Continued guilt, shame, and internalised stigma correlated to alcohol and other drug use

If you’ve ever found yourself thinking “Part of me wants to change… but part of me’s not sure”, you’re not alone. That back-and-forth, weighing things up—“Should I? Shouldn’t I?”—is a normal part of how people process big (and small) decisions. In counselling, this is called ambivalence, and rather than seeing it as a barrier, Motivational Interviewing (MI) treats it as a starting point for meaningful conversations.

What Is Motivational Interviewing?

Motivational Interviewing is a counselling approach that helps people explore their own reasons for change, without pressure or judgment. It’s a respectful, supportive way of helping you work through the push-pull that often comes with making decisions. You’re in the driver’s seat—we’re just here to help you navigate.

You might hear MI described in different ways:

In simple terms:
“MI is a collaborative conversation style that helps strengthen your own motivation and commitment to change.”

In practice:
“MI is about helping you make sense of mixed feelings and explore what’s right for you—based on your values, your goals, and your life.”

MI isn’t about telling you what to do. It’s about listening deeply, asking thoughtful questions, and helping you make sense of where you’re at—and where you might want to go.

Why It’s Not Just a Quick Fix

While MI can be used in short sessions, the research shows it works best when there’s time to really explore your thinking. In studies where people had just one 15-minute session, the outcomes were decent. But when they had more time—say, several sessions of an hour—the results were much stronger. That’s probably because real change often takes time, reflection, and a bit of back-and-forth.

MI originally started in the health world—helping people reduce alcohol use, manage weight, or improve their health. More recently, it’s been used to address things like vaccine hesitancy. But MI isn’t just for health issues. It can also help with things like relationship struggles, career decisions, or anything where you might feel stuck or unsure.

Ambivalence Is Normal

Let’s say you’re thinking about quitting smoking, leaving a relationship, or starting something new. You might feel torn—part of you is ready, and another part isn’t. That’s ambivalence.

MI offers tools to help with this, including something called the Decisional Balance, which simply helps you look at both sides: What are the good things about staying the same? What are the reasons you might want to change?

But here’s the thing—MI isn’t about pushing you toward a particular outcome. If you’re trying to make a decision where there’s no obvious “right” answer—like whether to stay in a relationship—the counsellor stays neutral. They don’t steer you in one direction. Instead, they help you explore what matters to you.

Talking Your Way Toward Change

One of the interesting things about MI is how it pays attention to the language you use when you talk about change.

Some of the things people say when they’re starting to think about change include:

• “I probably should cut down…”
• “I’d like to feel better about this…”
• “I don’t know if I can keep doing this…”

These kinds of statements are called change talk—and they’re actually signs that something inside you is shifting. MI aims to gently encourage and grow this kind of talk, because research shows that the more someone talks about change, the more likely they are to act on it.

There’s also sustain talk, which sounds like:

• “I don’t smoke that much…”
• “I know I should, but it helps me relax.”
• “Now’s not really the right time.”

Both are normal. In MI, there’s no need to rush. Instead, the focus is on listening to both sides of you—and helping you get clearer about what you want to do next.

Getting Skilled Support

Like any professional approach, MI works best when the counsellor is trained and skilled in using it. Some practitioners have their sessions reviewed (with consent) by independent experts to make sure the spirit and skills of MI are being used well.

If you ever hear a practitioner say they “do MI”, you can ask what that looks like. The most effective use of MI goes beyond just asking open-ended questions or offering summaries—it’s about how your counsellor supports you in finding your own reasons for change.

What a Session Might Involve

Motivational Interviewing tends to follow a flexible process with four key parts:

1. Engaging – Building trust and understanding
2. Focusing – Exploring what matters most to you
3. Evoking – Drawing out your own reasons for change
4. Planning – When you’re ready, looking at possible next steps

You don’t have to go through these in a straight line. Some days you might focus on one step, then circle back to another later. It’s all guided by you—your pace, your readiness, your goals.

In Summary

If you’re feeling uncertain about making a change—or you’ve been thinking about it for a while but haven’t quite landed on what to do—Motivational Interviewing could be a really helpful way to explore things.

It’s not about being told what to do, and it’s not about “fixing” you. It’s a respectful, evidence-based approach that helps people work through their own ambivalence, connect with what matters to them, and move toward change when they’re ready.

Change doesn’t have to be instant. And it doesn’t have to be perfect. But it can start with a conversation.

Stephen Porges, psychiatry professor and researcher, on the polyvagal theory he developed to understand our reactions to trauma:

[Paraphrased] Polyvagal theory articulates three branches of the autonomic nervous system (ANS) that evolved from primitive vertebrates to mammals. First, there is a system known as ‘freeze’, which involves death feigning or immobilisation. Second, the ANS has a ‘fight or flight’ system, which is a mobilisation system. And third, with mammals, there is what Porges calls, a social engagement system (SES), which can detect features of safety, and actually communicate them to another. The SES may also be referred to by some as ‘rest and digest’, which Porges theory suggests is a function of the Vagus Nerve – the tenth cranial nerve, a very long and wandering nerve that begins at the medulla oblongata. When an individual experiences feelings of safety (within an SES state), the autonomic nervous system can support health restoration. In terms of dealing with a life threat, an ordinary person will most likely go into a feigning death, dissociative state of ‘freeze’.

Polyvagal theory in psychotherapy offers emotional co-regulation as an interactive process between therapist and client which engages the social engagement system of both therapist and client. Social engagement provides experiences of safety, trust, mutuality and reciprocity in which we are open to receiving another person, just as they are.

The following extract has been retrived from https://www.theguardian.com/society/2019/jun/02/stephen-porges-interview-survivors-are-blamed-polyvagal-theory-fight-flight-psychiatry-ace

Polyvagal theory has made inroads into medical and psycho-therapeutic treatment, but how should it inform how people treat each other?

“When we become a polyvagal-informed society, we’re functionally capable of listening to and witnessing other people’s experiences, we don’t evaluate them. Listening is part of co-regulation: we become connected to others and this is what I call our biological imperative. So when you become polyvagal-informed you have a better understanding of your evolutionary heritage as a mammal. We become aware of how our physiological state is manifested, in people’s voices and in their facial expression, posture and basic muscle tone. If there’s exuberance coming from the upper part of a person’s face, and their voice has intonation modulation or what’s called prosody, we become attracted to the person. We like to talk to them – it’s part of our co-regulation.

So when we become polyvagal-informed, we start understanding not only the other person’s response but also our responsibility to smile and have inflection in our voice, to help the person we’re talking to help their body feel safe.”

Clink on the link below to hear Dr. Bessel van der Kolk, one of the world’s leading experts on developmental trauma, explain how our long-term health and happiness can be compromised by prior exposure to violence, emotional abuse, and other forms of traumatic stress.

https://youtu.be/53RX2ESIqsM

Supporting someone who’s having thoughts of suicide is one of the most important, and at times most challenging, parts of a support persons role. People who experience suicidality can vary from passing ideas to serious planning and often come from a place of deep emotional pain. We all have a duty to respond with care, compassion, and an attempt to understand the experience in a way that keeps safety at the heart of every conversation.

Firstly, if you or someone you know is having thoughts of suicide, please know that you’re not broken or beyond help. These thoughts often come when emotional pain feels unbearable and we can’t see a way out. But things can shift, and help is available. We may spend much of our time alone, and we can feel alone even in a crowded room, but you are not alone in this. Suicidality is not uncommon.

The Numbers Today

According to the latest figures (ABS, 2023):

Suicide is the leading cause of death for Australians aged 15 to 44.

In 2022, over 3,100 people died by suicide—about 8.6 deaths each day.

Men account for 75% of those deaths, though women attempt suicide more often (but less often fatally).

According to the Black Dog Institute, roughly 65,000 Australians attempt suicide each year, while around 3,200 die by suicide annually.

Rates among Aboriginal and Torres Strait Islander peoples are more than double the national average.

People living in rural and remote areas face higher suicide risks due to isolation, limited services, and other pressures.

Why Does the Mind Think About Suicide?

From a humanistic psychology point of view, suicidal thoughts are not signs of illness or failure, they are a deep emotional signal that something in your life or environment needs care, change, or healing.

Each person and living creature on the planet are inherently worthy, with an innate drive to survive, grow, connect, and for humans, find meaning. When life feels full of suffering, such as grief, isolation, trauma, shame, or hopelessness, the mind may start to believe that death is the only way to stop the pain.

In this view, suicidal thoughts are often not about wanting to die—but about wanting the pain to stop.

They arise when:

You feel disconnected from others or from yourself.

You feel stuck in circumstances that seem unchangeable.

You believe your worth or purpose has been lost.

You’re exhausted from holding on or pretending you’re okay.

But the humanistic perspective also holds this powerful truth: you are more than your pain, and within you is a capacity for healing, choice, and change, even if it doesn’t feel like it right now.

Treat Yourself with Compassion, Not Criticism

It’s easy to get caught in a spiral of self-blame. But you are not weak or selfish. You are a human being who is hurting—and just like you wouldn’t shame someone for being in physical pain, you deserve the same care when your pain is emotional.

Ask yourself:

If someone I loved felt this way, what would I want them to know?

Then try to offer yourself the same kindness.

Reach Out – Connection Saves Lives

Talking to someone can ease the intensity of what you’re feeling. You don’t have to explain everything. Just saying, “I’m not okay right now,” is enough to start.

Lifeline 13 11 14

Beyond Blue 1300 22 4636

Suicide Call Back Service: 1300 659 467

Beyond Blue: 1300 22 4636

13YARN (Support for Aboriginal and Torres Strait Islander Peoples): 13 92 76

QLife – National LGBTQIA+ Peer Support and Referral Service: 1800 184 527

Hours: 3pm – Midnight (local time), every day

What they offer: Confidential, non-judgemental, and inclusive support from trained LGBTQIA+ peer workers. They are not a crisis line like Lifeline, but they can support people in distress and connect you with further help if you’re at risk.

How Counselling Can Help: Evidence-Based Approaches

Counsellors and Psychologists don’t rely on guesswork when helping someone who’s feeling suicidal. They use researched strategies to support recovery. Here are a few key approaches:

Collaborative Assessment and Management of Suicidality (CAMS): This method focuses on working together with the person in distress, rather than telling them what to do. It aims reduce suicidal thoughts more effectively than traditional therapy.

Cognitive Behavioural Therapy for Suicide Prevention (CBT-SP): This version of CBT focuses specifically on managing suicidal thoughts by teaching problem-solving and positive thinking strategies.

Dialectical Behaviour Therapy (DBT): Originally designed for people with intense emotions or borderline personality disorder, DBT is now widely used to reduce suicide risk by teaching emotional regulation, mindfulness, and better relationship skills.

Safety Planning: This involves creating a personalised plan for what someone can do when they feel at risk, including who to call, calming strategies, and safe places to go.

Means Restriction Counselling: This involves helping someone reduce their access to anything they might use to harm themselves, like certain medications or weapons, done through sensitive, respectful conversations.

Barriers to Speaking Up

Even with growing public awareness, there’s still a strong stigma around suicide. Many people worry they’ll be judged, locked up, or shamed if they admit they’re struggling. These fears can stop people from reaching out for help, which is why creating a safe, non-judgmental space is so important in counselling.

Rural and Remote Communities

People in regional and remote parts of Australia often find it harder to access mental health support. Telehealth (online or phone sessions) has helped bridge that gap, but it’s not always easy to pick up on non-verbal cues or respond to crises from a distance.

Cultural Awareness Matters

For Aboriginal and Torres Strait Islander peoples, suicide cannot be separated from the impacts of colonisation, loss of culture, and ongoing trauma. Culturally safe, community-led solutions are essential and more effective in these contexts.

Remember That Feelings Change—Even the Darkest Ones

It may not feel like it right now, but these feelings will pass. Emotions are like waves—sometimes crashing, sometimes calm—but never permanent.

What you feel today is not a life sentence. With support and time, things can change. You deserve the chance to see what healing and hope feel like.

Safe Haven NSW Services (for suicidal distress, NOT EDs)

Please check official websites for update information re contact information, hours of operation, and status of operation i.e., still operating. The information on this website has been collected June 2025.

Safe Havens are calm, non-clinical spaces where you can talk with peer workers and mental health clinicians if you’re in emotional crisis — no appointment needed.

No police or emergency involvement unless requested or necessary.

Warm, trauma-informed and recovery-focused.

🔗Find your local Safe Haven: nsw.gov.au/mental-health-initiatives/safe-haven

Examples:

Safe Haven locations across NSW — these are welcoming, non-clinical places where anyone feeling suicidal or in deep distress can drop in and speak to peer workers or mental health clinicians. No appointment, referral, or Medicare card needed. Visit the following for operating hours and locations across NSW: Safe Haven

Regional & Metro Locations

Campbelltown / Ambarvale (SWSLHD)

Address: 80 Woodhouse Drive, Ambarvale (Campbelltown area)

Open Mon, Fri, Sat, Sun 2 – 9 pm

Phone: 0457 093 109 during hours swslhd.health.nsw.gov.au

North Ryde (Macquarie Hospital)

For youth aged 12–17 (sometimes to 18 if still at school)

Open daily 4 – 8 pm and public holidays nslhd.health.nsw.gov.au

Parramatta / Westmead

Drop-in at 26 Grand Ave, Westmead

Open Sun–Wed 3:30 – 9:30 pm

Phone: 0436 377 113

Bega Safe Haven, Bega, NSW, Australia, Supports 14 + in a calm, welcoming space.

Broken Hill Safe Haven, Broken Hill, NSW, Australia, Supports 17 + with peer and clinician support 

Brookvale Safe Haven, Brookvale, NSW, Australia, High‑school aged young people support

Darlinghurst Safe Haven,

Darlinghurst, NSW, Australia, 16 + LGBTQIA+ inclusive spot at St Vincent’s

St Vincent’s O’Brien Centre, 390 Victoria Street, Darlinghurst NSW 2010

Hours: Monday: closed, Tuesday: closed, Wednesday: 5:00pm – 8:30pm​, Thursday: 5:00pm – 8:30pm, Friday: 5:00pm – 8:30pm, Saturday: 12:00pm – 4:00pm, Sunday: 12:00pm – 4:00pm​.

Gosford Safe Haven, General adult Safe Haven

Corner of Ambulance Road and Holden Street, Gosford NSW 2250

Hours: Monday: 9:00am – 4:30pm, Tuesday: 9:00am – 4:30pm, Wednesday: 9:00am – 4:30pm, Thursday: 9:00am – 4:30pm, Friday: 9:00am – 4:30pm, Saturday: closed, Sunday: closed, Closed on public holidays​

Phone: (02) 4394 1597​​

Kogarah Safe Haven, Kogarah, NSW, Australia,16 + adults,

U2/15 Kensington St, Kogarah NSW 2217

Phone: (02) 9113 2981