ABSTRACT
This chapter concerns understanding possible limitations to motivational therapies and indeed motivational dialogue in general. Motivational dialogue is about helping people to decide that they want to change a particular behaviour. People can change their drinking, smoking or drug use and the causes of change are much the same regardless of the particular substance used. For some people, those with more social stability and psychological strengths, stopping or controlling drinking or drug use may automatically follow. The challenge for therapists is to move from the first set of thoughts to the second set and it is in bringing about this shift of thinking that motivational dialogue, or indeed any specific motivational therapy, is used. Where the possibility of changing adverse social circumstances is bleak or where the substance use alleviates psychological problems it may be difficult to secure any real sense of motivation to change.
