Module 3: Treatment Strategies

4B. Motivational Enhancement Approaches

Many youth do not see their psychiatric symptoms or substance use as problematic. Denial and poor motivation in treatment are major barriers to successful outcomes. Even when a youth is initially motivated for treatment, commitment to behavior change often fluctuates during the course of an intervention.

Motivational enhancement and interviewing is one approach that addresses denial and poor motivation (Miller & Rollnick, 1991). This approach assumes that internal motivation develops. The main task of the treatment provider is to create an environment that supports and reinforces the youth’s own motivation and commitment to change.

The following are five basic motivational principles that can lead youth to decide to change their behavior, comply with treatment recommendations, and remain committed to behavior change (Miller & Rollnick, 1991; Griffin, Hills, & Peters, 1996).

• Express empathy: Motivation may be enhanced by listening without making judgments, accepting the youth (including their psychiatric symptoms and substance use), and acknowledging that it is normal to have mixed feelings about wanting to change their behavior.
• Develop discrepancy: Motivation may be enhanced by making the youth more aware of the gap between what their life is like now and how they want their life to be. It may be helpful to highlight some of the negative consequences associated with their current behavior and positive outcomes if they pursue their desired life.
• Avoid argument: The confrontational approach taken by many substance abuse treatment programs often results in the youth taking the opposite position just to show that they still have some freedom. The more an authority figure tells them how things are or what to do, the more defensive the youth become. The motivational approach avoids telling the youth what to do. Instead, the treatment provider helps the youth identify the negative consequences of drug-using behavior and begin to devalue the positive aspects of taking drugs. The youth do not need to "admit" to anything and no diagnostic labels are given. The goal is for both the youth and the treatment provider to see the benefits of change and develop arguments in support of decreased use.
• Roll with resistance: Resistance can be countered when the treatment provider offers new ideas, but does not force them on the youth, and reinforces positive steps the youth are already taking. The treatment provider explores any ambivalence and assures the youth that this is okay. If resistance is encountered, the treatment provider identifies a different approach.
• Support self-efficacy: Motivation is enhanced when youth believe they can change their behavior. They need a great deal of encouragement and should be reinforced for thinking confidently about making these very difficult changes. Without hope of success, there is little motivation to continue working on their problems.