Motivational Interviewing (MI) is a counseling method that uses collaborative, client-centered, and goal-oriented communication to foster behavioral change in the individual. MI aims to address the key problem of ambivalence toward behavioral change that exists within individuals and encourage an internalization of the desire for change in the client. MI addresses personal motivation through the exploration and identification of the individual’s own reasons and desires for change.
MI has been applied to many different contexts, but is particularly used in the treatment of substance users and the problems related to substance use (e.g., driving under the influence). MI has been used to counsel juveniles in multiple areas, including substance use, smoking, eating disorders, sexual risk taking, managing illness and disability, and behavioral problems.
While MI is adapted to each individual and the specific behavioral problems that individual presents, it is a collaborative effort between the therapist and the individual to identify and forge a path to behavioral change using the latter’s own motivations. MI has several core components that guide this process:
· Engaging to establish a rapport and listening reflectively to understand the ambivalence and issues that the individual is presenting
· Guiding the individual to strategically concentrate on certain aspects of his or her behavior
· Evoking in the individual his or her own motivations for change through selective questions, responses, and summaries
· Planning a behavioral change in the individual and solidifying the individual’s commitment
MI is developed to act on the ambivalence that exists within an individual contemplating a behavioral change. A traditional argument for change by a therapist can be met by the argument for continuation by the individual. MI seeks to foster, encourage, and elicit the desire and motivation for change that already exists within the individual to drive future behavioral changes. MI adopts a client-centric approach, building a program and motivation for change within the individual in collaboration and partnership with the therapist, while respecting the individual’s autonomy in decision-making.
14 to 19
Although both studies reported some positive outcomes and significant findings, the preponderance of evidence showed that the program had no effect in changing the targeted behaviors of juveniles. There were no statistically significant differences on most of the measured outcomes between the treatment and control groups.
Engagement With Treatment
The results of the Stein and colleagues (2006a) study show only one significant result. At the follow-up, the Relaxation Therapy (RT) group showed significantly more negative engagement with substance use therapy than the Motivational Interviewing (MI) group exhibited. While all other outcome measures were favorable to the MI group, these findings did not reach levels of statistical significance. There were no other significant differences between the MI group and the RT group.
Driving Under the Influence (and Passenger)
In the second Stein and colleagues (2006b) study, the driving under the influence (DUI) and being a passenger of a driver under the influence (PUI) outcomes were found to be mediated by depressive symptoms. MI significantly decreased DUI–alcohol for adolescents with low levels of depressive symptoms. However, at high levels of depressive symptoms there were no significant differences between MI and RT. Within the RT group, those with high depressive symptoms had significantly fewer DUI–alcohols. In addition, there were no significant results for MI in reducing DUI–marijuana. Within the RT group, however, those with high depressive symptoms reported significantly lower DUI–marijuana scores. Overall, the RT group had better outcomes for those with high depressive symptoms than the MI group in regards to DUI-alcohol and marijuana.
For adolescents with low depressive symptoms, the MI group reported significantly fewer PUI–alcohol events than the RT group did. There were, however, no significant differences between the two groups with high-depressive-symptom adolescents. Within the RT group, adolescents with high depressive symptoms had significantly lower PUI–alcohol scores than low depressive symptom adolescents. There were no significant differences between interventions in the PUI–marijuana scores. Within the RT group, adolescents with high depressive symptoms did report significantly fewer instances of PUI–marijuana. Overall, for most of the measured outcomes, the MI group was not significantly different from the RT comparison group.