1. Incorporating Parents Into the Recovery Process With Adolescents
JG Regnier, LADAC
(501)

2. How many helpers does it take to change a light bulb?
A Helping Truism
How many helpers does it take to change a light bulb?
Just one, but the light bulb has to want to be changed.

3. “I am not a drop off service”
It became a standard part of the “orientation” to explain how important it is for them to be involved in any recommendations or plans, etc.
Since my early days as an adolescent counselor with ACH it has seemed to be the tendency for many parents to want to come in and once they get the initial paperwork done to “drop their kid off” for me, for us to fix them.
“I am not a drop off service”

4. The parent that says , “I do not know what to do. Help me.”
These parents are literally looking for help. The parenting skills they know or learned along the way aren’t working. They are wanting to change things.

5. Why is Parental Involvement So Important ?
For one research shows the two most important risk protective and risk reduction factors for teens are their education and parental involvement.
The care coordinator or therapist can develop the plan but the primary caregiver has to carry it out.
With the proper signed releases the check-ins between service provider and the parents can be very helpful to gather information about treatment progress.
It is also an opportunity to educate and possibly a chance to refer the parent to their own counselor, group, etc.
Why is Parental Involvement So Important ?

6. Types of Parenting Approaches
1. Authoritarian
2. Permissive
3. Uninvolved
4. Authoritative

7. Authoritarian Parenting
Authoritarian parents are often thought of as disciplinarians.
They use a strict discipline style with little negotiation possible. Punishment is common.
Communication is mostly one way: from parent to child. Rules usually are not explained.
Parents with this style are typically less nurturing.
Expectations are high with limited flexibility.

8. Permissive or Indulgent
Permissive or Indulgent parents mostly let their children do what they want and offer limited guidance or direction. They are more like friends than parents.
Their discipline style is the opposite of strict. They have limited or no rules and mostly let children figure problems out on their own.
Communication is open but these parents let children decide for themselves rather than giving direction.
Parents in this category tend to be warm and nurturing.
Expectations are typically minimal or not set by these parents.
Permissive or Indulgent

9. Uninvolved parents give children a lot of freedom and generally stay out of their way. Some parents may make a conscious decision to parent in this way, while others are less interested in parenting or unsure of what to do.
No particular discipline style is utilized. An uninvolved parent lets a child mostly do what he wants, probably out of a lack of information or caring.
Communication is limited.
This group of parents offers little nurturing.
There are few or no expectations of children.
Uninvolved

10. Authoritative
Authoritative parents are reasonable and nurturing, and set high, clear expectations. Children with parents who demonstrate this style tend to be self-disciplined and think for themselves. This style is thought to be most beneficial to children.
Disciplinary rules are clear and the reasons behind them are explained.
Communication is frequent and appropriate to the child’s level of understanding.
Authoritative parents are nurturing.
Expectations and goals are high but stated clearly. Children may have input into goals.

11. Helicopter Parent
a parent who takes an overprotective or excessive interest in the life of their child or children.
"some college officials see all this as the behavior of an overindulged generation, raised by helicopter parents and lacking in resilience“
First time I googled the term helicopter parents many years ago there had been over 250,000 searches at that time

12. Ideas I Share About Parenting High Risk Teens
Spend
Spend time with them
Show
Show them how much you love them
Resolve
Resolve problems
Let
Let them help you
Help
Help them learn to cope with negative emotions
Show them how great the world is
Even
Even if they are resistant, say no or walk out remain true to your values

13. Teach the Parent Communication Skills
If you have been at any of my trainings you know I use a lot of Motivational Interviewing techniques.
I teach a lot of the parents the basics:
Stages of Change
Oars &
Opening Strategies
Handling Resistance
Change Plans
Often times parents that have good communication skills are the “best therapist”

14. Decreasing Resistance
Why is decreasing resistance so important?
If parents can get their kids to verbalize the need to change the teen is 10 more times likely to change than if the authoritarian parent, for example. “tells” them to change.
Decreasing Resistance

15. It’s All about Decreasing Resistance and Eliciting Change Talk

16. Can we improve the way parents and teachers (or care coordinators) talk to children and to one another?
MI skills help engage parents
Training improves teachers in MI
MI trained teachers better at engaging students
Engagement associated with better outcomes

17. Motivational Interviewing Primary Goals
Reduce or Minimize resistance
Explore discrepancy between behavior and values/goals… resolve ambivalence
Module 3

18. Realities Of Change Most change does not occur overnight
teens can get stuck in the early stages
Individuals who are hesitant or reluctant resist being pushed to action/change
Contextual: all elements of the person are affected (H.A.L.T.)
“He who would learn to fly one day must first learn to stand and walk and run and climb and dance; one cannot fly into flying.” ~ Friedrich Nietzsche~
Module 3

20. What is the Righting Reflex?
It is the natural inclination we have to make it better for another person
What’s the danger? We tell the other person what to do, how to do it, and why they should do it without talking to them and learning what they think.
It creates resistance in that we move away from the partnering stance of MI and into the expert top down role.
What to do when you find yourself doing this? Stop and Reset: “Mrs. Smith, I realize I have been just lecturing you on how you can deal with your diabetes without learning what you are thinking. Let me back up and hear from you, wherever you would like to start.”
What is the Righting Reflex?

21. Righting Reflex Assumptions to Let Go of in Motivational Interviewing
1. They ought to change
2. They want to change
3. Their health is the prime motivating factor for them
4. If they do not decide to change, the consultation has failed
5. Individuals are either motivated to change, or they’re not
6. Now is the right time to consider change
7. A tough approach is always best
8. I’m the expert they must follow my advice
9. A negotiation approach is always best
Righting Reflex Assumptions to Let Go of in Motivational Interviewing

22. Stage of Change Model
Offers framework for understanding resistance and behavior change
Series of stages through which teens progressively pass as they change behavior
Module 3

23. Pre-Contemplation… Preparation Contemplation Maintenance
Relapse/Recurrence
Action
Pre-Contemplation…
Preparation
Contemplation
Module 3 23

24. Time in any stage may be transient (lasting for moments, minutes, days, weeks)
A person in any later stage can move to any former stage… is often a normal part of change
Stages of Change Model
Module 3

26. 12 Roadblocks in Communication Slide 1
Ordering, directing
Warning, threatening
Giving advice, making suggestions, providing solutions
Persuading with logic, arguing, lecturing
Moralizing, preaching
Judging, criticizing, blaming
12 Roadblocks in Communication Slide 1

27. 12 Roadblocks in Communication Slide 2
Agreeing, approving, praising
Shaming, ridiculing, name calling
Interpreting, analyzing
Reasoning, sympathizing
Questioning, probing
Withdrawing, distracting, humoring, changing the subject
12 Roadblocks in Communication Slide 2

28. What is MI? Miller and Rollnick’s Definition of MI
MI is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion
What is MI? Miller and Rollnick’s Definition of MI

29. Key Concepts of Motivational Interviewing
To understand how the individual sees the problem
One uses active listening and reflection to facilitate this process
One asks questions to elicit information
Central focus is to examine and resolve ambivalence
One points out discrepancies
The relationship is a partnership

30. Key Concepts of Motivational Interviewing
Motivation to change is elicited from the individual, not imposed by the teacher/parent
It is the persons’s task, not the teacher/parent to state and resolve the ambivalence
Direct persuasion is not effective
One’s approach is generally quiet and eliciting one
You are directive in assisting the individual
Readiness to change is not static, but fluctuating

31. Key Concepts of Motivational Interviewing
Resistance and denial are seen as a product of environmental factors, not a character trait
Motivational level over the course of treatment is more important that initial motivation (or lack thereof)
Priority is given to resolving ambivalence
The MI practitioner is persuasive, but not coercive; at times challenging, but never argumentative
Key Concepts of Motivational Interviewing

32. Motivational Interviewing is…
An interpersonal style
A subtle balance of directive and person- centered components
Affirming the individuals’s freedom of choice and self- direction
Self-empowering
Motivational Interviewing is…

33. Strategies of Motivational Interviewing
Express empathy
Promote self-efficacy because the belief that one can change is a powerful motivator
Encourage the individual to develop their own solutions to the problems that they themselves have identified
Assist the person in seeing how some of their current ways to doing things may lead them away from their eventual goals
Strategies of Motivational Interviewing

34. Caveats to Consider in Motivational Interviewing
Avoid arguing
Ensure that any resistance to change is not generated by “jumping ahead” of the person
Stay away from labeling, blaming, being the expert, confrontation
Pressing one to change may increase resistance
Caveats to Consider in Motivational Interviewing

35. More Caveats to Consider in Motivational Interviewing
Don’t use an authoritarian stance, leaving the client in a passive role
Don’t offer direct advice or give feedback without direct permission to do so
Avoid the question-answer-question (leads to a hierarchical relationship)
More Caveats to Consider in Motivational Interviewing

36. Stage Matching Interventions
Precontemplation
Empathy/Understanding
Contemplation
Explore & Amplify Ambivalence
Preparation
Clarify Focus, Plan & Set Goals
Action
Support Self-Efficacy
Maintenance
Monitor Relapse Triggers
Relapse
Roll with it - Reassess and Revise
Module 3 36

37. you facilitate “resistance”
WARNING!!!
Mismatching your intervention to the client’s stage of change fosters resistance
When you get
attached to an outcome OR
YOU push a quicker pace,
you facilitate “resistance”
Module 3 37

38. CARL ROGER’S PARADOX
“ACCEPTANCE FACILITATES CHANGE, WHILE PERCEIVED EXPECTATION OF CHANGE GENERATES RESISTANCE”
Motivational Interviewing: Preparing teens for Change (second ed) by William R. Miller and Stephen Rollnick, New York: Guilford Press, 2002 pg 39.
Module 3 38

39. “Listening looks easy, but it’s not simple. Every head is a world.”
Strategic Reflections
“Listening looks easy, but it’s not simple. Every head is a world.”
Cuban proverb

40. Strategic Reflections
Reduces RESISTANCE…
Seeking to understand their ideas
Target line of thinking of the one seeking change
Gets thoughts out of his/her head and more ‘real’… less single-minded
Helps clarify unspoken feelings
NOT a matter if we are right or wrong
Module 3 40

41. Resistance Talk Sustain Talk Change Talk Commitment Talk
4 types of Talk
Resistance Talk
Sustain Talk
Change Talk
Commitment Talk

42. Resistance Talk Focusing attention outside of self
Making it personal towards you
‘Fight’ or ‘Blame’ talk
Any message that someone or something else is the problem
Module 3 42

43. Sustain Talk Any rationale for why behavior is not going to change
Any message of being stuck or planning on staying the same
One side of the coin of ambivalence
Change Talk
Sustain Talk
Module 3 43

44. Resistance Vs. Sustain RESISTANCE Talk SUSTAIN Talk
Focusing outside self
Relationally oriented
Fight Talk
Lightning Rod language
Making it personal between you two
SUSTAIN Talk
Focusing internally
Staying the same
Stuck talk
Status quo
About his/her behavior
Natural w/ ambivalence
RESPONSE:
Empathic Reflection
“You feel…”
RESPONSE:
Rescue change talk
“You want…”

45. If resistance (re)surfaces, you are moving too far ahead of the client in the change process (mismatching stages).
With resistance, “more” intensity is not better.
More intensity increases defensiveness, producing negative outcomes.
Continued Resistance
Module 3 45

46. STOP DROP Your agenda Your righting reflex Roll
Whatever it is that you are doing – pushing, confronting, educating, explaining, etc.
STOP
DROP
Your agenda
Your righting reflex
Roll
…with resistance by reflecting of what you are hearing
Module 3 46

48. Asking The Right Question

49. Asking the Right Question
What do we mean by this?
Open ended
Invites elaboration
Why is inviting elaboration so important?
Elaboration makes teens take responsibility for session content
The teens teaches you about themselves and what is important to them, values, children, job, faith, etc.
Affirmations, Reflections and Summaries come very easily by the parent just listening to elaboration from a high-quality question

50. O.A.R.S. O Open-Ended Questions A Affirmations R Reflective Listening
S Summarizing

51. Open-ended Questions
Open-ended questions are the type of questions that require more than a short answer.
Ex. “Tell me what brings you here today?”
“ Tell me what your next steps are going to be?”
“How can I help you?”

52. Strengths of Good Open-Ended Questions
Don’t pull for yes/no answers or terse answers or specific pieces of information
Begin “What, “ “ How,” “In what” and somewhat less preferably “Why.”
Lead off with “Tell me” or “describe”
Questions that elicit open conversation by the teens about their problems and commitment to change
Strengths of Good Open-Ended Questions

53. CORRECT INCORRECT Examples
“What brings you here today and how I can help you”
“What are some of the ways that substance abuse has affected your life?”
“What kinds of difference have you noticed in..?”
CORRECT
“Do you use marijuana? When was the last time you used?”
“Can you tell me how heroin affects you?”
Your boyfriend thinks you are addicted to cocaine. Are you addicted to cocaine?”
INCORRECT
Examples

54. Key Questions What do you think you will do?
What does this mean about your use of…?
What do you think has to change?
What could you do? What are your options?
In what areas do you want to make a change?
What are the likely consequences of your actions?
How do you plan to reach the goals?

55. More Key Questions In what ways could other teens help you?
How will you arrange for support?
What do you hope to see happen as a result of this change plan?
What benefits could be expected from this change?
What could go wrong?
How can you continue to work on this even if you encountered problems or setbacks?
More Key Questions

56. Even More Key Questions
What is the first step towards your goals.
It must be uncomfortable for you now, seeing all this…..What’s the next step?
How would you like for things to turn out for you now , ideally?
It sounds like things can’t stay the way they are now. What are you going to do?
How will you recognize your progress toward goals?
Even More Key Questions

57. Affirmations of Strengths
Affirmations are statements of praise or encouragement to the teens acknowledging past or current efforts and successes
“This is your sixth approach to recovery, you need to be commended for your persistence.”
“I want to praise you for stopping the alcohol use and cutting back on the crack use.”
“I can tell when you talk that your family is really important to you.”

58. Strengths of Good Affirmations
Expresses confidence in teen's abilities to achieve his/her goals
Uses compliments or praise
Acknowledges tense's personal qualities, competencies or abilities that might promote change
Recognition of small steps taken by teens to change
Reframes to turn a potential negative into a positive, such as complimenting a person “as being persistent” on multiple treatment attempts as opposed to focusing on “what they missed.”
Fostering the belief that there is hope in teen's abilities to change behaviors
Strengths of Good Affirmations

59. “It sounds as if this has been really hard for you
“It sounds as if this has been really hard for you. You are really trying hard to work on yourself.”
“It sounds as if you have really thought a lot about this and have some good ideas about how you might want to change your drug use.”
MORE EXAMPLES
“ I really want to commend you for having the strength to come here today though you were forced to come against your will. That’s a huge step forward.”

60. Reflective Listening
Reflective listening communicates understanding and acceptance. To give all of your energy to the process of understanding what the person means and to reflect the meaning back to the person accurately
The ideal reflection takes the form of a statement rather than an inquiry. Your voice will drop an octave at the end. If your voice goes up it becomes a question.

61. Types of reflection: Repeat: “ Your girlfriend nags you about your drinking all of the time.” Rephrase: “ You are tired of your girlfriend nagging about your drinking.” Reflect a feeling: “You are frustrated with your girlfriend’s nagging.” Paraphrase: “ You don’t like being picked on.” Double-sided reflection: “On the one hand you would like to try to stop drinking but it irritates you a great deal that your wife nags you so much.”
Reflective Listening

62. Examples “Using drugs makes you feel worse now.” Simple Reflection
“So, you have found that using drugs to deal with how badly you feel is not working well for you anymore.”
Rephrasing
“ In the past using drugs helped you feel better when you were having a hard time or feeling badly. Now, it is only making matters worse for you.”
Paraphrasing Using a Double-Sided Reflection
“Let me see if I understand what you have told me so far…”
“Here is what I have heard you say so far…”
Introductions to a Reflective Summary
Examples

63. Strengths of Reflective Statements
Accurately clarifies and captures teens meaning and parent conveys understanding of tense's meaning or point of view
Uses technique to encourage teens to elaborate and explore the topic(s)
Repeats, rephrases, paraphrases and summarizes thoughts and feeling s of teens
Summaries include the reflection of several pieces of teens information that invite further elaboration of material to highlight ambivalence or invite transition to another topic.
Often in depth
Strengths of Reflective Statements

64. Summarizing is when you bring together all the main points of the session or part of a session that you wish to emphasize. It is a great opportunity for the parent to stress the points they want to emphasize or change direction in the session.
“ Let me see if I got this right. Your want to quit drinking, but your wife nags too much and it makes your want to drink some more. Also you are not sure if your ready to stop drinking altogether. Is that about it?”
Summarizing

65. M.I. STRATEGIES CONTINUED
Elicit Change Talk
Problem recognition
Concerns
Optimism
Intention to change
Affirm and Support Change Talk
Summarize Change Talk
Video – Ambivalence & Role Play – 2 counselors, 1 teens and 1 recorder

66. MORE MI OPENING STRATEGIES CONTINUED
Evocative Questions
Exploring Pros and Cons
Asking for Elaboration
Imagining Extremes
Looking Forward
Looking Back
MORE MI OPENING STRATEGIES CONTINUED

67. Evocative Questions Problem recognition
“What makes you think this is a problem?”
Concerns
“What is there about your drinking/drugging that you or other teens might see as reasons to worry?”
Optimism
“What makes you think that if you decided to change that you can do it?”
Intention to change
“The fact that you are here indicates that at least a part of you thinks it is time to do something. What are your reasons for making a change?

68. Exploring Pros and Cons
To what extent did the Parent address or explore the positive and negative effects or results of the tense's substance use and what might be gained and lost by abstinence or reduction in substance use?
To what extent did the parent use decisional balancing, complete a cost-benefits analysis, or develop a list of pros and cons of substance use?
How much did the parent express appreciation for ambivalence as a normal part of the change process?
“Tell me about the good things and not so good things involved in making these changes?”
Exploring Pros and Cons

69. Asking for Elaboration
Another technique is for the Parent to ask the teen to describe a typical day and ask for details.
After a self-motivational statement ask the teens to elaborate more, to reinforce the changes they have identified.
“ So you want to spend more time with your wife and children. Can you elaborate or tell me more about how you plan to accomplish that goal?”
Asking for Elaboration

70. Imagining extremes is when the person is ambivalent about making changes and the parents asks about extremes.
“What concerns you the most?”
“What are your worst fears about what might happen if you don’t make a change?”
“What do you suppose are the worst things that might happen if you keep on the way you’ve been doing?”
Imaging Extremes

71. A technique used to look forward and to create possibilities and hope.
“If you decided to a make a change, what are your hopes for the future?”
“How would you like to see things turn out for you?”
“I can see that you’re feeling really frustrated right now. How would you like things to be different?”
What are your choices now? What could you do?”
“What would be the best results you could imagine if you make a change?
Looking Forward

72. Looking back is when the parent asks about when things were going well, before the drinking/drugging became a problem. parents use the feedback to reframe any dangerous signs.
“What were things like before you started drinking/drugging? What were you like then?”
Do you remember a time when things were going well for you? What has changed?”
How has your use of drugs stopped you from progressing, from moving forward?”
Looking Back

73. “Readiness Ruler” How important is it to change?
Not Ready to Change Unsure Ready to Change Trying to Change
How important is it to change?
How confident are you that you can change?

74. Transition from Phase I to Phase II
Summarize Phase I
Concerns
Reluctance
Reasons for change (Most important)
Self-motivational Statements (All)
Question – Now what?
Move to Phase II
Negotiate a plan (general)
Decision of next step (specific)
Transition from Phase I to Phase II

75. The Change Plan The changes I want to make are…
The most important reasons why I want to make these changes are…
The steps I plan to take in changing are…
The ways other teens can help me are….
I will know if my change plan is working if…
Some things that could interfere with my plan are…

76. Questions, maybe answers