Motivational Interviewing

It can be difficult to obtain mental health help for teenagers. They may deny anything is wrong, believe therapy is embarrassing or feel so hopeless that they doubt anything will work. One option is to liken therapy to having a coach, who will teach new skills, strategies and ways to succeed. Another possibility is to find several practitioners and allow your adolescent to interview them. Selecting the one he/she will see can provide a sense of control and a greater likelihood of therapeutic success. A third alternative is Motivational interviewing (MI), a type of therapy intended to create a non-judgmental, safe environment for youth to establish personal goals and values and discover how altering unhealthy behaviors will benefit them. By having the patient play an active role, MI can explore and confront any ambivalence or resistance he/she has to treatment and increase motivation for change.

MI was created in the 1980s by psychiatrists William R. Miller and Stephen Rollnick. It is employed with adolescents (rather than children, who are not as emotionally developed and have less control over their environment) and is often used to treat self-harm and substance abuse. MI is collaborative, compassionate, confidence-building, non-confrontational, positive and respectful; and views clinicians and clients as equal partners. Its core principles include Open-ended questions (to determine an individual’s values and goals for treatment), Affirmations (to build the confidence to change), Reflections and Summarization (so the patient will feel heard during the process). In MI, therapists avoid providing unsolicited advice or direction.

There are multiple phases to MI. The initial one is Engagement where a therapist creates a judgment-free space for a youth to share his/her feelings and any reservations he/she has about change. Next is Focusing where the specific behaviors the client is willing to alter (“change targets”) are identified. Evoking then examines the disadvantages of retaining unhealthy behaviors in order to reveal the benefits of modifying them. Finally, Planning is an optional phase. It is intended to help patients establish manageable goals, consider any potential barriers and develop skills, including combating all-or-nothing thinking, expressing self-compassion to practice acceptance and maintaining goal-oriented behavior.

Not simply a standalone process, MI can be combined with other forms of treatment, such as cognitive-behavioral therapy. It can be particularly beneficial for youth, who often prefer clinicians who actively participate in conversation rather than being passive listeners. Adolescents with mental health issues need to want to get better and be willing to work with a practitioner for that to occur. MI can be a valuable tool for reducing resistance to therapy and provide the internal motivation necessary for altering self-destructive behaviors (while acknowledging how difficult that change can be.)