Motivational Interview (MI)

Motivational Interview (MI) refers to a style of counselling, which is client-centered and directive, being aimed at eliciting behavior change and helping to explore and resolve ambivalence in clients. The concept of MI emanated from Bill Miller’s experience of treating victims of alcohol addiction, which was later structured into a more professional and detailed clinical procedure. The primary objective of MI is to engage the client in negotiations instead of conflicts. In addition, Bill Miller’s process of conceiving the idea also entailed the MI technique of listening, reflecting, checking, and clarifying the clients’ problem. Since its discovery, MI’s concept was incorporated in several theoretical models related to human behavioral change and interpersonal process.

Parents are entrusted with the burden of ensuring that their kids grow up to be responsible citizens who will drive the economy of the nation to the upper level. The process of children’s growth involves passing through different stages of life. For parents, the adolescent stage is the most challenging in terms of taking care of a child. It is at this stage that the child starts being secretive if the parent does not take control in earnest. Till certain age, a child is greatly dependent on parents for everything but as the adolescent stage sets in, the child starts trusting his/her peers for advice more often than parents. The stage is marked with a change in behavior as well as the physical change. In most cases, the parent is not able to win the trust of the kid. In this respect, motivational interview comes in handy to help parents with making children adopt the desired behavior even as they undergo the all-important stages of their growth up until adulthood. Consequently, motivational interview strategies are critical in ensuring a behavioral change of the adolescents.

Motivational Interview Concept

Originally, the method of motivational interview was used for behavioral change of adults concerning substance abuse. Judging from the numerous cases that were dealt with during that time, the method was found to be capable of helping the adolescents as well. The method of behavior change was thus found to be efficient among younger population hence its application for the adolescents is relevant. Modifying the behavior of a young person can be tough, as research has shown that the more one attempts to persuade the younger generation to do a particular thing and avoid another, the more they tend to resist the adults. It was, therefore, imperative to find a way out to achieve behavior change in young population. In order to achieve this, one has to work with the adolescents (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010).

Motivational interviews employ the use of open-ended questions. The open-ended questions are aimed at allowing the patients, who in this case are the adolescents to give extra information, as they are not limited to what they should give. MI also employs the use of reflective listening, which allows the patient to be engaged in the discussion on behavioral change. The move is aimed at reducing the risks that the patient may find him/herself at as well as maintain good health. Motivational interview, therefore, increases the receptivity of the patient and decreases resistance to change. A relationship of mutual respect and trust is critical for the motivational interview, without which the patient may not disclose helpful information. The pediatrician makes sure that he/she summarizes the information obtained to ensure easier interpretation of the patient’s statements.

Motivational Interview Techniques

The practical application of motivational interviews involves four main techniques. The techniques are significant in achieving change in the patient. The techniques include the use of open-ended questions, affirming, reflection, and finally summarizing. The open-ended questions are preferred to close-ended questions because in this case the patient will give much more information. The patient takes the time to reflect on his/her life, actions and thoughts and then answers the questions that have been asked. The information that they will provide will always contain a few facts that will motivate them to change. Open-ended questions will also make the clients free, and they will not have to think about being pressured to change their behavior or being forced to provide certain private information. By far, open-ended questions are best suited for increasing one’s motivation to change (Naar-King & Suarez, 2011).

The second technique, which is the affirmation, involves building a rapport that will help in the provision of feedback and bring about some positive behavioral changes rapidly. Appreciating the youth for what he/she has done is one of the ways to give affirmations. These may include reporting to a meeting early enough or completing an assignment right on time. Pointing out interesting things in the person is also a way of giving affirmations. An example is appreciating the patient for an action of responsibility like taking care of a brother or sister. Affirmations go a long way in ensuring that the patient recognizes his/her development of thinking abilities. The advantages of affirmations are that they build a stronger relationship between the patient and the pediatrician. The self-esteem of the patient will also improve significantly (Lundahl et al., 2010). Affirmations also help to build trust among the players, and this is critical in that a more open conversation will inevitably be held hence helping the pediatrician to achieve positive change in the patient.

Reflections being the third technique are statements that one believes the client is saying or thinking about. It is possible to understand when an adolescent is lying or not being sincere in what he/she is saying. After reflections, the client will know that he/she has been talking to someone who has been listening. It also shows that the patient has been listening to what he/she has been told about certain behaviors. Reflections give a real thrust to discussions, as the client will be able to correct any misunderstandings thus helping him/her elaborate further actions. In addition, reflections make the clients process their thoughts without any difficulties. When they hear what they have said, it helps them to draw a connection between the things they have said and to notice the presence of any discrepancies, which is a critical step towards beginning to contemplate change (Lundahl et al., 2010).

Summarizing is the last technique in the motivational interview. It is an important tool in ensuring that the goals of the process have been achieved. With the realization of the attainment of goals or without it, plans can be made to make the treatment method more efficient. It also helps in giving a direction to help in streamlining things. All this is made possible through summarizing the important discussion points and clarification of any agreed action plan. Finally, it helps in confirming that both the client and the pediatrician have decided to make an action plan. An outstanding advantage of summarizing is that it stresses on positive steps headfirst, which have been recorded, and this enables one to affirm and positively reinforce them.

Strategies to Improve MI Receptivity and Resistance

Considering the increase in receptivity and the decrease in resistance, it is necessary to discuss the strategies of achieving the above goals. Strategies to increase receptivity include but are not limited to the following. The first strategy is a simple reflection, whereby the pediatrician recaps what the client has uttered. The move is aimed at guaranteeing that the patient is certain of what he/she has just said and that it was never misunderstood or will never be misinterpreted. The second strategy is the reflection of meaning. The reflection, in this case, is aimed at analyzing the intellectual content of what was said. Reflection of feelings is the next strategy, which helps to reflect implied or fundamental affective content in what was said. The third strategy is the double-sided strategy. It is an interesting strategy in that both sides of the ambivalence are looked into. The most important part is the one, which reflects the perspective favoring the status quo and finally helps to find a perspective that would encourage change (Rollnick, Butler, Kinnersley, Gregory, & Mash, 2010).

The final strategy for increasing receptivity is the amplified reflection. The strategy is applicable only when the negative side of the ambivalence is used. Exaggerating and intensifying what the patient has said will lead to him/her correcting the distortion. The strategy must be applied with a light touch and in case; the patient has noticed some ambivalence. For instance, when the patient says that she/he is not sure whether it is necessary to undergo treatment, the best response is telling him/her that his/her life is much better at the moment. The intensification of what he/she has said earlier will make him/her rethink his/her statement hence correcting the distortion.

The strategies to reduce resistance are as follows. The first strategy is shifting the focus. During an interview, the teen will at times want to disagree with the therapist’s suggestions upon a certain issue. An example is that one may suggest that in order to avoid teen pregnancy, the patient has to use available methods of birth control. The teens’ respond towards this may be that she does not have to use a birth control, as she does not think she will get pregnant. In shifting focus, the pediatrician may want to know more about what the teen means by saying she may not get pregnant. As seen, she is at first resistant to the remedy being offered, but as she explains herself, she may come to the realization that indeed she is wrong and thus end up following what has been initially suggested (Jensen et al., 2011).

The second strategy for reducing resistance is to emphasize the idea that for the behavioral change to take place; the teen has to make his/her personal choice and control it. By this, the teen will realize that nothing is being forced on him/her and that every decision is made on his/her own. Convincing the adolescent that the use of a birth control method to avoid pregnancy is entirely upon her is critical in ensuring that she does not feel as if you are doing something against her will. Reframing the teens’ statement is another strategy of reducing resistance. When the pediatrician restates what he/she has said earlier, making it look better, he/she might see some sense in it. An example is a teen who may have started smoking. He/she might say that his/her parents are nagging him/her and bugging him/her about a newly acquired habit. In reframing his/her statement, it will be important to tell the teen that the worries of his/her parents are what make it look like nagging, but they mean well for him/her (Lai, Cahill, Qin, & Tang, 2010).

How It Works

The fourth strategy of decreasing resistance to modification behavior lies in agreeing with the teen with a twist. This can be achieved by combining a reframe and a reflection. However, it is important that the words come out with a light touch to avoid it being perceived as sarcasm or criticism. The final strategy is siding with the negative things that the teen is saying. It can also be referred to as coming alongside. It should be noted that this is the last resort if absolutely nothing seems to work out for the patient. Extreme exaggeration must be applied in this matter to make the adolescent come back to a more open posture. For instance, a teen may think that the treatment is not helpful at all to him/her. In applying the coming alongside method, as a pediatrician, you can agree with the teen and even go further stating that maybe it is not the right time to encourage behavioral change in the teen. With this, the teen will recognize that there is a change already that needs to be rectified hence giving it a thought.

Conclusion

Concisely, motivational interview is a sure way of encouraging behavioral change in adolescents. The realization that the method was not only applicable to the older population who were struggling with substance abuse but could also be applied to the younger population shows that the method has also withstood the test of time. The four techniques are also readily applicable in the motivational interview as seen from above data. They tend to make this method of behavior change in adolescents easier and more practical. Avoiding the things that would make the teen resistant to change is also critical. In instances when it becomes difficult to prevent certain things, employing the strategies mentioned would go a long way in solving the problem. Finally, banking on the things that would increase the receptivity of the adolescent is imperative in making the motivational interview more efficient.