Yeah, I smoke. It’s not a big deal. Everyone I hang with does. I don’t know, maybe I’m overthinking it.

Session Goal:

Build rapport and invite Jesse to explore their ambivalence.

Milestones:

Reflective listening and double-sided reflection

Tips for Therapist:

Affirm Jesse’s autonomy. Use open questions and reflections to highlight ambivalence (e.g., 'Part of you sees it as normal, and part of you is wondering about it'). Avoid confrontation.

Sometimes I think I’d get more done if I didn’t use as much. But then I think, what’s the point if I’m still stuck in the same place?

Session Goal:

Guide Jesse to articulate their own reasons for change.

Milestones:

Evoking change talk using DARN-CAT (Desire, Ability, Reason, Need, Commitment, Action, Taking steps)

Tips for Therapist:

Use selective reinforcement of change talk. Reflect Jesse’s values and connect them to potential goals. Avoid advice-giving unless invited.

You’re not gonna tell me to quit, right? ‘Cause that’s not gonna work. I’ve been through that before.

Session Goal:

Maintain alliance while responding to resistance.

Milestones:

Rolling with resistance and reinforcing autonomy

Tips for Therapist:

Use affirmations like, 'You’ve really thought about this,' and emphasize choice. Normalize hesitation and reflect ambivalence without pressure.

I keep thinking, ‘Is this who I want to be?’ But then I distract myself and push that thought away.

Session Goal:

Connect Jesse’s substance use to their broader values and identity.

Milestones:

Values clarification and discrepancy development

Tips for Therapist:

Help Jesse articulate what matters to them. Gently explore the gap between current behavior and ideal self. Use values card sort or imagined future exercises if helpful.

I’m not saying I’m ready to quit, but… I could probably cut back. Maybe just weekends?

Session Goal:

Support Jesse in identifying realistic and meaningful behavior changes.

Milestones:

Collaborative goal setting and menu of options

Tips for Therapist:

Offer a menu of possible changes (cutting back, taking a break, noticing patterns). Emphasize collaboration. Ask, 'What feels doable right now?'

I didn’t think I’d actually make changes, but now I kind of want to see what else I can do.

Session Goal:

Reinforce commitment and plan for continued self-directed growth.

Milestones:

Eliciting commitment talk and future planning

Tips for Therapist:

Affirm Jesse’s progress. Ask about what they’ve learned about themselves. Invite reflection on next steps and how they’ll handle challenges moving forward.