What characteristics come to mind when you think about treating adolescents? Do words like unmotivated, rebellious, and insecure enter your consciousness? Teenagers think they know it all and they are tired of adults telling them what to do. They also are struggling with self-image and will do almost anything to fit in. As a result, we find many adolescents rebelling against authority and performing behaviors with negative consequences. You may wonder how to break through the resistance so often seen when working with teenagers. Motivational interviewing is here to help.
What is Motivational Interviewing?
Motivational Interviewing is a specific type of psychotherapy aimed at facilitating change, especially among people who feel ambivalent about modifying their behavior. Originally conceived to assist people with overcoming alcoholism, it has been adapted to tackle many other behavioral barriers. Although not created specifically for adolescents, it lends itself to the resistance often exhibited by teenagers.
The work of Prochaska and Diclemente has displayed how change happens in stages. The first two stages of change are the pre-contemplation and contemplation stages. These stages are marked by great reluctance and ambivalence toward change. Motivational interviewing can be used to help progress clients through these difficult stages until they are truly prepared to make meaningful changes in their lives.
The 4 Components of Motivational Interviewing
Motivational Interviewing takes the concepts of Carl Roger’s person-centered therapy and combines them with techniques to promote positive change. Here are the four main underlying principles of motivational interviewing:
- Empathy. Motivational Interviewing is a collaborative approach between client and therapist. The therapist exhibits empathy toward the client rather than displaying any criticism. This is crucial for the relationship as the client is usually expecting negative judgments for their behavior.
- Discrepancy. The therapist helps the client see the contrast between current behavior and desired behavior. Clients must develop their specific goals and understand how their current behavior will not help them achieve them. This helps to motivate change.
- Don’t fight resistance. Therapists often challenge clients when they display defensive or ambivalent attitudes. The instinct is to try to correct or convince them that their perspectives are flawed. In motivational interviewing, however, the therapist accepts, rather than fights, client resistance. Motivational Interviewing comes from the perspective that the more you try to tell a client they are wrong, the more they will become entrenched in their position and unwilling to change. The goal then is to help people figure out on their own that change is to their benefit, rather than trying to force them into adaptive behavior.
- Support self-efficacy. Self-efficacy is the belief that you can accomplish something through your behavior. For example, if you believe that you can stop smoking by taking the appropriate steps, then you possess self-efficacy. As you might imagine, self-efficacy is integral to change. If you don’t believe in yourself, you won’t succeed in altering your behavior. It is the therapist’s job to boost self-efficacy if the client has doubts about their abilities.
Motivational Interviewing Techniques
Therapists who employ motivational interviewing use the following techniques exemplified by the acronym OARS:
Open-ended questions. Open-ended questions invite the client to speak more openly about what is on their mind. They also tend to lead to more elaborate and complete answers. Closed questions, on the other hand, tend to guide people toward a certain answer and lead to shorter responses. For example, a therapist might ask, “how do you feel your drug use impacts your life?” vs. “Tell me why your drug use is harmful?”
Affirmations. Motivation is often linked to how a client perceives their progress. If they feel like their attempts are failing they will likely stop trying. Therapists use affirmations to help boost the confidence of clients so that they will continue to make concerted efforts toward change. You may note that affirmations are the polar opposite of criticism and judgment. Being positive with clients is one of the tenets of motivational enhancement.
Reflections. Person-centered therapy brought the importance of reflective listening to the forefront. Reflection, put simply, is reflecting what the client says back to them. This technique lets the client know that the therapist understands what they are saying and allows them to continue thinking and speaking about important topics. Ultimately, it shows that the therapist is empathizing with the client.
Summaries take reflection one step further. The therapist is asked to distill the meaning of what the client is saying and summarize the main points. This lets the client see that the therapist grasps their meaning and allows them to clarify any parts that the therapist may have misunderstood. The therapist may also use the summary to illustrate a client’s goals and move them forward toward a related topic that needs addressing.
When Should I Use Motivational Interviewing?
Motivational interviewing is not ideal for every type of problem. It was created for people that were struggling to stop alcohol addiction and it appears to be more beneficial when addressing similar issues, such as cigarette smoking, substance abuse, and other risky behaviors. It works well when a lack of motivation is one of the main contributing factors to a problem. It is not thought to be as beneficial when used as the primary treatment option for other psychological issues, including mood disorders and anxiety.
However, the strength of motivational enhancement is in helping clients move forward when they are stuck. And the techniques can be valuable when used in conjunction with other therapies, such as cognitive-behavioral therapy (CBT) or interpersonal therapy. Think about how many problems are perpetuated due to a lack of motivation. For example, people with depression have trouble motivating to perform small tasks. People with anxiety avoid activities out of fear and worry. And many clients exhibit resistance to therapy itself. Motivational interviewing can help clients overcome their ambivalence and ultimately help treat problems that are treated primarily with other forms of therapy.
Because teenagers don’t like to be challenged by authority and are easily influenced, motivational interviewing would appear to be an optimal therapy style to use with them. Young people frequently initiate future problematic behaviors during adolescence but resist any type of help. Motivational Interviewing may be one of the few types of counseling styles that can be used as an effective treatment. In addition, adolescence is an ideal time to implement the practice of healthy habits. Motivational interviewing can help teenagers adopt a healthy lifestyle that they will carry with them into adulthood.
Does Motivational Interviewing Work?
• Motivational Interviewing has been well researched in its effectiveness in treating behavioral problems. Not surprisingly, it has been found to work well in treating substance abuse issues, which was the original intent of its creators.
• We have noted that kids often initiate the use of alcohol and other drugs during their teenage years. It would seem especially important then, to find a treatment that works for this frequently resistant population. Luckily, motivational interviewing has proven effective in reducing substance abuse in adolescents. Further, the positive effects of motivational interviewing on teenagers appear to maintain themselves over time.
• Adolescents can also be very impulsive and may engage in risky behaviors. Motivational interviewing has been found to reduce risky behavior in adults and teenagers alike. One reason for its particular success with teenagers appears to be that it is effective in increasing client engagement in treatment. It has even been found to decrease delinquent behavior in incarcerated teenagers post-release.
• Although a lot of the focus of motivational interviewing has been on substance abuse and risky behavior, it also can be effective in improving health. How you may ask? Motivation plays a major role in a healthy lifestyle. Exercising, eating healthily, and self-care are major components of a healthy way of life. If you can help a client motivate to perform those behaviors, their health risks will decrease. For example, motivational interviewing has been shown to help clients reduce their body mass index (BMI), cholesterol, and blood pressure. In addition, preliminary evidence shows that it may help people in decreasing risk factors that lead to cardiovascular disease.
• Adolescents have also exhibited an increase in healthy behaviors as a result of motivational enhancement. In a study targeting health behaviors other than substance use, the authors found that teenagers decreased sexually risky activity, increased exercise, and initiated a healthy diet as a result of motivational interviewing.
• As discussed above, motivational interviewing appears to have value as an adjunct treatment for certain psychological disorders that may have stalled due to client resistance. Research has found that motivational interviewing increases treatment engagement and decreases resistance in clients receiving cognitive behavioral therapy for anxiety disorders. It also shows similar promise in the treatment of depression. And maybe most importantly, it improves treatment outcomes. As valuable as motivational interviewing is as a primary therapy, the importance of making already effective treatments better cannot be overstated.
Motivational Interviewing Resources
• PositivePsychology.com has a nice article on the principles of motivational interviewing, including examples of the questions and skills therapists can use to be most effective when working with clients. If you don’t know anything about motivational interviewing, this brief resource is a perfect primer.
• Case Western Reserve University’s school of applied sciences has a webpage dedicated to motivational interviewing resources. These include a workbook, relevant research, recommended readings, and tools to use with clients. They also provide a handy MI reminder card, which is a checklist for practitioners that reminds them what skills they should utilize that are most effective with clients.
• PsychologyTools.com has information on almost every mental health concept known to man. They have dedicated a page to motivational interviewing, which includes an overview of its core concepts as well as practical strategies and techniques every therapy can use with clients. Not everything on PsychologyTools is free but everything on this page comes with no charge.
• Psychwire offers the best of both worlds. It provides numerous free multimedia resources as well as complete paid courses on motivational interviewing. The courses are done online and are self-motivated but the course materials are taught by some of the biggest names in motivational interviewing, including founders William Miller and Stephen Rollnick. Completion of the main course will earn you a certificate in motivational interviewing and there are many opportunities to earn continuing education credits as well.
• The Institute for Research, Education, and Training in Addictions (IRETA) has a motivational interviewing toolkit on its site. And a specific part of their resources is dedicated to practitioners. What I find most useful is a link to a webinar on how to improve your motivational interviewing skills and two videos that show the correct way to perform motivational interviewing and the not-so-right way.
• Sylvie Naar-King and Mariann Suarez do a great job breaking down the use of motivational interviewing in the treatment of adolescents. Their book is a how-to guide for practitioners who want to utilize this type of therapy with teenagers.
• I saved the best for last. If you want an exhaustive resource for everything motivational interviewing, MINT (Motivational Interviewing Network of Trainers ) provides it. Do you want recent research? You got it. Want to attend a training? There is a list of training events. Feel like perusing some motivational interviewing multimedia resources? It is there. You could spend hours on this site learning about motivational interviewing. And if you find yourself unable to stay away, you can join their organization.
Motivational Interviewing is a premier therapy in helping people overcome the ambivalence that is hindering their progress in tackling difficult behavioral problems. It is especially effective in the treatment of substance abuse and reversing maladaptive habits. It can also assist youth in developing a healthy lifestyle. What’s more, it is useful as an adjunct treatment to help motivate people to address impediments to other psychological difficulties, such as anxiety and depression. Its non-judgmental, supportive stance makes it particularly appealing in the treatment of the hard-to-reach adolescent population. Please visit the TheraPlatform resource center today to find free worksheets, templates, exercises, and apps that will help inform the practice of motivational interviewing and all things mental health.