Reading: The 5 Rs of precontemplation
Reveling, reluctance, rebellion, resignation and rationalization, and what helps with each.
Reading: The 5 Rs of precontemplation
What you’ll learn
- Recognize the five ways clients in precontemplation tend to express sustain talk.
- Choose an approach that fits each one.
- Build rapport and raise doubt without arguing.
Clients in precontemplation aren’t considering change. Many don’t see a problem, and many are there because someone else pushed them. Your goals are to build rapport and trust, and to raise doubt about their substance use, gently and without arguing.
Start with rapport
Before you raise change with someone who isn’t thinking about it, they need to feel safe enough to talk honestly. As clients engage, their defensiveness drops. Things that help:
- Explain how sessions work: how long they last, what you’ll do together, and what you expect.
- Ask how they see the situation, and what led to them coming in.
- Recognize that they came, especially if it wasn’t their idea.
- Ask permission before talking about their substance use.
- Agree on a direction together.
The 5 Rs
Clients who aren’t ready to change usually express sustain talk in one or more of five ways. Recognizing which you’re hearing tells you what’s likely to help.
- Reveling
- What it can sound like“I’ve never had a problem. It’s the best part of my week.”
- What helpsObjective, nonjudgmental feedback about risks, offered with permission
- Reluctance
- What it can sound like“I don’t really see what the big deal is.”
- What helpsFeedback on how use affects their own life, and reassurance they can manage without it
- Rebellion
- What it can sound like“Nobody tells me what to do.”
- What helpsEmphasizing that the choice, and the responsibility, are theirs
- Resignation
- What it can sound like“I’ve tried a hundred times. Nothing works for me.”
- What helpsRebuilding hope: past successes, barriers, and people who have changed
- Rationalization
- What it can sound like“It’s only a problem for people who can’t handle it.”
- What helpsDouble-sided reflections instead of arguing
| Style | What it can sound like | What helps |
|---|---|---|
| Reveling | “I’ve never had a problem. It’s the best part of my week.” | Objective, nonjudgmental feedback about risks, offered with permission |
| Reluctance | “I don’t really see what the big deal is.” | Feedback on how use affects their own life, and reassurance they can manage without it |
| Rebellion | “Nobody tells me what to do.” | Emphasizing that the choice, and the responsibility, are theirs |
| Resignation | “I’ve tried a hundred times. Nothing works for me.” | Rebuilding hope: past successes, barriers, and people who have changed |
| Rationalization | “It’s only a problem for people who can’t handle it.” | Double-sided reflections instead of arguing |
When they don’t see a problem
Clients who are reveling mostly remember the good times and haven’t had many consequences yet. Clients who are reluctant don’t know enough about the problem, or how it affects them personally, to see a reason to change. Both often respond to honest, nonjudgmental feedback, such as their own assessment results, offered as information rather than as an argument. Reluctant clients also need reassurance that they could manage without the substance.
When they push back
Clients who are rebelling are invested in their substance use and afraid of losing control over their lives. Pressure makes them dig in. Say plainly that the choice is theirs, and help them make choices that serve them rather than rebel against what feels like pressure.
Clients who are rationalizing have an answer for everything: substance use may be a problem for others, but not for them. Arguing feeds the debate. Double-sided reflections work better. Acknowledge what they say, and bring back any reservations they’ve mentioned earlier.
When they’ve given up
Clients who are resigned feel hopeless and overwhelmed by what change would take. Many have been through treatment before or tried repeatedly to quit on their own. They need hope before anything else. Explore what got in the way, and what has worked, including changes in other parts of their life. Share how treatment has helped people who thought they couldn’t change, and connect them with people in recovery.
Sure I drink, but I never miss work. People who lose their jobs have a problem. I don’t.
Work matters a lot to you, and so far drinking hasn’t gotten in the way of it.
Right. Well, Mondays are rough sometimes.
You’ve kept your job, and Mondays are getting harder.
The counselor doesn’t dispute the client’s point. Reflecting it, then pairing it with the concern the client raised, lets the client weigh both sides.
This client sounds resigned. Write a response that offers hope without arguing.
ClientWhat’s the point? I’ve been through rehab three times.
Show a model answer
“After three tries, it makes sense to feel worn down. And you’re here again, so part of you hasn’t given up. What did you learn from those times?” It reflects the discouragement, affirms persistence, and invites the client to look at what has helped.
Key takeaways
- Rapport comes first. A client who feels judged early rarely comes back.
- Listen for which of the 5 Rs you’re hearing, and match your approach to it.
- Raise doubt with information and reflections, not arguments.
Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapter 4. Public domain. Open TIP 35, precontemplation and the 5 Rs