- April 27, 2023
- Jennifer Salerno
POV: You’re the parent of a teen. Your 16-year-old daughter comes home from school every day and takes a 2-hour nap in her room before emerging for dinner and then back to her room for another late night of studying. When you ask her how she’s doing she looks at you, rolls her eyes, and says “fine.”
POV: You’re a school social worker and one of the 7th graders on your caseload has a history of self-harm. He never wants to talk about it. Whenever you try to bring it up, he looks to the ground and just mumbles, “I don’t know.”
POV: You’re a college wellness advisor and the junior with a DUI who was referred to you says it was all a fluke – a one-time bad decision. Yet, records show this was their third DUI. Their parents even called to ask if you could refer them to treatment for alcohol dependency. They deny any sort of problem.
The parent, social worker, and wellness advisor all have one thing in common: they’re working with youth who are reluctant to talk.
Whether you’re a professional or a parent, engaging resistant youth can be really challenging.
Motivational interviewing (MI) is one of the most effective communication strategies for helping professionals strengthen their skills in talking with at-risk youth about risks, healthy lifestyles, and more. In this article, we will look at the key pillars of MI, a few sample scripts to consider how you might put these strategies into practice, and a brief overview of the research base that supports it.
What Is Motivational Interviewing?
At its core, MI is a set of communication strategies designed to support self-directed positive behavior change. It is different from other communication methods for motivating change because it is not externally focused or clinician-driven.
MI takes a different approach, exploring and resolving ambivalence to change by creating an atmosphere of empathy conducive to honest conversations. This ‘spirit’ of MI allows the youth to feel more comfortable in disclosing information about their risk behaviors or risk factors. It increases their motivation to make a change, plan for safer behaviors, and seek advice on how to make those changes.
MI focuses on collaboration and partnership between the trusted adult and the youth. It respects the youth’s right to make choices and recognizes that some degree of ambivalence and resistance is normal.
Motivational Interviewing OARS
The core skills of MI are commonly referred to as OARS. Following OARS helps professionals guide youth in risk reduction and exchange information with empathy and respect.
O – Open-ended Questions
Ask open-ended questions that invite the youth to share their experiences, perspectives, and ideas. Open-ended questions guide youth to think about how the behavior change may be meaningful or possible. For example, instead of asking, “Have you talked to your parents about this?” (which invites a short, closed response), try asking, “What do you think would happen if you shared your feelings with your parents” (which invites elaboration).
Information may be exchanged by first asking the youth to share what they already know, seeking permission to offer what the professional knows, and then using open-ended questions to explore the youth’s response.
A – Affirmations
Affirmations encourage and support youth during the change process by helping to build their sense of hope and confidence in their ability to change. They should speak to the youth’s strengths, perspectives, or past successes. You might say, “You believe in taking care of yourself,” or, “You are a good friend.”
R – Reflections
Reflections, or reflective listening, is about carefully listening, trying to understand what the youth is saying, and making a guess as to what they mean. The professional uses statements (rather than questions) during this phase and moves through a flow of repeating, rephrasing, inferring (guessing what the youth is trying to communicate), and reflecting back feelings. Reflective listening is one of the key ways professionals express empathy during MI.
Remember the 16-year-old from our introduction? Imagine her parents have just learned that she has been borrowing her friend’s Adderall to help her stay awake and focused on schoolwork. When asked about it, she says that she needs it because she can’t get all of her AP work done without it. Using reflective listening in this scenario may look like this:
(Repeating) – “You’re having a hard time getting all the AP work done.”
(Rephrasing) – “You need support to help you get everything done.”
(Paraphrasing/Guessing Meaning) – “You would like to figure out how to get all of your work done and at a high standard.”
(Reflecting Feeling) – “It’s overwhelming and exhausting trying to keep up with your AP classes.”
Reflective listening is about staying close to what the client has said with some rephrasing and synonyms. It is active, meaning the professional – or in this case, the parent – is actively deciding which elements of the youth’s information to repeat and rephrase to help direct the conversation. Notice how the parent did not reference Adderall in these initial reflections.
S – Summarizing
The final component of MI is summarizing. Summarizing helps the youth see that the professional has been listening carefully the whole time. This is key! The professional links material together – including elements of what the youth has shared, expressed desires for change, and/or information about the change that the professional has shared. During this stage, the professional also helps emphasize or reinforce key points that the youth makes and then, ultimately ends the session with the youth.
Sample MI Scenarios and Scripts
Let’s look at how to put the OARS of MI into practice. Imagine you are the professional working with a 15-year-old male who is having sex and not using condoms and being seen out of concern about having a sexually transmitted infection (STI).
You might start with an open-ended question or statement, like this: “Tell me about using condoms.”
When the youth has shared their experiences, you may then ask permission to share the information you have to offer by offering a statement like, “I would like to share some things I know about condoms. Is that OK?”
Affirmation statements should be tailored to the individual’s strengths, perspectives, and past successes. They might look something like this –
You are committed to staying healthy.
You have taken care of your body in other ways – when you use sunscreen, drink water, and play sports.
You believe in keeping yourself and your partners safe.
When the conversation moves to reflection, you will move through a series of repeating, rephrasing, guessing meaning, and reflecting feelings.
(Repeating) – “You’re having sex and not using protection.”
(Rephrasing) – “You’re not using protection and you don’t want to get an STI.”
(Paraphrasing/Guessing Meaning) – “You would like to figure out how to be safer when having sex.”
(Reflect feeling) – “It’s scary to think about getting an STI.”
Finally, when it’s time to summarize, you will thoughtfully show the youth how you’ve been listening with a brief compilation of what you have talked about. It might sound like this –
“Right now, you’re having sex and aren’t using protection. You want to figure out how to be safer when having sex so that you don’t get an STI and you’re open to hearing more about different contraception options. You believe in keeping yourself and your partners safe.”
Research Base that Supports Motivational Interviewing
Clinical psychologists and researchers William R. Miller and Stephen Rollnick of the University of New Mexico initially developed MI to support patients with substance use disorders. In the decades following, the use of MI has expanded to include multiple disciplines and demographics and it is now widely used by professionals in medicine, nursing, behavioral health, and social work/case management.
The research base supporting MI is extensive. More than 100 randomized control trials prove its effectiveness in helping people make lifestyle and behavior changes, such as reducing alcohol intake or increasing exercise. As MI has expanded, the original authors, Miller and Rollnick, identified 10 things that MI is NOT in an effort to promote quality assurance in research, practice, and training. They state that MI is not:
- The transtheoretical model of change
- A way of tricking people into doing what you want them to do
- A technique
- Decisional balance
- Assessment feedback
- Cognitive-behavior therapy
- Client-centered therapy
- Easy to learn
- Practice as usual
- A panacea
This clarification helps narrow the focus of MI to ensure it is used with fidelity by those who have specific training in its design.
For more on the effectiveness of MI, check out our whitepaper here.
Limitations of Motivational Interviewing
The best professionals tailor their treatment plans and interventions to the individual needs of the youth they serve. While MI will be an effective tool for most, it may not be the right approach for all.
Youth who are experiencing clinical depression often struggle with motivation, which is an essential component of MI–individuals need to be able to identify or reflect upon a desired change. So, utilizing MI with these youth may require more eliciting of change talk (motivations) than youth without depression. Additionally, individuals who have been diagnosed with bipolar disorder or schizophrenia may not be appropriate candidates due to limited mental clarity or capacity to reflect upon the advantages and disadvantages of their actions or to formulate a plan. Using MI with these youth would be determined by the professional working with them and on a case-by-case basis.
Another potential limitation of MI is time constraints for the professional. Yet, once you are comfortable with MI, adopting strategies that incorporate the ‘spirit’ of MI and lead youth towards change become part of your rapport and trust building occurs without a lot of conscious effort or additional time.
Possibilities For Change offers a continuum of MI education and resources. Whether you’re looking for a quick webinar to brush up on your knowledge or an in-depth self-paced online course, we’ve got you covered. Check out the resources below to take the next step in your MI professional development:
- Motivational Interviewing Webinar – This interactive introductory webinar is designed specifically for professionals who are dedicated to identifying and reducing risk factors among their youth populations and want to take their skills to the next level. In just 2 hours participants will strengthen their ability to talk with youth about risks, healthy lifestyles, and more.
- Motivational Interviewing Online Course (MITEY Change) – Motivational Interviewing Training for Empowering Youth towards Change provides education and resources to enhance professionals’ knowledge, skills, and confidence in using MI strategies to provide effective and efficient youth risk coaching. Available to individuals and teams, this course has been shown to improve skills and confidence when addressing youth risk.
- Motivational Interviewing Workshops – Our 3-4 hour workshops (hosted virtually or in person) translate MI knowledge gained from the self-guided learning modules into effective practice. The workshops support adult learning by providing participants with a dynamic and engaging experience with personalized feedback from experienced MI trainers.
Get in touch today to learn which motivational interviewing resource is right for you.