Motivational Interviewing Webinar

Official Transcript

Hello and welcome to the Empowering Youth and Families Program’s webinar on motivational interviewing. My name is Paul Toriello. I’m a professor at East Carolina University, I’m a team member on the program, and most importantly I’m a father of two children and what I’d like to talk to you about today are a couple communication strategies and techniques that you can use with your children after your child has made a poor or unhealthy decision. Unhealthy decisions around substance use, sexual behavior, they’ve received some poor grades, breaking curfew, and those kinds of behaviors. These strategies I want to share with you are based on what’s called motivational interviewing.

Motivational interviewing is an evidence-based counseling practice. It has been practiced and studied for over 20 years and there’s a lot of research support behind these strategies and techniques that make up motivational interviewing. It is used by most substance abuse counselors. It is used by a lot of mental health counselors. It is widely used in behavioral change settings. So to be clear even though this is an evidence-based counseling intervention when you use these strategies, when you use these techniques, when you’re using motivational interviewing you’re not being a counselor. You can do these things at home with your family, again you’re not being a counselor, you’re not being a psychologist, you’re being a parent, you’re being a caregiver. Also to be clear these strategies, these techniques are best used with adolescents your children at the adolescent age 11, 12, and then of course into the teenage years. 

So what I think about my children and when they make poor decisions or unhealthy choices I think there are at least three conversations that have to happen between myself and my children or the caregiver and their youth. The first conversation is the prevention conversation. This is where we’re having discussion with our children about our expectations for them. What are the rules of the house? What are the expectations and curfews is a classic example of an expectation. This also our time as parents to share our values around sex and in drug use. What do we expect of them? What do we hope for them? For example one of my wife and I expectations and our hope for our children is that they wouldn’t have sex until they are married, that’s for our family. You choose what the expectations are for your family and part of that first prevention, planting the seeds of values conversation. 

The second conversation is when one of our children breaks a rule. They get busted. They get caught. That’s a simpler conversation. It’s usually about just collecting the facts: what happened, what did you do, who was involved, and then naturally there are consequences implemented for not meeting the expectation. Now as you can see the first two conversations are pretty much one way. Talking about values and setting expectations can certainly be a negotiation between us and our children but ultimately as the authority the parent has the final say. When it comes to that second conversation consequences are pretty much instituted by us as parents. Maybe there is some negotiation, however these first two conversations we are the parents, we are the caregivers, we are the authority. 

The third conversation is where the strategies and techniques of motivational interviewing can fit in. This conversation is really about being supportive about building that relationship and maintaining that relationship with your children. The message of this conversation is you can talk to me about anything. In the previous conversations, yes I’ve grounded you, I’ve taken away your car, I’ve taken away your privileges. In this conversation I need to change my mode as a caregiver, as a parent so you can talk to me about anything and I will seek to understand where you’re coming from. The other purpose of the third conversation is to increase the chances that our children will change, that they’ll make different decisions moving forward, to increase their self-esteem, their sense of empowerment that they can make different decisions. So again with these conversations with our children we’re balancing between the authoritative parent and a supportive parent. 

Now when our children are adolescents, the adolescent brain and body is what I call a perfect storm of psychosocial physiological change. Hormones are raging, peer pressure is unprecedented these days with digital access to constant barrage of stimuli, adolescents are going through an intense phase of curiosity and experimentation and risk-taking, and a final key characteristic of adolescence is rebellion. Remember when you were an adolescent? I remember when I was an adolescent. I was quite the rebellious adolescent. There’s a lot going on in that rebellion. What I think is really important in the rebellious adolescent is they’re starting to feel mixed feelings. Adolescence is the developmental stage where we begin to feel mixed feelings. Another mixed feeling for an adolescent I want to drink beer with my buddies because it’ll be fun and at the same time my parents don’t want me to drink beer, they don’t want me to to use drugs so those mixed feelings so the strategies of motivational interviewing are really geared toward us as caregivers having conversations with our adolescent about their mixed feelings or ambivalence. Ambivalence is having mixed feelings. We’re going to have these conversations and use strategies to help our adolescents resolve their ambivalence. to resolve the mixed feelings hopefully in a direction of healthy choices, hopefully in a direction of more pro-social choices. 

So the title of the conversation is I want to understand. If it’s you and your spouse, if they’re multiple caregivers simply call we want to understand. The goals of this conversation are to understand, accept and support. Understanding. Seeking to understand. Remember we’ve had the conversations where we’ve been the authority now we’re having the conversation where I want to support you in making different decisions moving forward. I want to understand what you’re thinking and feeling from the situation you just got in trouble for. It’s expressing empathy. I want to feel what my adolescent is feeling. I want to experience what they’re experiencing. That’s the understanding part. The acceptance is just that: to accept the thoughts and feelings of my adolescent child, to not judge them. We’ve already judged their behavior with consequences now during this conversation. I’m going to accept the thoughts and feelings they share with me because I want to understand where they’re coming from. And lastly, to support them in moving forward. They’re going to be tempted down the road to engage in the same behavior. How can we support them? Part of the conversation is how can you make different decisions moving forward and how can I as a parent, as a caregiver support you? So those are the three goals of the ‘I want to understand/we want to understand’ conversation: to understand, to accept, and support.

So with those goals of the conversation in mind, here are the tasks. There are two tasks: discuss the mixed feelings about the situation the behavior they engaged in and discuss change. Discuss the mixed feelings and discuss change. Techniques and strategies: I’m going to boil it down to just two techniques and strategies that I’d like you to consider. Open-ended questions: open-ended questions facilitate the conversation, open-ended questions hopefully get your adolescent child talking to you, open-ended questions are ‘what’ questions, are ‘how’ questions, even ‘why’ questions. Open-ended questions. The other technique and strategy is reflection. Reflection is where you state back to your adolescent child what you think and feel they’re saying. Your child will share a thought or feeling with you and you reflect it back to them using your own words, your own understanding, your own sense of where your child is coming from and the structure of the conversation is to question and reflect. Question and reflect. It’s really that simple. It’s a simple powerful conversation where we’re discussing mixed feelings, we’re discussing change through open-ended questions and reflection, so what I’d like to do now is go through an example of such a conversation. 

So I’m about to go through a hypothetical conversation of an ‘I want to understand’ conversation with an adolescent named Chris who got in trouble drinking. 

Chris, let’s talk for a few minutes. I want to understand your thinking about drinking beer with your friends and what happened. Chris, you’re not in more trouble. We’ve already talked about being grounded. That conversation is over. For this conversation I just want to really understand what you were thinking, feeling, what it was like for you. So here’s my question Chris, what did you like about it? What did you, what were the good things about the drinking? 

Chris might say I like the way I felt. I felt carefree. 

So Chris you liked how the beer took away the pressure and the stress that you were under. Chris for you the beer helped you blow off some steam. What did you not like about the drinking? What were the not-so-good things about the experience? 

Chris may say, well getting caught and getting grounded sucks. 

Sure, the negative consequences of poor decisions is never fun. What else didn’t you like about it? What else was the downside of the situation or the drinking. 

Chris might say something like I felt embarrassed puking in front of all my friends, I felt like I disappointed myself, and I really felt embarrassed when I had to call you to come pick me up. 

So Chris it looks like you have some mixed feelings about drinking. On the one hand you’d liked how the beer helps you relax, have a good time, to blow off some steam, and on the other hand you didn’t like getting in trouble, you didn’t like throwing up, you didn’t like disappointing me and being embarrassed in front of all of your friends. So you have some mixed feelings about drinking and how it and how it helps you relax, how it fits into your life. So Cris I certainly understand where you’re coming from. When I was your age I had similar experiences where I got in trouble with drinking and felt embarrassed and was grounded. I also understand you know you feel a need to be, to feel carefree, to blow off some steam, to let some stress out, so Chris how about you and I brainstorm some new activities or hobbies that could help you feel carefree to help you blow off some steam maybe some activities we can do together. 

Hopefully Chris will say something like that sounds good.

So as you can see that conversation had a structure of me asking a question, Chris would give a response, I would reflect it, ask another question and continue on with the conversation. You can see how it played out from seeking to understand. I would ask Chris about the good things about the drinking. I’d also ask him about the not so good things about drinking. That’s key to discussing ambivalence or discussing mixed feelings: what were the good things about the drinking, the not-so-good things and you can apply that to any behavior or any poor choices your child makes. Having sex, breaking curfew, poor grades. What are the good things about not doing your homework? What were the not-so-good things? It’s the same conversation exploring the ambivalence, having your child talk about what they liked about the behavior even though it got them in trouble and having them talk about what they didn’t like about the behavior. It allows them to verbalize, to share with you their ambivalence, their mixed feelings and as they’re sharing their ambivalence or mixed feelings, our job as supportive listeners is just to listen and reflect that. To accept it, to not judge it. 

So in that conversation you saw and heard where I was using reflections, where I was reflecting Chris’s mixed feelings and again those mixed feelings, that ambivalence is a key aspect of adolescents particularly as they’re trying to deal with peer pressure and other temptations for unhealthy choices and other poor choices. There are many ambivalences that you can discuss with your child, one of them being substance use and for the purpose of this project we’re talking about opioid/prescription drug abuse. If there are prescription drugs in your house and your son or daughter take some or they get in trouble with them in some form or fashion, this is a conversation you can have with them about the use of opioids. The same thing applies to ambivalence. What were the good things about taking the pills? Your child may say it felt great, I didn’t feel any pain, I felt the happiest I’ve ever been, and then we follow up that question in reflection with: what is the downside? What did you not like about it? I started throwing up after about 30 minutes, I got in trouble at school, I got kicked off the my sports team, I got in trouble at home, I got grounded. So it applies to really any risky behavior or any challenging behavior your adolescent youth is confronted with: opioids, other substances, drinking like Chris was challenged with, poor grades, doing homework, meeting the expectations that we have set as a family we can have a conversation around.

You probably also notice that I shared a little personal experience. These conversations are good opportunities to do that because we’ve all been adolescents, we’ve all had our rebellious nature to some extent or another, so it’s a good time to let our children know that when I was your age, I felt the same way. I had mixed feelings, I wanted to do these things that my friends were doing, and at the same time I knew it wasn’t a healthy thing to do and that’s a tough place to be. For us as caregivers to share that feeling with our adolescent youth really helps increase the bond 

So the final goal of the conversation that you saw was discussing change. I asked Chris about different activities, different hobbies that that he may engage in that doesn’t require drinking, to where he can blow off steam get rid of some stress without getting in trouble. So again seeking to understand, talking about the mixed feelings that our adolescent youth have, accepting those mixed feelings as normal, as something we went through ourselves when we were their age, and then discussing ways they can make different decisions moving forward. It’s a simple conversation. I want to understand where you’re coming from, I accept where you’re coming from, and how can I help you change? 

So thanks for watching this webinar on motivational interviewing. As always with our webinars there will be some links at the end for you to click on and get some more resources on these conversation strategies. Thank you.