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How Motivational Interviewing Helps Teens

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The benefits of Motivational Interviewing (MI) are vast, especially for teens. Are you more likely to do something if someone else tells you to? Or if it’s your own idea? Hence, most people are inspired to make a change when they personally believe it’s important. Not because someone else thinks they should do it. That’s an element of human nature that helps explain why Motivational Interviewing works. A core principle of MI is that individuals are more likely to accept and act on opinions that they voice themselves.

Additionally, that’s why it can be particularly helpful for teenagers, as teens tend to resist suggestions from others about how to behave. Scientists have found that MI is successful in raising self-esteem and self-confidence for teens.

Furthermore, Motivational Interviewing helps teens reach their personal goals. It also helps them develop a better decision-making process. Therefore, they begin to make positive choices that support their health and well-being.

What Is Motivational Interviewing?

To summarize, Motivational Interviewing is a clinical approach for healing mental health and substance use disorders. Additionally, MI also helps people who need to make lifestyle changes to address physical health conditions, such as diabetes, heart disease, and asthma.

Specifically, MI is an interpersonal counseling method that helps people find the internal motivation they need in order to change their self-destructive behavior. Furthermore, MI acknowledges how difficult it is to make life changes.

The Benefits of Motivational Interviewing for Teens

Moreover, MI appears to be particularly effective for individuals who are initially resistant to change. As a result, Motivational Interviewing for teens works well, because adolescents are sometimes resistant to therapy. Plus, they might feel angry or resentful about being in treatment for substance use or another disorder. Thus, they need to find inner motivation to start making healthier choices. And MI helps them do that.

William R. Miller, the founder of MI, and his colleague Stephen Rollnick defined Motivational Interviewing as “a collaborative conversation style for strengthening a person’s own motivation and commitment to change.”

Here is Miller and Rollnick’s official definition of MI:

“Motivational Interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”

Newport Academy Mental Health Resources: Motivational Interviewing

How Motivational Interviewing Works

The Motivational Interviewing process is based on several assumptions and understandings. Firstly, MI therapy acknowledges that people with substance abuse disorder or other mental health conditions might be ambivalent about changing their behavior. Typically, this is quite normal. However, ambivalence can be an obstacle to recovery.

Therefore, MI aims to resolve ambivalence by helping clients get in touch with their inner motivations and values. Specifically, MI therapists ask questions that draw out client’s reasons for wanting to change, as well as any concerns they might have about making a change.

A Path of Acceptance and Collaboration

Moreover, in MI, therapists do not give advice, opinions, or instructions. In Motivational Interviewing, the recovery professional becomes a helper in the change process by expressing acceptance of clients, regardless of outcome or result. As a result, the relationship between an MI therapist and MI client is a collaborative partnership.

Thus, a Motivational Interviewer encourages clients to talk about their need for change and their reasons for wanting to change. Subsequently, the interviewer listens and reflects back the client’s thoughts. In this way, the client hears their reasons and motivations clearly stated. Subsequently, they are much more willing to make a commitment to change their behavior.

“Motivational interviewing is a way of being with a client, not just a set of techniques for doing counseling.”

—William R. Miller and Stephen Rollnick, authors of “Motivational Interviewing: Helping People Change”

Motivational Interviewing is

  • Gentle
  • Non-confrontational
  • Positive
  • Compassionate
  • Confidence-building
  • Respectful
  • Collaborative.

Moreover, Motivational Interviewing

  • Moves individual away from a state of indecision or uncertainty
  • Is done “for” and “with” a person, not “to” and “on”
  • Was not designed as a way to trick or manipulate people
  • Acknowledges that clients are the best “experts” on themselves
  • Starts from where the client is now, in terms of readiness to change
  • Shifts clients toward finding the motivation to make positive decisions and accomplish established goals
  • Recognizes that you can’t change someone who doesn’t want to change.

The Four Principles of Motivational Interviewing

The four principles of Motivational Interviewing have proven to be effective with younger populations, such as teens. Specifically, the principles of MI therapy highlight the following:

Express Empathy

MI therapists express empathy through reflective listening. “Content reflections” are used to elicit the basic facts in the client story. “Feeling/meaning reflections” mirror the client’s emotions and may include a statement of why they feel that way. Specifically, reflections might look like this: “If I heard you correctly, this is what I think you are saying…” or “Given what you said, you might feel …”

Develop Discrepancy

This stage focuses on helping the client to see the difference between their goals or values and their current behavior. Clients sometimes look at a list of values and choose several that are important to them. Next, the therapist asks the client how changing their behaviors would relate to their values and goals. The list of values and attributes can be tailored to the particular client population or the health behavior being addressed. For example, a list for teens might include values such as “being popular” or “being mature.

Roll with Resistance

In MI sessions, therapists avoid arguments and confrontations. Instead, they carefully adjust to a client’s resistance rather than opposing it directly. In other words, they might agree with the client about something even what they are saying is not factually incorrect or unfairly places blame on others. Therefore, the therapist learns more about the client’s reasons for not changing. As a result, this approach allows clients to express their resistance without feeling judged or pressured to change.

Support Self-Efficacy

In this phase of the MI process, therapists optimistically encourage clients’ confidence that they can create change. They help them focus on their ability to succeed and give them resources to do so. Moreover, they provide clients with information and strategies that might help them change, such as activities to improve their decision-making skills. In this way, the MI therapist helps the client develop a plan for successful change.

Motivational interviewing is generally used as short-term counseling. However, it can also be used as an intervention alongside other, longer-term therapies. Cognitive Behavior Therapy, group therapy, and stress management training can be combined with MI to help clients heal from mental health conditions.

Newport Academy Mental Health Resources: Motivational Interviewing

The Development of Motivational Interviewing

 American clinical psychologist William Miller formulated Motivational Interviewing in 1983. He was inspired in part by Carl Rogers’ person-centered, or client-centered, approach to counseling and therapy.

Miller was on sabbatical in Norway and was asked to meet with a group of young psychologists. Their questions about his treatment approach helped him clarify and shape the MI technique.

Originally, Miller envisioned Motivational Interviewing as a method for treating substance use disorders. Specifically, he was looking for a way to effect lasting change in clients who had not improved with traditional treatment approaches.

The Benefits of Motivational Interviewing — Clinical Trials

Thereafter, Miller and his colleagues conducted three clinical trials to test the efficacy of MI for substance abuse. In all three studies, clients receiving MI showed double the rate of total abstinence at three to six months after inpatient or outpatient treatment. Moreover, this was true for both adults and adolescents. Additionally, MI increased the participants’ motivation for change.

Subsequently, Miller and other therapists discovered that Motivational Interviewing techniques for substance abuse are transferable to other situations and conditions, both psychological and physical. In fact, MI is now used in health, social services, criminal justice, and education settings.

Research on Motivational Interviewing for Teens

Researchers have examined MI from many different standpoints, including physical health, mental health, and addictive behaviors. The benefits of Motivational Interviewing are evident. Results from three of the studies involving teens are below.

  • In one study, researchers found that adolescent clients who participated in MI were more likely to follow up with outpatient appointments after an inpatient stay at a psychiatric hospital.
  • Researchers have found that MI, used alone or in conjunction with other therapies, is more effective than non-MI interventions in helping adolescents to stop smoking cigarettes. Additionally, a study of 40 teens showed that MI resulted in significant decreases in smoking dependence and number of days smoked.
  • High-risk teens participated in a brief Motivational Interviewing intervention focused on alcohol consumption and drug use. After three months, the teens reported less marijuana use, lower perceived prevalence of marijuana use, fewer friends who used marijuana, and lower intentions to use marijuana in the next six months, as compared to teens assigned to usual care. Researchers concluded, “Providing this type of brief intervention is a viable approach to working with high-risk teens to decrease substance use.”

The OARS Strategy

The acronym OARS stands for the four main techniques for guiding MI conversations. Here’s a look at how OARS can be used with teenagers.

Open-ended questions: Open-ended questions help to draw out information from teenagers who might not usually talk much. Moreover, open-ended questions encourage teens to reflect on their lives, their thoughts, and their actions. Furthermore, Motivational Interviewing questions give young people a chance to tell their story. Examples of open-ended questions are “What else would you like to add?” “Where does that leave us?” and “Tell me more about …”

Affirm: In MI, therapists affirm teenagers by validating their experience. Additionally, they optimistically promote the teen’s self-efficacy—their power to change their own lives. Plus, affirming includes emphasizing past experiences that demonstrated the teen’s strengths and ability to accomplish goals.

Reflective Listening: In reflective listening, the therapist is genuinely interested in what the client has to say. After the teen shares, the therapist repeats what they said, rephrasing it and reflecting the emotions.

Summarize: In the summary portion of an MI session, the therapist recaps what has been said, highlights important aspects, and prepares the teen to move forward in the healing process. Moreover, they support the teen in setting goals and next steps.

Another acronym used in conjunction with Motivational Interviewing is ACE.

A = Autonomy: Only the client has the power to change their lives.

C = Collaboration: Client and therapist work together, rather than the therapist giving advice.

E = Evocation: The therapist evokes and elicits reasons for the client to make a change.

Newport Academy Mental Health Resources: Motivational Interviewing

Ambivalence and Change

William Miller and Stephen Rollnick, who developed MI, emphasized the importance of focusing on the willingness of patients to change, rather than on their fears or what they would like to avoid. Thus, the goal of MI is to foster a patient’s predisposition toward change. To assess clients’ openness to change, Miller and Rollnick pinpointed what they called “change talk.” Specifically, they define change talk as “any self-expressed language that is an argument for change.”

5 Key Ideas About Change

Additionally, Miller and Rollnick based the Motivational Interviewing approach on these five key ideas about change

  • Change occurs naturally.
  • Moreover, change is influenced by the interactions between people.
  • Expressing empathy is a means of effecting change.
  • The best predictor of change is confidence, on the part of the client or therapist, that the client will change.
  • Clients who say they are motivated to change are more likely to actually change.

However, Miller and Rollnick also stressed that clients are often ambivalent about making a change. Thus, reducing ambivalence is an important step of the MI process.

Four Strategies to Reduce Ambivalence to Change

According to Miller and Rollnick, there are four main strategies to reduce ambivalence regarding change:

  1. Show the client the disadvantages of staying the same.
  2. Encourage the client to envision the benefits of change.
  3. Demonstrate optimism that change is possible.
  4. Support patients in their intention to change.

Shift is Necessary

Ultimately, in order to change, patients must be ready, willing, and able to shift their behavior. Even if they think changing is important, they are unlikely to commit to change if they do not feel confident that they can do so.

Therefore, the MI therapist helps the client develop a “change plan.” Specifically, they help the client set goals and break down those goals into manageable pieces. Next, the client and therapist discuss what steps the client can take to move toward those goals.

In conclusion, Motivational Interviewing is an effective modality for helping both teens and adults get in touch with their desire to change their behavior. Once they are committed to change, they can make better choices along the way. Finally, MI supports individuals on the journey toward self-empowerment and a healthy, happy life.

Images courtesy of unsplash


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