Motivational Enhancement Therapy: an Effective Approach for Counseling Unmotivated Adolescents
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Article 8 Motivational Enhancement Therapy: An Effective Approach for Counseling Unmotivated Adolescents Glenn W. Lambie and Shari Sias Many adolescents whom counselors regularly the counselor pushes to resolve the problem, the worse counsel are ambivalent and unmotivated to behavioral the situation becomes (Lambie, 2004). Not surprisingly, change. Adolescents are frequently sent for services not a confrontational style of counseling tends to produce of their own volition, but rather by a concerned parent/ resistance in adolescents (Miller & Rollnick, 2002) who guardian or other adult. Many of the traditional feel their personal freedom is threatened; therefore, they counseling theories and approaches were developed for become defensive and use defense mechanisms such motivated adults. Additionally, research has indicated as anger, confrontation, and denial, which all may be that when most people begin counseling they are not perceived as resistance. The harder a counselor pushes, ready to take action to change (Isenhart, 1994), although the more energy an adolescent is going to exert to push the majority of counseling models are constructed for back, confirming Newton’s third law of motion: for working with clients who are ready to take action to every force there is an equal and opposite counterforce change (Prochaska, DiClemente, & Norcross, 1992). (Cowen & Presbury, 2000). Thus when adolescents feel Stereotypical descriptions of adolescents, such as that they are choosing to do something for their own being moody, narcissistic, resistant, and challenging, self-interest, their motivation can be intense (Lambie, and having social and interpersonal problems, are 2004). Consequently, counselors should avoid using similar to generalizations of another difficult statements that belittle, label, order, prescribe, lecture, population, clients with substance abuse issues (Lambie, give mixed messages, or takeover the problem (McCoy, 2004). For the latter group, Motivational Enhancement 1995). Therapy (MET) has been found to be an effective counseling approach (Miller, Zweben, DiClemente, & Motivational Enhancement Therapy Rychtarik, 1995). MET is brief in duration and designed for counseling counselees at all levels of motivation MET is a development of the Transtheoretical and readiness to change. MET is particularly useful with Model of Change (TMC) (Prochaska et al., 1992), individuals considered “difficult,” “resistant,” and designed to help counselees build commitment and “unmotivated” (Aubrey, 1998). For these reasons, MET reach behavioral change. Drawing on strategies from appears to be a well-suited counseling approach for client-centered counseling, cognitive therapy, systems adolescents. theory, and the social psychology of persuasion (Miller & Rollnick, 2002), some features of MET are that (a) Counseling Adolescents motivation to change is elicited from the counselee; (b) it is brief in duration; (c) direct persuasion is Adolescents need to be differentiated from adults avoided; (d) the style is generally quiet and eliciting; and young children due to the unique developmental (e) readiness to change is seen as fluctuating in relation transformations they are going through. Additionally, to interpersonal interaction; and (f) the counseling it can be difficult to establish a therapeutic relationship relationship is more like a partnership or with adolescents who have historically questioned companionship than expert/recipient roles (Miller & society’s beliefs and values (Katz, 1997). Adolescents Rollnick, 1995). tend to mistrust counselors and often manifest this reaction crudely, intensely, provocatively, and for Transtheoretical Model of Change prolonged periods. Many adults address adolescents’ “resistance” TMC is different from most theories of with aggressive confrontation, resulting in a power psychotherapy because its focus is on how people struggle and an emotional shouting match. The harder change rather than on defining the problem. This model 37 allows counselors with different theoretical orientations contemplation stage of change (Isenhart, 1994). In these and styles to share a common focus. Based on their stages, the counselor works to reduce resistance by research and the findings of others, Prochaska et al. using nondirective counseling techniques such as asking (1992) proposed that people who change behaviors, open-ended questions, listening reflectively, affirming, whether on their own or with the help of a counselor, and summarizing. As the adolescent moves to the higher tend to go through five stages of change and frequently stages of change (preparation, action, and maintenance), use different processes or methods at various stages. the counselor becomes more directive and behavioral These five stages (as cited in Ingersoll & Wagner, 1997) by assisting the counselee in developing and are as follows: implementing a plan for behavioral change (Miller & Rollnick, 2002). 1. Precontemplation. The counselee does not consider his or her behavior to be a problem Motivational Enhancement Therapy and/or is not currently considering changing his or her behavior. MET has been thoroughly researched in the field 2. Contemplation. The counselee is considering of substance abuse with some research specific to that his or her behavior may be a problem adolescent substance abuse clients. Clients with and is seriously thinking of, or substance abuse issues and adolescents often share the contemplating, changing his or her behavior. stereotypical characteristics of being resistant, 3. Preparation. The counselee has made a challenging, and narcissistic (Lambie, 2004). Therefore, commitment to change a behavior he or she it is postulated that an effective substance abuse considers problematic, and is intending to counseling approach would also be successful with make the change soon. The individual may adolescents. have a specific plan in mind or may simply MET was designed as a standardized four-session have a target date set for change. counselor approach in Project MATCH (Matching 4. Action. The counselee is currently in the Alcohol Treatments to Client Heterogeneity), a clinical process of modifying his or her behavior or trial of patient-treatment matching sponsored by the environment to reduce or eliminate the National Institute of Alcohol Abuse and Alcoholism problem. The individual is considered to be (NIAAA). MET is designed to help people work in the action stage for up to 6 months through their ambivalence about change, primarily following the initial behavior change through the use of active listening and gentle feedback (assuming that he or she maintains the techniques. The MET approach is founded on the change during the period). assumptions that counselees have the capacity and 5. Maintenance. The counselee works to responsibility for change and that it is the counselor’s prevent a return to the problem behavior and task to create conditions that enhance clients’ motivation to stabilize the new behaviors and/or for and commitment to change (Miller et al., 1995). In environment that supports his or her new brief, the goal is to prepare people for change, not way of living. necessarily to push them into changing right away (Ingersoll & Wagner, 1997). MET seeks to support Change is difficult, and most people do not intrinsic motivation for change, which leads the successfully maintain behavior change on their first counselee to initiate, persist in, and comply with attempt. TMC offers a spiral pattern of the stages of behavior change efforts. change (linear progression toward change is possible, Miller and Rollnick (2002) listed six basic but rare) in which people can progress from motivational principles underlying the MET contemplation to preparation to action, but most people approach: (1) expression of empathy—the counselor will lapse to an earlier stage (Prochaska, 1995). communicates respect for the counselee and listens Furthermore, TMC is based on the belief that people rather than tells; (2) assisting the counselee in perceiving learn from the lapse and can try something different discrepancy—the counselor uses motivational the next time to avoid the same mistakes (Prochaska et psychology principles to help the counselee perceive a al., 1992). discrepancy between where he or she is and where he TMC can guide the counselor to more successful or she wants to be; (3) avoiding argumentation because outcomes by matching counseling processes to the it is seen to evoke resistance, which is a counselee’s counselee’s individual level of readiness to change reaction to a threatening interpersonal interaction and (Ingersoll & Wagner, 1997). Most counselees beginning resistance is a counselor’s issue; (4) rolling with a counseling relationship are in precontemplation or resistance—the counselor does not meet resistance head 38 on, but rather rolls with the momentum, with a goal of 3. Shifting focus. Here the counselor refocuses shifting counselee perceptions in the process; (5) the counselee’s attention away from what ambivalence is viewed as normal and openly seems to be a barrier blocking progress. This discussed—the counselor elicits solutions from the approach moves the adolescent away from counselee; and (6) support of self-efficacy—the a topic where he or she is entrenched to an counselor works to enhance the counselee’s sense of area where he or she may feel more self-efficacy, or ability to achieve goals. People only comfortable and less defensive. move toward change when they perceive that there is