Motivational Interviewing crash course for parents

photo credit: sampsyo

After setting up a scene of a parent with a child in the ER for the second time with alcohol poisoning, a blogger at intervene.drugfree.org offers some advice:

People tend to only listen to one person — themselves.  And, as a result, they’re only influenced by one person …again — themselves.  So, as frustrating as this may be for a parent who would like to sternly say, “You have to stop!” and to have that be enough, the real trick to motivating someone is to get them to convince themselves to make a change for their own good reasons.

The two most important things to do are:

1)    STOP trying to motivate your child by telling her about your feelings, thoughts or reasons for change, such as, “You’re worrying me to death!” “I think you HAVE to go to rehab right from the hospital” or “The best reason for you to stop drinking is for your health.”

2)    START asking your child questions that are specially-designed to evoke her own good reasons for change.

DON’T…

  • Express your anger.
  • Blame.
  • Confront her with admonitions to stop.
  • Tell her your reasons for why she needs to stop drinking by nagging.
  • Assume the ER will somehow scare her away from drinking in the long-term.
  • Use a “tough love” approach, such as threatening harsh punishments.

DO…

  • Start by saying, “While I am very concerned about your drinking, I know that it’s ultimately your decision whether you choose to accept help.
  • Ask , “Why might you decide to get help for your drinking?”
  • Ask, “Have you ever done something you regretted while drinking? What was it?” .
  • Ask, “How ready are you to take a next step on getting help (e.g., looking up local specialists with you), on a scale from 1-10, where 1 means not at all and 10 means totally ready?”
  • Ask her why she did not pick a LOWER (yes, lower) number?
  • (If she said “1″ to the scale question), Ask, “What would turn that “1″ into a “2″?
  • Reiterate the good answers AND ignore the bad.
This approach is a huge improvement over yelling, begging, shaming and freaking out. It steps out of the argument and gets the substance user talking about their use rather than defending his/her self. However, Motivational Interviewing demands a kind of detachment that I suspect is unrealistic for parents or anyone who is emotionally entangled with person misusing drugs and alcohol. Of course, the big question is, “What then.” Because, unlike a therapist, parents live the other 167 hours of the week with this person in the physical and emotional space.
I think the spirit of this combined with the spirit of the Love First intervention approach might provide helpful instruction for parents. (Theses are instructions for writing a letter for an intervention, however their spirit can be instructive. Note that these are based on the assumption that the loved one is an alcoholic and could be adapted if that is less clear.):
  • begin with a simple statement of love and concern…. come straight from the heart.
  • recall a time when the alcoholic has been especially helpful to you, or when you have been proud of [him/her]
  • make a brief statement about your new understanding of alcoholism as a disease, and your desire for the addict to get help in a formal treatment setting
  • This should be followed by a statement of facts about the alcoholic’s negative behavior. As Sargent Joe Friday used to say: “The facts ma’am, just the facts.”
  • repeat your love and concern, and then ask the addict to accept help for the illness
What then? Take care of yourself spiritually, emotionally and physically.

4 Comments

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4 responses to “Motivational Interviewing crash course for parents

  1. Lou

    This is excellent. Clearly explained and practical. It would have been helpful to me back in the day when I was getting vague advice on enabling, supporting recovery, raising the bottom, and other terms that have become misused to the point of being useless.

  2. Jess

    These seem like helpful tactics overall and far more useful than a reactionary response. The part I find confusing for a parent/guardian of a minor child, or maybe even of an adult child who lives at home or is supported by the parents, is that at some point it seems appropriate and necessary to say, “You are going to treatment” or “we are getting professional help to deal with this” whether the child agrees or not. The article suggests “fair but firm boundaries and consequences is more effective than harsh discipline in motivating people” – sure, but with an addicted teen those boundaries and consequences probably aren’t working the way they would in a teens who’s abusing substances by choice. Is a parent supposed to continue to allow the status quo while practicing motivational techniques and waiting for a minor to agree to go to treatment and hoping the next experience isn’t death instead of near-death? Especially in a scenario like the one given where there have been TWO near-death experiences already and presumably the teen in the example given is probably in trouble with the law, the school, etc? I would give more credibility to this if the example was less serious; in this example the advice seems seriously lacking in what to do if the teen is not presently motivated. Also, SBIRT is a great tool and a parent can certainly ask ER personnel to SBIRT their child – but if the ER doesn’t automatically do this it’s probably because they are not trained in SBIRT.

  3. I agree with you that parents of minors have an unusual burden/opportunity/responsibility to use their authority in these situation.

    This approach could be a great start, with its emphasis on getting the kid to talk and listening, but, as I mentioned in the post, the critical question is what comes next.

    Thanks.