- June 29, 2023
- Jennifer Salerno
Editor’s Note: To read Part I of Motivational Interviewing, check out our first post: How to Strengthen Your Connections with At-Risk Youth. In it we provide an overview of Motivational Interviewing, including the key pillars (open-ended questions, affirmations, reflections, and summarizing), sample scenarios and scripts, and more. In the following we dive into the stages of change model as it relates to motivational interviewing.
Take a moment to remember what life was like when you were a teenager.
How would you describe yourself?
What words do you think your family would use? What about your teachers?
Regardless of the memories that flash as you recall your adolescent years, one thing that nearly all teens have in common is the desire to experience greater independence and a sense of control. This is a normal and natural part of growing up.
When adults step in with comments or mandates to teens about making changes to risky behaviors they see, it’s also normal and natural for teens to resist.
Because it’s not on their terms.
Motivational interviewing (MI) offers professionals a set of communication strategies to engage teens in a respectful and effective way to make lasting changes toward safer, healthier behaviors and increased well-being.
MI is all about communication. The strategies support professionals as they engage teens in self-directed positive behavior change. Originally developed for use with individuals with substance use disorders, MI has since been widely adopted by professionals across disciplines.
Key MI strategies include asking open-ended questions, providing affirmations, using reflective listening, and summarizing (OARS). These strategies are effective with teens as well as with adults.
MI is different from other communication methods for motivating change because it is not driven by the professional. The professional does not dictate steps towards recovery or define the goals of treatment (for example). Instead, motivational interviewing is a mutual process of exploring and resolving ambivalence to change by creating an atmosphere of trust and compassion. This ‘spirit’ of MI facilitates honest conversations and helps teens feel more comfortable sharing information about their risk behaviors or risk factors.
Teens are more likely to be vulnerable when they feel emotionally safe. (This is true for all of us!)
Participating in the MI process ultimately increases motivation to make a change, plan for safer behaviors, and seek help on how to make those changes.
MI also respects a teen’s right to make choices and recognizes that some ambivalence and resistance is normal. This is where the stages of change come in. The stages of change model holds the idea that change is a process involving progress through a series of stages. It is closely linked with MI because it recognizes that youth will be at various levels of readiness to accept help and/or change. Let’s dive in –
Stages of Change
The stages of change model is also called the Transtheoretical Model of Change. It was originally developed in the 1970s by psychologists James O. Prochaska and Carlo DiClemente. The name, ‘transtheoretical,’ refers to the use of multiple psychological theories embedded into the model. The stages of change model includes 6 stages:
- Preparation (Determination)
It is important to understand the characteristics of each phase so professionals can employ stage-appropriate interventions and ask MI questions that appropriately meet the youth at their level of readiness to change. Doing so builds trust and contributes to the spirit of MI. It also helps prevent youth from pushing back or shutting down altogether.
The first stage of change is precontemplation. Teens in precontemplation are not yet thinking about making a change. They are either unaware of a need for change or uninterested in considering a change. Professionals who engage with resistant teens can still take actionable steps towards decreasing risk during this stage, including gathering the teen’s history and listening for any discrepancies between the teen’s stated goals and their choices.
For example, consider a 19-year-old female, Jamie, who is a sophomore in college. Jamie has been mandated to see a counselor once per week for the spring semester after being caught drinking underage at a university-sponsored event. Jamie does not see her actions as problematic – she normalizes her actions as typical behavior among her peer group and notes that drinking alcohol at age 19 is legal in other countries. She states that she has never been unsafe when drinking and always earns good grades.
As the professional assigned to work with Jamie, we understand that Jamie is not yet thinking about making a change. Our task at this point in the helping relationship is to empathize and ask open-ended questions (or statements) to learn about Jamie’s goals and lifestyle choices. We may also ask permission to offer education about alcohol-related risks. Some of this questioning may sound like this:
- It can feel like an additional burden to have to meet every week. Tell me more about how your sophomore year is going.
- How do you feel about what happened at the event?
- Is it okay if I share some information with you about alcohol consumption?
The next stage of change is contemplation. During this stage, teens are considering making a change but they are not yet ready to take definitive action or make a commitment. During this stage, professionals can use motivational interviewing strategies to help teens navigate the ambiguity they may feel around the possibility of a change.
Here professionals should use OARS to explore both the positive and negative aspects of the potential change and try to gently point the teens in the direction of safer, healthier behavior by reflecting back what the teen has already shared.
In Jamie’s example, the script may include phrases such as these:
- What are some of your reasons for drinking? What are some reasons for not drinking?
- How do you decide when to drink and when not to?
- You shared that“legal trouble” is a potential downside to your drinking. How might legal trouble impact your goal of getting into law school?
During the preparation (determination) stage, teens are preparing for action in the near future. They are motivated to make a change and see some advantages to changing their behavior. Individuals in the preparation stage may appreciate and benefit from having clear choices for what to do instead, or for how to receive help. This may include providing health education, offering resources, sharing information, or making referrals, for example.
When our example client, Jamie, is in the preparation phase, she may need support in identifying possible barriers to change as well as suggestions for alternatives to replace drinking. Using motivational interviewing strategies, we could ask Jamie –
- What do you need in order to avoid drinking?
- Which of your friends would be supportive of your choice not to drink?
- There are a lot of non-drinking activities that help you release stress. Tell me what you have considered trying.
- You want to continue meeting and talking through stress relieving activities, did I get that right?
In the action stage, teens are actively working on the change.
They are implementing the quit-smoking plan, they have started using birth control, they have a plan for how to eat more fruits and vegetables, they are beginning therapy for their depression – whatever the risk is, the teen is moving towards well-being and away from adverse outcomes and further risk.
Professionals working with teens in the action stage can help them navigate unexpected challenges and find coping mechanisms that are effective for them.
Imagine Jamie experiences success during her first month of sobriety. She begins to feel proud of herself for her renewed focus on her health and is even more determined to continue on the path toward law school. Then, she slips up during the second month at her best friend’s 21st birthday party. Using motivational interviewing, we may help her process this hurdle:
- You are disappointed that you drank.
- There isn’t anything you can do to change what happened at your friend’s party. What would be helpful for you to make the choice not to drink in the future when you go to another party?
- It sounds like your best friend drinks most weekends. What other activities do you both enjoy?
- Let’s revisit some of the strategies we identified when we last met to see if we need to make any updates.
In this stage of change, teens are consistently adhering to the healthy lifestyle changes they have made. Professionals work with teens to help them see the benefits associated with the changed behavior and continue to support them in maintaining the changes. MI strategies are key during this stage as well to help facilitate conversations about potential triggers and situations that may lead to relapse.
The termination stage is when there is no longer any desire to engage in the risk behavior. Not everyone who is motivated to change their behavior will reach the termination stage. For example, the urge to drink in excess may be a pressing challenge for Jamie for a long time. She may stay in the maintenance stage. For others, seeing the gains associated with the behavior change may eventually outweigh any desire to re-engage in old habits.
MI and the stages of change model are important tools for professionals working with youth to respectfully and effectively engage youth about sensitive topics.
Possibilities For Change offers a continuum of MI education & 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.