Weighing Pros and Cons

11th December 2015
See also Pros and Cons (Decisional Balance) exercise for video role play...

This is a technique (also known as "decisional balance" but ultimately a version of a "cognitive challenge") that is designed to elicit thinking (Mentalizing) about a specific behaviour (eg drug use), or a specific cognition (eg a belief that the young person is perceived to be clinging to, which the therapist believes may be associated with other symptoms - such as the depressive cognition "I am useless").

Materials/techniques:

  • Paper, pens
  • Use a diagram of a set of weighing scales (this is apposite for young people who may have seen dealers weighing out cannabis)
    • one pan for PROS
    • one for CONS

Start with the PROS first, not the CONS.

  • Avoiding starting with the cons first is an Engagement technique from Motivational Work
  • Invite the young person to reflect (Mentalizing) on why they like Cannabis/other drugs, or why they agree/support the cognition in question.
  • Only prompt when they get stuck:
"I am thinking to myself, that there may well be more reasons than that - most people don't do something unless they are getting something back..."... in the case of drugs this might be:
    • Pleasure (never deny the possibility of this)
    • Socialising
    • Joining techniques? A way to join a group in which the young person is less confident (Cue discussion of SocialEcology)
    • "Psychonauts" - exploring the intriguing fact that "I have this thing called a mind!", creativity, etc (Consider the possibility that this is a form of Pseudomentalizing?)
    • Self-medication (a "Smokescreen" to blank out trauma, depression, etc) - see Assessment for SUD-Rx.
    • ...others

Move on to CONS

  • If there are none, consider the Stages of Change and Adapt your Discourse accordingly.
  • Be very careful to Roll with Resistance (a principle from Motivational Work)
  • Use Normalising techniques to suggest possible cons that "other young people have told us about":
    • Cost ("We can agree that it could be cheaper!")
    • Criminal record
    • Interference with academic work or employment
    • Disruption of family/other relationships ("...So you don't have any particular problems with the weed, but when you smoke it your family go ballistic and THAT is a drag for you - have I got that right?")
    • ...others