Using Motivational Interviewing with Parents and Children

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Using Motivational Interviewing with Parents and
Children

• Jeanne L. Obert, MFT, MSM
• Executive Director, Matrix Institute
• UCLA Integrated Substance Abuse Programs

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Outpatient Treatment 90 of clients are
presently treated in outpatient
treatment National Survey of Substance
Abuse Treatment SAMHSA, 2000
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Outpatient Treatment

• The first goal of every outpatient session is
• TO HAVE ANOTHER SESSION

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Retention in Treatmentis Directly Related to

• 1. WHAT WE DO
• 2. HOW WE DO IT

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One Way of Thinking
The Stick

• Change is motivated by discomfort.
• If you can make people feel bad enough, they will
  change.
• People have to hit bottom to be ready
• Corollary People dont change because they
  havent suffered enough

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Assumptions in working with people who clearly
need to change
You better ____ or ________!
If the stick is big enough. There is no need for
a carrot.
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Assumptions in Working with Mandated Clients

• Clients are either motivated or not.
• If they are not, there is little we can do.

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BUT DO THEY ALWAYS ?
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Motivational Interviewing, 2nd Edition. Miller
and Rollnick

• We cant help wondering, why dont people change?
  You would think
• that having had a heart attack would be enough to
  persuade a man to quit smoking, change his diet,
  exercise more, and take his medication

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You would think..

• that hangovers, damaged relationships, an auto
  crash, and memory blackouts would be enough to
  convince a person
• to stop drinking

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You would think..

• that the very real threats of blindness,
  amputations and other complications from diabetes
  would be enough to motivate weight loss and
  glycemic control

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You would think..

• that time spent in the dehumanizing privations of
  prison would dissuade people from re-offending

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AND YET

• Addictive behaviors persist despite overwhelming
  evidence of their destructiveness.

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What has occurred

• The field of addictions has provided a natural
  arena to study the process of change.
• What causes change to occur?
• How does the process unfold?
• Is it possible to push the river?
• What is the best way to do that?

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Another Way of Thinking
The Carrot

• People are ambivalent about change
• AMBIVALENCE is the key issue to be resolved
  for change to occur.
• Lack of motivation can be viewed as
• unresolved ambivalence.

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Ambivalent people may not respond in predictable
ways.

• Increasing the negative consequences (using the
  stick) does not always decrease the
  attractiveness of the behavior.
• It can sometimes exacerbate it rather than
  diminish it.

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The Theory of Psychological Reactance(one
possible explanation)

• This theory predicts an increase in the rate and
  attractiveness of a behavior IF the person
  perceives a challenge or infringement to his or
  her personal freedom.

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What facilitates change
The Carrot

• Constructive behavior change comes from
  connecting with something valued, cherished and
  important
• Intrinsic motivation for change comes out of an
  accepting, empowering, safe atmosphere where the
  painful present can be challenged

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The Process of Change

• Positive change often occurs without formal
  treatment.
• Treatment can be viewed as facilitating what is a
  natural process of change.

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Most Change Happens Early

• A little counseling can lead to significant
  change.
• Dozens of studies from many different countries
  document the effectiveness of brief interventions
  for many problems.

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Perceived Efficacy

• People who believe that they are likely to change
  do so. People whose counselors believe that they
  are likely to change do so. Those who are told
  that they are not expected to improve or who do
  not believe they will improve indeed do not.
• Beliefs about possibility of change become
  self-fulfilling prophecies. (Waiting list
  effects in control groups.)

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Getting Results in Adolescent Drug Abuse
Treatment

• What factors influence whether
• a teen stays in treatment or a
• parent participates?
• Factor that seems to make the biggest difference
  is the professional to whom the patient is
  assigned.

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Back Where We Started

• Ideal atmosphere for change within the
  therapeutic relationship (Carl Rogers, 1959)
• Accurate empathy
• Non-possessive
• warmth
• Genuineness

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Some things weve learned

• Caregiver empathy can be a significant
  determinant of persons response to treatment.
• Directive, confrontational
• counseling styles increase
• patient/client resistance.
• Empathic counseling styles facilitate change.

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More things weve learned

• Level of MOTIVATION is often a good predictor of
  outcome.
• MOTIVATION can be influenced by naturally
  occurring factors and by specific interventions.

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What Causes a Person to be Judged Motivated

• The person agrees with us
• Is willing to comply with our recommendations
  and treatment prescriptions
• States desire for help
• Shows distress, acknowledges helplessness
• Has a successful outcome

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Definition of Motivation
The probability that a person will enter into,
continue, and comply with change-directed
behavior
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Motivational Interviewing
Elicit behavior change
Respect autonomy
A patient-centered directive method for enhancing
intrinsic motivation to change by exploring and
resolving ambivalence.

Tolerate patient ambivalence
Explore consequences
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Stages of ChangeProchaska DiClemente
Precontemplation
Contemplation
Maintenance
Preparation
Action
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Four Principles ofMotivational Interviewing
1. Express empathy 2. Develop discrepancy 3. Avoi
d argumentation 4. Support self-efficacy
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Building MotivationOARS

• Open-ended questioning
• Affirming
• Reflective listening
• Summarizing

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Open-ended Questions

• An open-ended question is one with more than a
  yes or no response
• Helps person elaborate own view of the problem
  and brainstorm possible solutions

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Affirmations

• Focused on achievements of individual
• Intended to
• Support persons persistence
• Encourage continued efforts
• Assist person in seeing positives
• Support individuals proven strengths

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Reflective Listening Key-concepts

• Listen to both what the person says and to what
  the person means
• Check out assumptions
• Create an environment of empathy (nonjudgmental)
• You do not have to agree
• Be aware of intonation (statement, not question)

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SUMMARIZING

• Summaries capture both sides of the ambivalence
• (You say that ___________ but you also
  mentioned that ________________.)
• Summaries also prompt clarification and further
  elaboration from the person.

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JLObert_at_matrixinstitute.org
www.matrixinstitute.org www. uclaisap.orghttp/
/motivationalinterview.orgEnhancing Motivation
for Change in Substance Abuse TreatmentTIP 35