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What Keeps
Adolescents
Moving Forward in
Treatment?
Motivational Interviewing
Techniques in Juvenile Drug
Court
Developed by NDRI, Inc.
www.ndri.org
Joe Lunievicz, BA, RYT
Director Training Institute
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Dyads:
What Motivated You?
What was most important
to you:
• When you were 13?
•
When you were 16?
•
When you were 19?
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What Motivates your
participants to move
towards graduation?
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Important Considerations
 Adolescence
 Autonomy
 The
is about identity.
issues are powerful.
adolescent brain is still developing.
 Adolescent
culture and values are different
than adult culture and values.
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Why not just change?
 Keep
in mind the family dynamics
adolescents go home to:
 Do
their parents use?
 Were they born addicted?
 Are they safe?
 Have they witnessed the unimaginable?
 Are there co-occuring mental health issues?
 Are there learning disabilities?
 How early did they start using?
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Motivational Interviewing
A directive, client-centered
counseling style for eliciting behavior
change by helping clients to explore
and resolve ambivalence. It is a style
of helping that uses a set of specific
strategies.
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Motivational Interviewing
(Cont.)
Motivation- or presumed lack of it- is not
viewed as a personality problem or
character trait, but as a state of readiness
for change that can be influenced by a
helping relationship.
Rollnick & Miller, 1995
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MI Basic Principles
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
Expressing Empathy

Developing Discrepancy

Rolling with Resistance

Supporting Self-Efficacy
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Why use MI in Drug Court?
Better
More
Engagement
Information
Better
Assessments
More
Relevant Recommendations
More
Successful Outcomes
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“You
don’t understand.”
“You won’t understand.”
- Anonymous Adolescent
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Seek first to understand,
then to be understood.
-Stephen R. Covey
7 Habits for Highly Effective People
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MI Strategies - OARS
 Open
Ended questions
 Affirm
 Reflection
 Summarize
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Impact of Communication
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Open Ended Questions
Who, what, where, when
Tell
me about…
How
did you…
Redirect: Now
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tell me about…
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Open-ended Examples:
 What
worries you about your current situation?
 What
difficulties have you had with your drug use?
 What
do you think will happen if you don’t change?
 How
has your anger interfered with your life?
 What
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would your life be like 5 years from now?
Practice:
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Open-ended
Questions
Interview your partner by
asking only open ended
questions.
Buzzer sounds whenever a
closed ended question is
asked.
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Affirm (but don’t flatter)
 Strengths
based technique
 Verbally
supports or validates a
participant’s thoughts, emotions, or actions
 Demonstrates: Appreciation,
Understanding, Support
 When
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you see a strength, notice it
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Affirmation Example:
1. Participant arrives on time for his case
management appointment.
“You’re punctual. That will be a big help in this
program.”
2. Participant: “I don’t want to do anything more than
I need to. I just want to finish the program and get on
with my life.”
“Determination is a good characteristic to have in
treatment. It will help to keep you focused.”
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Practice:
Affirming
Read the statement to
your partner and your
partner must respond
with a strength’s based
affirmation.
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Reflective Listening

Rationale
Conveys willingness
to try to understand
 Serves as a
perception check

Clarifies
feelings
Leads to more
exploration
 Demonstrates
empathy

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Common Errors
Not listening
closely
 Limited feeling
vocabulary
 Monotone vocal
qualities
 Premature focus on
problem solving

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Reflection
Expressing Empathy:
“So, what I hear you saying is…”
Reflecting Conflict:
“On the one hand…but on the other hand…”
“So what you’re saying is…but you are not able
to…”
Rolling with resistance:
“You don’t have to do anything you don’t want to.”
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Practice:
1.
2.
3.
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Reflection
Paraphrase
Reflect conflict
Roll with resistance
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Summarizing
The
 Let
set-up statement
me see if I understand correctly…
Reflection, Reflection, Reflection
Open
 What
ended Question
did I miss?
 What other concerns do you have?
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Practice: Summarize
•
Let me see if I
understand correctly…
•
•
Reflection
Reflection
Reflection
•
What did I miss?
•
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Questioning Skills
Effective vs. Ineffective Questions

Ineffective
Too many questions
 Accusatory questions: Why?


Multiple questions

Explanatory questions

Closed questions
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Questioning Skills
Effective vs. Ineffective Questions

Effective
Have specific objectives in mind
State background for question
Use language of the client
Check out whether client is understanding
Ask openly: Who, What, When, Where &
How
Use open-ended questions
Paraphrase; Reflect; Summarize
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Resources: EBPs that Address
Adolescents

Behavior Therapy (BT)

Cognitive-Behavioral Therapy (CBT)

Motivational Interviewing (MI)

Motivational Enhancement Therapy/Cognitive Behavioral
Therapy (MET/CBT

Relapse Prevention Therapy (RPT)

Adolescent Community Reinforcement Approach (A-CRA)

Seeking Safety (SS)
National Registry of Evidence-based Programs and Practices, SAMHSA
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Resources: EBTs that Address
Familial Issues

Multisystemic Therapy (MST)

Addresses COD issues also

Brief Strategic Family Therapy (BSFT)

Functional Family Therapy (FFT)

Family Behavior Therapy (FBT)

Addresses COD issues also
From: Evidence-Based Practice Recommendations for Juvenile Drug Courts by
the National Center for Mental Health and Juvenile Justice in collaboration
with the Louisiana Supreme Court Drug Court Office - 2009
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Resources: EBTs that Address
CODs

Trauma Focused Cognitive Behavioral Therapy (


Motivational Enhancement Treatment (MET, CBTS)


Individual, outpatient modality
Individual and Group sessions
Continuous, Comprehensive, Integrated System of Care
Nodel (CCISC)

A set of practice guidelines for dual diagnosis treatment
From: Evidence-Based Practice Recommendations for Juvenile Drug Courts by
the National Center for Mental Health and Juvenile Justice in collaboration
with the Louisiana Supreme Court Drug Court Office - 2009
Lunievicz/MI/