Motivational Interviewing with Adolescents


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How to work effectively with Adolescents who have drug and alcohol issues

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Motivational Interviewing with Adolescents

  1. 1. Enhancing Motivation to Change in the Substance-Using Adolescent: …What the Non-Specialist Needs to Know By Elizabeth Kotkin, MA, LMFT Clinical Standards Coordinator
  2. 2. What Do You Do to Relax?
  3. 3. What If Someone Said NO • Took away all the ways you relax. • Told you that you have to do something else. • Told you that you have to stop doing what you like to do to relax, but everyone you know can continue.
  4. 4. • Just think about some of the family dynamics that ‘our’ kids go ‘home’ to. o Do their parents use? Where they born addicted? o Are they safe? o Have they witnessed the un-imaginable? o Are there any mental health or learning disabilities? o How early did they start using?
  5. 5. So Why Do Adolescents Use Drugs? • To try new things • To be oppositional • To be accepted • To get away from negative emotions or feelings • To try to be in control
  6. 6. The Cycle Of Addiction Tension Inability to control affective state Behavior Drug & Alcohol Use Return of Negative Feelings Negative Emotions Move to coping mechanism to reduce tensionTemporary Relief
  7. 7. Definitions According to Gold and Miller (1994), recent research indicates that drugs are addictive because they “reinforce drug-taking behavior…addiction arises because prolonged use of the drug alters the basic neurochemistry of the brain, leading to physiological and psychological changes…(which) in turn result in continued and accelerating use of the drug.” The American Psychiatric Association’s DSM-IV (APA, 1994) now reflects this updated research-based definition of addictive disorder, with core concepts including: (1) Compulsion (2) Loss of control (3) Continued use despite negative consequences
  8. 8. What Do Adolescents Really Want? To be accepted
  9. 9. Motivational Interviewing “Motivation can be understood not as something one has but rather as something one does. It involves recognizing a problem, searching for a way to change and then beginning and sticking with that change strategy” Miller (1995) o Motivational Interviewing is a way to minimize resistance, resolve ambivalence and induce change. o Readiness levels are accepted starting points for treatment rather than reasons for elimination from treatment services.
  10. 10. Motivation: The Old Way
  11. 11. o Motivation is key to change and it is constantly in flux o Motivation is influenced by social interaction, namely the counselor’s style o At all stages of change, ambivalence is seen as normal and not pathological o Confrontation is a goal, not a therapeutic technique CONCEPTUALIZING MOTIVATIONAL INTERVIEWING
  12. 12. Client Resistance Involves feelings-actions-behaviors of an interpersonal nature where there is a lack of collaboration
  13. 13. Stages Of Change • Precontemplation stage • Contemplation stage • Preparation stage • Action stage • Maintenance • Relapse
  14. 14. “There is a myth…that more is always better. More education, more intense treatment, more confrontation will necessarily produce more change. Nowhere is this less true than with precontemplators. More intensity will often produce fewer results with this group. So it is particularly important to use careful motivational strategies, rather than mount high-intensity programs…We cannot make precontemplators change, but we can help motivate them to move to contemplation.” DiClemente, (1991)
  15. 15. Stage 1: Precontemplation • The client does not consider change. Seeks treatment due to outside pressures such as family, job, etc., or due to legal and/or medical concerns
  16. 16. Motivational Interviewing Tasks Building Readiness • A) Raise doubt about client’s belief that AOD use is harmless • B) Increase the client’s perception of risks and problems with current behaviors
  17. 17. Clinical Interventions • A) Establish rapport and trust and explore what brought client into treatment • B) Summarize: link the information together, especially focusing on the client’s ambivalence. Educate about possible links to AOD use
  18. 18. “Contemplation is often a very paradoxical stage of change… Ambivalence is the archenemy of commitment and a prime reason for chronic contemplation. Helping the client to work through the ambivalence, to anticipate barriers, to decrease the desirability of the problem behavior and to gain some increased sense of self-efficacy to cope with this specific problem are all stage-appropriate strategies.” DiClemente, (1991)
  19. 19. Stage 2: Contemplation o The client is highly ambivalent about change. The client both considers change and rejects it. The client will seesaw between reasons for concern and justifications for continued AOD use
  20. 20. Ambivalence • A state of mind in which a person has coexisting but conflicting feelings, thoughts, and actions about something • The “I do but I don’t” dilemma
  21. 21. Motivational Interviewing Tasks: Increasing Commitment • A) Tip the decisional balance and strengthen self-efficacy • B) Evoke from the client reasons to change and risks of not changing
  22. 22. Clinical Interventions • A) Show interest in how AOD use affects all areas of the client’s life • B) Reframe resentment: validate the client’s observations, but offer a new interpretation of the data
  23. 23. Stage 3: Preparation • The client is committed to and planning to make a change in the near future but is still considering what to do • Goal: Help client to get ready to make a change • Elements of Change:…Ready….Willing….Able
  24. 24. Strategies For Preparation Stage • Clarify goals & strategies • Menu of options • Offer advice • Negotiate change plan • Identify barriers • Get social support • Treatment expectations • Publicize change plans
  25. 25. Stage 4: Action • Client has decided to make a change • Client has verbalized or demonstrated a firm commitment to change • Efforts to modify behavior and/or environment are being taken • Client demonstrates motivation and effort to achieve real change • Client is involved in, and committed to, the change process • Client is willing to follow suggested strategies and activities to change
  26. 26. Maintenance and Relapse
  27. 27. You Can Make A Difference