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Reexamining Confrontation and Motivational Interviewing

Polcin, Douglas L. EdD

Addictive Disorders & Their Treatment: December 2006 - Volume 5 - Issue 4 - p 201-209
doi: 10.1097/01.adt.0000205048.44129.6a
Original Articles

Motivational interviewing (MI) was largely conceived as an alternative to “confrontational” approaches used in drug and alcohol treatment. Thus, MI emphasized building an empathic, collaborative alliance with clients rather than arguing or attacking in an attempt to “break down denial.” An unintended consequence of this contrast with confrontation was a frequent application of MI that overemphasized client-centered aspects and deemphasized directive MI interventions that are equally important. This paper provides an alternative definition of confrontation that focuses on potential harm the client may experience as a result of their substance use. Research supporting this type of confrontation is reviewed and it is suggested that confrontation is integral to the directive interventions of MI. Suggestions for using confrontation to facilitate MI are provided.

From the Alcohol Research Group, 2000 Hearst Avenue, Suite 300, Berkeley, CA

Supported by NIAAA Grant R01 AA014030-03.

Reprints: Douglas L. Polcin, EdD, Alcohol Research Group, 2000 Hearst Avenue, Suite 300, Berkeley, CA 94709-2130 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.