When Teens Talk Back

Sara P Boy Photos

A big thanks to Rick McLeod for inventing this title for a class he taught many years ago at Families First in Missoula.

For tips on how parents can handle it when teens talk back, listen to the latest episode of the Practically Perfect Parenting Podcast. You can catch it on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or Libsyn: http://practicallyperfectparenting.libsyn.com/

Here’s the blurb for When Teens Talk Back:

In this episode, Dr. Sara decides to consult with Dr. John about her hypothetical “friend’s” teenage and pre-teen boys, who coincidently, happen to be the same ages as Sara’s own children. Other than being a disastrously bad consultant, John ends up complaining about how disrespectful our culture is toward teens. This leads Sara and John to affirm that, instead of lowering the expectation bar for teens, we should re-focus on what’s great about teenage brains. Overall, this turns out to be a celebration of all the great things about teenagers . . . along with a set of guidelines to help parents be positive and firm. Specific techniques discussed include limit-setting, do-overs, methods for helping teenagers calm down, role modeling, and natural, but small consequences.

If you want more info on this topic, check out the re-post below, originally posted on psychotherapy.net

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric dismiss and disrespect teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Stephen Colbert once quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would rather not be treated.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations for teenagers are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

Revisiting the 3-Step Emotional Change Trick — Including a Video Example

One of my current students asked where she might find a video example of the 3-Step Emotional Change Trick. Since I made up the Emotional Change Trick in 1997, the answer was easy: No such video exists.

Then I remembered that this past summer, while putting together video content with Wiley for our Clinical Interviewing text, I did a video demo of the 3-Step ETC with a 12-year-old girl. Due to space considerations, the footage didn’t make it into the text, but Wiley sent me a copy of the 6:44 minute clip.

Keep in mind that the girl in this video is exceptional. She’s the daughter of some friends and she agreed to be filmed for educational purposes. My sense is that she could have taught me the 3-Step ECT, but I tried to make it look like I was teaching her anyway.

Here’s the youtube link: https://www.youtube.com/watch?v=ITWhMYANC5c

And below you can read a version of the Emotional Change Technique adapted from Tough Kids, Cool Counseling:

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The Three-Step, Push-Button Emotional Change Technique

            An early and prominent Adlerian therapist, Harold Mosak, originally developed and tested the push-button technique as a method for demonstrating to clients that thinking different thoughts can effectively change mood states (Mosak, 1985). The purpose of Mosak’s technique was to help clients experience an increased sense of control over their emotions, thereby facilitating a sense of encouragement or empowerment (Mosak, 2000, personal communication).

            Mosak’s push-button technique can be easily adapted to work with young clients. When we implement this technique with younger clients, we are playful and call it an emotional change trick. When using this technique with teenagers, we describe it as a strategy for gaining more personal control over less desirable emotions. In essence, the three-step, push-button, emotional change technique is an emotional education technique; the primary goal is to teach clients that, rather than being at the mercy of their feelings, they may learn some strategies and techniques that provide them with increased personal control over their feelings.

The following example illustrates Adlerian emotional education principles and Mosak’s push-button technique expanded to three distinct steps.

Case example.  Sam, a 13-year-old European American boy, was referred because of his tendency to become suddenly stubborn, rigid, and disagreeable when interacting with authority figures. Sam arrived for his appointment accompanied by his mother. It quickly became obvious that Sam and his mother were in conflict. Sam was sullen, antagonistic, and difficult to talk with for several minutes at the outset of the session. Consequently, the Three-Step, Push-Button Emotional Change Technique (TSPB) was initiated:

Preparation/Explanation.

JSF:     I see you’re in a bad mood today. I have this . . . well, it’s kind of a magic trick and I             thought maybe you’d be interested. Want to hear about it?

S:         (Shrugs).

JSF:     It’s a trick that helps people get themselves out of a bad mood if they want to. First, I need to tell you what I know about bad moods. Bad moods are weird because even             though they don’t really feel good, lots of times people don’t want to get out of their bad mood and into a better mood. Do you know what I mean? It’s like you kind of want to stay in a bad mood; you don’t want anybody forcing you to change out of a bad mood.

S:         (Nods in agreement.)

JSF:     And you know what, I’ve noticed when I’m in a bad mood, I really hate it when someone comes up to me and says: “Cheer up!” or “Smile!”

S:         Yeah, I hate that too.

JSF:     And so you can be sure I’m not going to say that to you. In fact, sometimes the best thing to do is just really be in that bad mood—be those bad feelings. Sometimes it feels great to get right into the middle of those feelings and be them.

S:       Uh, I’m not sure what you’re talking about.

JSF:     Well, to get in control of your own feelings, it’s important to admit they’re there, to get to   know them better. So, the first step of this emotional change trick is to express your bad feelings. See, by getting them out and expressing them, you’re in control. If you don’t  express your feelings, especially icky ones, you could get stuck in a bad mood even    longer than you want.

As you can see, preparation for the TSPB technique involves emotional validation of how it feels to be in a bad mood, information about bad moods and how people can resist changing their moods or even get stuck in them, hopeful information about how people can learn to change their moods, and more emotional validation about how it feels when people prematurely try to cheer someone up.

Step 1: Feel the feeling. Before moving clients away from their negative feelings, it’s appropriate—out of respect for the presence and meaning of emotions—to help them feel their feelings. This can be challenging because most young people have only very simplistic ideas about how to express negative feelings. Consequently, Step 1 of the TSPB technique involves helping youth identify various emotional expression techniques and then helping them to try these out. We recommend brainstorming with young clients about specific methods for expressing feelings. The client and counselor should work together (perhaps with a chalk/grease board or large drawing pad), generating a list of expressive strategies that might include:

  • scribbling on a note pad with a black marker
  • drawing an angry, ugly picture
  • punching or kicking a large pillow
  • jumping up and down really hard
  • writing a nasty note to someone (but not delivering it)
  • grimacing and making various angry faces into a mirror
  • using words, perhaps even yelling if appropriate, to express specific feelings.

The expressive procedures listed above are easier for young clients to learn and understand when counselors actively model affective expression or assist clients in their affective expression. It’s especially important to model emotional expression when clients are inhibited or unsure about how to express themselves. Again, we recommend engaging in affective expression jointly with clients. We’ve had particular success making facial grimaces into a mirror. (Young clients often become entertained when engaging in this task with their counselor.) The optimal time for shifting to Step 2 in the TSPB technique is when clients have just begun to show a slight change in affect. (Often this occurs as a result of the counselor joining the client in expressing anger or sadness or general nastiness.)

Note: If a young client is unresponsive to Step 1 of the TSPB technique, don’t move to Step 2. Instead, an alternative mood-changing strategy should be considered (e.g., perhaps food and mood or the personal note). Be careful to simply reflect what you see. “Seems like you aren’t feeling like expressing those yucky feelings right now. Hey, that’s okay. I can show you this trick some other day. Want some gum?”

Step 2: Think a new thought (or engage in a new behavior). This step focuses on Mosak’s push-button approach (Mosak, 1985). It’s designed to demonstrate to the client that emotions are linked to thoughts. Step 2 is illustrated in the following dialogue (an extension of the previous case example with John and Sam):

JSF:     Did you know you can change your mood just by thinking different thoughts? When you think certain things it’s like pushing a button in your brain and the     things you think start making you feel certain ways. Let’s try it. Tell me the funniest thing that happened to you this week.

S:         Yesterday in math, my friend Todd farted (client smiles and laughs).

JSF:     (Smiles and laughs back) Really! I bet people really laughed. In fact, I can see it makes you laugh just thinking about it. Way back when I was in school I had a friend who did that all the time.

The content of what young people consider funny may not seem particularly funny to adults. Nonetheless, it’s crucial to be interested and entertained—welcoming the challenge to empathically see the situation from the 13-year-old perspective. It’s also important to stay with and build on the mood shift, asking for additional humorous thoughts, favorite jokes, or recent events. With clients who respond well, counselors can pursue further experimentation with various affective states (e.g., “Tell me about a sad [or scary, or surprising] experience”).

In some cases, young clients may be unable to generate a funny story or a funny memory. This may be an indicator of depression, as depressed clients often report greater difficulty recalling positive or happy events (Weerasekera, Linder, Greenberg, & Watson, 2001). Consequently, it may be necessary for the counselor to generate a funny statement.

S:         I can’t think of anything funny.

JSF:     Really? Well, keep trying . . . I’ll try too (therapist and client sit together in silence for about 20 seconds, trying to come up with a positive thought or memory).

JSF:     Got anything yet?

S:         Nope.

JSF:     Okay, I think I’ve got one. Actually, this is a joke.  What do you call it when 100 rabbits standing in a row all take one step backwards?

S:         Huh?

JSF:     (repeats the question)

S:         I don’t know.  I hate rabbits.

JSF:     Yeah.  Well, you call it a receding hare line.  Get it?

S:         Like rabbits are called hares?

JSF:     Yup.  It’s mostly funny to old guys like me.  (JSF holds up his own “hare line”)

S:         That’s totally stupid, man (smiling despite himself). I’m gonna get a buzz cut pretty             soon.

When you tell a joke or a funny story, it can help clients reciprocate with their own stories.  You can also use teasing riddles, puns, and word games if you’re comfortable with them.

We have two additional comments for counselors who might choose to use a teasing riddle which the client may get wrong. First, you should use teasing riddles only when a strong therapeutic relationship is established; otherwise, your client may interpret teasing negatively. Second, because preteen and teen clients often love to tease, you must be prepared to be teased back (i.e., young clients may generate a teasing riddle in response to a your teasing riddle).

Finally, counselors need to be sensitive to young clients who are unable to generate a positive thought or story, even after having heard an example or two. If a young client is unable to generate a funny thought, it’s important for you to remain positive and encouraging. For example:

JSF:     You know what. There are some days when I can’t think of any funny stories either. I’m sure you’ll be able to tell me something funny next time. Today I was able to think of some funny stuff . . . next time we can both give it a try again if you want.

Occasionally, young clients won’t be able to generate alternative thoughts or they won’t understand how the pushbutton technique works. In such cases, the counselor can focus more explicitly on changing mood through changing behaviors. This involves getting out a sheet of paper and mutually generating a list of actions that the client can take—when he or she feels like it—to improve mood.

Sometimes depressed young clients will need to borrow from your positive thoughts, affect, and ideas because they aren’t able to generate their own positive thoughts and feelings. If so, the TSPB technique should be discontinued for that particular session. The process of TSPB requires completion of each step before continuing on to the next step.

Step 3: Spread the good mood. Step 3 of this procedure involves teaching about the contagion quality of mood states. Teaching clients about contagious moods accomplishes two goals. First, it provides them with further general education about their emotional life. Second, if they complete the assignment associated with this activity, they may be able to have a positive effect on another person’s mood:

JSF:     I want to tell you another interesting thing about moods. They’re contagious. Do you  know what contagious means? It means that you can catch them from being around other  people who are in bad moods or good moods. Like when you got here. I noticed your  mom was in a pretty bad mood too. It made me wonder, did you catch the bad mood from    her or did she catch it from you? Anyway, now you seem to be in a much better mood. And so I was wondering, do you think you can make your mom “catch” your good mood?

S:         Oh yeah. I know my mom pretty well. All I have to do is tell her I love her and she’ll get all mushy and stuff.

JSF:     So, do you love her?

S:         Yeah, I guess so. She really bugs me sometimes though, you know what I mean?

JSF:     I think so. Sometimes it’s especially easy for people who love each other to bug each other. And parents can be especially good at bugging their kids. Not on purpose, but they bug you anyway.

S:         You can say that again. She’s a total bugging expert.

JSF:     But you did say you love her, right?

S:         Yeah.

JSF:     So if you told her “I love you, Mom,” it would be the truth, right?

S:         Yeah.

JSF:     And you think that would put her in a better mood too, right?

S:         No duh, man. She’d love it.

JSF:     So, now that you’re in a better mood, maybe you should just tell her you love her and spread the good mood. You could even tell her something like: “Dude, Mom, you really   bug me sometimes, but I love you.”

S:         Okay. I could do that.

It’s obvious that Sam knows at least one way to have a positive influence on his mother’s mood, but he’s reluctant to use the “I love you” approach. In this situation it would be useful for Sam to explore alternative methods for having a positive effect on his mother’s mood.

Although some observers of this therapy interaction may think the counselor is just teaching Sam emotional manipulation techniques, we believe that viewpoint makes a strong negative assumption about Sam and his family. Our position is that successful families (and successful marriages) include liberal doses of positive interaction (Gottman et al., 1995). Consequently, unless we believe Sam is an exceptionally manipulative boy (i.e., he has a conduct disorder diagnosis), we feel fine about reminding him of ways to share positive (and truthful) feelings with his mother.

To spread a good mood requires a certain amount of empathic perspective taking. Often, youth are more able to generate empathic responses and to initiate positive interactions with their parents (or siblings, teachers, etc.) after they’ve achieved an improved mood state and a concomitant increased sense of self-control. This is consistent with social–psychological literature suggesting that positive moods increase the likelihood of prosocial or altruistic behavior (Isen, 1987). Because of developmental issues associated with being young, it’s sometimes helpful to introduce the idea of changing other people’s moods as a challenge (Church, 1994).  “I wonder if you have the idea down well enough to actually try and change your mom’s mood.”

Once in a while, when using this technique, we’ve had the pleasure of witnessing some very surprised parents. One 12-year-old girl asked to go out in the waiting room to tell her grandmother that she was going to rake the lawn when they got home (something Grandma very much wanted and needed). Grandma looked positively stunned for minute, but then a huge smile spread across her face. The girl skipped around the office saying, “See.  I can do it.  I can change her mood.”

One 14-year-old boy thought a few minutes, then brought his mom into the office and said “Now Mom, I want you to think of how you would feel if I agree to clear the table and wash the dishes without you reminding me for a week.” Mom looked a bit surprised, but admitted she felt good at the thought, whereupon I (John) gave the boy a thumbs up signal and said, “Well done.”

Step 4.

At this point, readers should beware that although we’re describing a Three-Step technique, we’ve now moved to Step 4. We do this intentionally with young clients to make the point that whenever we’re working with or talking about emotions, surprising things can happen.

In keeping with the learn-do-teach model, we ask our young clients to teach the TSPB procedure to another person after they learn it in therapy. One girl successfully taught her younger brother the method when he was in a negative mood during a family hike. By teaching the technique to her brother, she achieved an especially empowering experience; she began to view herself as having increased control over her and her family’s emotional states.

Do You Want to Participate in The March Madness Research Project?

Madness 2017

If your answer is yes . . . here’s what you should do and what will happen:

  1. Email: ummadness2017@gmail.com and say “Yes, I’m in”
  2. You will be randomly assigned to one of three “March Madness Bracket Training” groups:
    • Relaxation and focusing
    • Hypnosis to view the games from the future
    • Educational information
  3. You will receive an email telling you where to meet. All groups will meet on campus at the University of Montana in a specific room in the Phyllis J. Washington College of Education building at 7pm on Tuesday evening, March 14.
  4. Show up at your designated room. When you arrive, you will fill out an informed consent form, a March Madness bracket, and complete a short questionnaire.
  5. Then you will participate in the training.
  6. After the training, you will complete another bracket
  7. You will leave your completed packet and your brackets with the researcher and it will be uploaded in to the ESPN Tournament Challenge website [we will need your email address to upload your selections into the ESPN system]
  8. You will receive information at the “Training” on how to login and track your bracket. If you lose or misplace this information, you can request an additional copy via email: ummadness2017@gmail.com

To sign up for this research project, email:

UMmadness2017@gmail.com

Let’s Do the Sex Talk Again

Rita Reading

Now, more than ever, we need to actively teach children about healthy and safe sexual behaviors. Why now?

First, pornography (which is arguably NOT the best sex education source for our children) is extremely easy to access.

Second, a former reality show star who was recently elected President has made statements that are likely to reinforce archaic ideas about female bodies being grabbed and groped and objectified–all in the interest of male pleasure. Personally, I’m against that message and hope you are too.

Third, parents have an important role in protecting their children from the range of different sexually transmitted diseases are associated with unprotected sex.

Fourth, well . . . why would anyone not want to actively teach children about healthy and safe sexual behaviors?

In the 10th episode of the Practically Perfect Parenting Podcast (PPPP), Dr. Sara Polanchek and I discuss why and how parents and caregivers should “. . . do the sex talk again and again.” Given the ubiquity of sex in the media, parents can’t afford to ignore this important topic. No longer is it good enough for parents or caregivers to toss an old sex education book into their child’s room and then hope that healthy sexual learning will magically occur.

Parents need to be brave. Parents need to face their own sexual issues and hang-ups. To get started, parents might want to listen to our latest PPPP episode titled: “Let’s do the sex talk again.”

Here’s the link to iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Here’s the link to Lisbyn: http://practicallyperfectparenting.libsyn.com/

Please forward this post and these links to parents or guardians or grandparents who you think might benefit. Feel free to ask questions and engage in discussion. Our podcast offers ideas about how to get more comfortable with this exceptionally important topic. Listening to it is a reasonably good way to spend 28 minutes of your life.

Dear National Review: I’ll help you get government out of parenting if you’ll stop letting bad journalists write articles.

Naked Babies II

A little over two months ago I got all worked up over an article on parenting published in the National Review that I thought was a little too “pro-child abuse” for my taste. I sent them a query about publishing it right away. Their editor responded a couple weeks later, asking to read the piece. Then he politely declined it, noting it was a bit stale (meaning too much time had passed). Of course, it got stale because he sat on it for two weeks. But I figure he didn’t want to publish it anyway, since I basically accused his writer of writing fake news and supporting child abuse.

So . . . I decided to send it to myself. And, after sitting on it for another six weeks, I’m publishing it because it’s crunchy like a piece of old stale bread.

Setting the Record Straight on Government

Interference in Parental Rights

John Sommers-Flanagan, Ph.D.

Abby Schachter’s National Review article (12/26/16) titled, “Why is the government telling us how to raise our kids?” is troubling on many levels.

To start, Ms. Schachter’s headline is inaccurate and misleading. The National Review deserves better than that. In reality, the government isn’t trying to tell parents how to raise their children. An accurate headline would have read, “Why is the government telling us how NOT to raise our kids?”

This is still an important question and begs for a clarification between laws that mandate behavior (e.g., seat belts and registration under the Affordable Care Act) and laws that prohibit behavior (e.g., driving while intoxicated and physical or sexual abuse of minor children). Laws that protect children from abuse are laws that prohibit particular (and unusual) parenting behaviors; they don’t mandate specific parenting behaviors. As is well known, laws mandating specific behaviors—whether within the realm of parenting or focusing on other citizen behaviors—are aligned with tyrannical governments. However, government policies that Schachter mocks in her article are legal efforts designed to protect children from parental abuse and neglect. Is it possible for the government to over-reach in that area? Absolutely yes! But Schachter’s complaints of “bureaucratic busybodies” miss the point and put children at further risk.

Schachter’s complaints about rampant government meddling with good-enough parenting represent a narrow perspective. The historical and current prevalence of child abuse and neglect is stunning. Even the usually stoic Sigmund Freud was shaken after viewing abused children’s bodies at the Paris Morgue in 1885. Child abuse is ugly and disturbing and children need protection. Schachter’s defense of parental rights at the risk of overlooking neglect and abuse implies that she hasn’t seen or appreciated the extent of child abuse in America. Her rhetoric could be interpreted as suggesting that child abuse and neglect should be legal variants of parental rights. I’m sure that’s not her intent.

There’s also a mathematical component to Schachter’s misunderstanding. Government laws prohibiting parental abuse and neglect are a best effort at predicting and therefore reducing child abuse. Schachter’s complaints stem from real cases, but her personal interpretation of the problems reflects no understanding of math and the Bayesian Theorem. To take her position, Schachter must assume the base rates of child abuse and neglect are extremely low, so low that parents and children might be better served if child abuse laws were eliminated. But the facts belie this perspective. According to the Children’s Defense Fund, over 1,800 incidents of child abuse occur every day in the U.S. Even assuming this is an overestimation and the real rates are 20% lower, this still translates to 1,440 abuse incidents daily or 60 per hour or 1 per minute. Let’s assume that Schachter is correct and some laws are an overreach and result in false positive identification of parents as abusive or neglectful. How many times do you suppose false government accusations occur per hour in the U.S.? Do we have 60 parents falsely accused of child abuse per hour? Not even close. But if we embrace Schachter’s position, we protect parental rights and risk a massive increase in unreported child abuse and neglect.

For my money, I’d rather have a few parents deal with the emotional pain of government hassles than to have children deal with the pain of parental neglect or physical and sexual abuse. Over four children a day die from parental maltreatment. I’m betting Schachter can’t find four cases a week like the one she covered in her article.

In the end, I agree with Schachter that government interference in good-enough parenting is wrong. But I also know that in the time it took you to read this article at least five more children in the U.S. experienced abuse or neglect. Parental rights shouldn’t be needlessly usurped. However, in this case, I’m siding with thousands of abused and neglected children over the rights of a relatively small number of parents.

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John Sommers-Flanagan is a clinical psychologist and professor of counselor education at the University of Montana. He’s the author of eight books, including How to Listen so Parents will Talk and Talk so Parents will Listen (John Wiley & Sons).

A Brief Description of Motivational Interviewing

In response to some questions on CESNET, I’m posting a brief description of Motivational Interviewing. Of course, Miller and Rollnick’s Motivational Interviewing text is a much more thorough source and is highly recommended if you want more complete information.

This description is an excerpt from the second edition of our Counseling and Psychotherapy Theories textbook. If you’re interested, you can check it out here: http://bcs.wiley.com/he-bcs/Books?action=index&itemId=0470617934&bcsId=7103

For the third edition (in preparation now), we’ll be substantially expanding this section and so if you have insights, publications, or other information that you think we should be aware of, please email me at john.sf@mso.umt.edu.

Here’s the excerpt:

Motivational Interviewing: A Contemporary PCT Approach

Person-Centered Therapy (PCT) principles have been integrated into most other approaches to counseling and psychotherapy. However, there are three specific approaches that are explicitly new generation person-centered therapies. These include:

  1. Motivational interviewing
  2. Emotion-focused therapy
  3. Nondirective play therapy

Next, we discuss motivational interviewing. Due to its strong integrational characteristics, emotion-focused therapy is covered in Chapter 14. Additional resources are available on nondirective play therapy (Landreth, 2002).

Moving Away From Confrontation and Education

In his research with problem drinkers, William R. Miller was studying the efficacy of behavioral self-control techniques. To his surprise, he found that structured behavioral treatments were no more effective than an encouragement-based control group. When he explored the data for an explanation, he found that regardless of treatment protocol, therapist empathy ratings were the strongest predictors of positive outcomes at 6 months (r = .82), 12 months (r = .71), and 2 years (r = .51; W. R. Miller, 1978; W. R. Miller & Taylor, 1980). Consequently, he concluded that positive treatment outcomes with problem drinkers were less related to behavioral treatment and more related to reflective listening and empathy. He also found that active confrontation and education generally led to client resistance. These discoveries led him to develop motivational interviewing (MI).

MI builds on person-centered principles by adding more focused therapeutic targets and specific client goals. Rollnick and Miller (1995) define MI as “a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence” (p. 326).

Focusing on Client Ambivalence

Client ambivalence is the primary target of MI. When it comes to substance abuse and other health related behaviors, Miller and Rollnick (2002) view ambivalence as natural. Most all problem drinkers recognize or wish they could quit, but continue drinking for various reasons. Miller and Rollnick described what happens when therapists try to push healthy behaviors on clients:

[The therapist] then proceeds to advise, teach, persuade, counsel or argue for this particular resolution to [the client’s] ambivalence. One does not need a doctorate in psychology to anticipate what [the client’s] response is likely to be in this situation. By virtue of ambivalence, [the client] is apt to argue the opposite, or at least point out problems and shortcomings of the proposed solution. It is natural for [the client] to do so, because [he or she] feels at least two ways about this or almost any prescribed solution. It is the very nature of ambivalence. (pp. 20–21)

In many situations, humans are naturally inclined to resist authority. Therefore, when resistance rises up in clients, MI advocates person-centered attitudes and interventions. This leads to Miller and Rollnick’s (2002) foundational person-centered principle of treatment:

It is the client who should be voicing the arguments for change (p. 22).

Although Miller and Rollnick describe Rogers as collaborative, caring, and supportive—they emphasize that he was not nondirective (W. R. Miller & Rollnick, 1998). Instead, they note that Rogers gently guided clients to places where they were most confused, in pain, or agitated and then helped them stay in that place and work through it. The four central principles of MI flow from their conceptualization of Rogers’s approach (W. R. Miller & Rollnick, 2002). According to these principles, it’s the therapist’s job to:

  • Use reflective listening skills to express empathy for the client’s message and genuine caring for the client.
  • Notice and develop the theme of discrepancy between the client’s deep values and current behavior.
  • Meet client resistance with reflection rather than confrontation (Miller and Rollnick refer to this as “rolling with resistance”).
  • Enhance client self-efficacy by focusing on optimism, confidence that change is possible, and small interventions that are likely to be successful.

MI is both a set of techniques and a person-centered philosophy or style. The philosophical MI perspective emphasizes that motivation for change is not something therapists can effectively impose on clients. Change must be drawn out from clients, gently and with careful timing. Motivational interviewers do not use direct persuasion.

A Sampling of MI Techniques

Miller and Rollnick (2002) provide many excellent examples of how reflection responses reduce resistance. The following interactions capture how reflection of client efforts lessens the need for resistance:

Client: I’m trying! If my probation officer would just get off my back, I could focus on getting my life in order.

Interviewer: You’re working hard on the changes you need to make.

or

Interviewer: It’s frustrating to have a probation officer looking over your shoulder.

Client: Who are you to be giving me advice? What do you know about drugs? You’ve probably never even smoked a joint!

Interviewer: It’s hard to imagine how I could possibly understand.

Client: I couldn’t keep the weight off even if I lost it.

Interviewer: You can’t see any way that would work for you.

or

Interviewer: You’re rather discouraged about trying again. (pp. 100–101)

In the following excerpt from Clinical Interviewing (2009), we describe the MI technique of amplified reflection:

Recently, in hundreds of brief interviews conducted by graduate students in psychology and counseling with client—volunteers from introductory psychology courses, consistent with Miller and Rollnick’s (2002) motivational interviewing work, we found that clients have a strong need for their interviewers to accurately hear what they’re saying. When their interviewer made an inaccurate reflection, clients felt compelled to clarify their feelings and beliefs—often in ways that rebalanced their ambivalence.

For example, when an interviewer “went too far” with a reflection, the following exchange was typical:

Client: I am so pissed at my roommate. She won’t pick up her clothes or do the dishes or anything.

Interviewer: You’d sort of like to fire her as a roommate.

Client: No. Not exactly. There are lots of things I like about her, but her messiness really annoys me.

This phenomenon suggests that it might be possible for interviewers to intentionally overstate a client’s position in an effort to get clients to come back around to clarify or articulate the more positive side of an issue. In fact, this is a particular motivational interviewing technique referred to as amplified reflection.

When used intentionally, amplified reflection can seem manipulative, which is why amplified reflection is used along with genuine empathy. Instead of being a manipulative response it can also be viewed as an effort on the interviewer’s part to more deeply empathize with the client’s frustration, anger, discouragement, and so on. Examples of this technique include:

Client: My child has a serious disability and so I have to be home for him.

Interviewer: You really need to be home 24/7 and really need to turn off any needs you have to get out and take a break.

Client: Actually, that’s not totally true. Sometimes, I think I need to take some breaks so I can do a better job when I am home.

Client: When my grandmother died last semester I had to miss classes and it was a total hassle.

Interviewer: You don’t have much of an emotional response to your grandmother’s death—other than it really inconveniencing you.

Client: Well, it’s not like I don’t miss her, too.

Again, we should emphasize that amplified reflection is an empathic effort to get completely in touch with or resonate with one side of the client’s ambivalence (from J. Sommers-Flanagan & Sommers-Flanagan, 2009, pp. 316–317).

End of excerpt

Author, Speaker, University of Montana Professor