches have become popularised and gained widespread support as a key psychotherapeutic intervention in the addictions field and beyond. The study on which this chapter is based was the first randomised controlled trial in which a motivational approach is directly compared with a non-directive psychotherapy. This chapter provides a selective review of the literature available at the time and explores issues related to therapist training. Finally there are reflections on the experience of delivering the two contrasting therapies from both training and therapist perspectives. 

The chapter proposes a protocol for integrating motivational dialogue into routine treatment of alcohol and drug dependence. It suggests a further integration whereby all interventions are delivered using a stepped care framework starting with assessment and simple advice and working up through increasingly intensive interventions. The chapter illustrates motivational dialogue applied to the delivery of four interventions of different intensities: Assessment, Simple Advice, Motivational Enhancement Therapy (MET), Social Behaviour and Network Therapy (SBNT). It demonstrates how treatments with different theoretical underpinning can be delivered in a motivational dialogue style. The intervention is based upon MET as practised in the UK Alcohol Treatment Trial (UKATT) in three sessions: the first session consisted in the giving of feedback from assessments; second session is to establish commitment for change in the light of change plans and for this purpose a change plan worksheet might be used; third session concentrates on building motivation for changed behaviour.