Motivational Enhancement therapy: a tool for professional school counselors working with adolescents

Professional School Counseling, April, 2004 by Glenn W. Lambie

Many adolescents whom professional school counselors regularly counsel are ambivalent and unmotivated to behavioral change. Motivational Enhancement Therapy (MET) is a counseling approach designed specifically for clients with these qualities. The purpose of this article is fourfold: (a) to identify the complexity and misconceptions of counseling adolescent students, (b) to introduce school counselors to the theoretical constructs of MET, (c) to review MET strategies for supporting change, and (d) to present case examples demonstrating MET techniques with students.

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The adolescents that professional school counselors (PSCs) work with can be challenging. Indeed, some counselors have noted that adolescents are the most difficult clients to work with in a therapeutic context (Church, 1994). Adolescents often display hostility, defiance, and other forms of resistance in establishing a counseling relationship and frequently are poorly motivated for behavioral change (Hanna, Hanna, & Keys, 1999; Lambie & Rokutani, 2002). For example, Trepper (1991) described counseling adolescents as an "adversarial sport" in which the counselor rarely ends up on the winning team. For this reason, many counselors avoid working with this population altogether (Biever, McKenzie, Wales-North, & Gonzalez, 1995). Students frequently come for help, or more often are sent for help, with specific problems while being in the midst of rapid developmental change (Jaffe:, 1997). Further contributing to the complexity of working with adolescents has been school counselors' lack of specific supervised training in counseling approaches with this population (Rubenstein & Zager, 1995). However, many school counseling training programs are now integrating theoretical models and experiential exercises designed and deemed effective with children and adolescents.

Many of the traditional counseling theories and approaches were developed for motivated adults. Students sent to see their PSC are nor adults and often are not motivated to change. Furthermore, research indicates when most people begin counseling they are not ready to take action to change (Isenhart, 1994); whereas the majority of counseling models are constructed for working with clients who are ready to take action to change (Prochaska, DiClemente, & Norcross, 1992). Complicating the situation further, PSCs are faced with the reality that counselor-student ratios and other noncounseling duties limit the amount of time they have to directly counsel students (Lambie & Rokutani, 2002; Stickel, 1991). Therefore, a practical school counseling approach needs to provide strategies that in a brief amount of time would assist students who may be unmotivated for change.

Stereotypical descriptions of adolescents such as moodiness, narcissism, being resistant and challenging, and having social and interpersonal problems are similar to generalizations of another difficult population, clients with substance abuse issues. For the latter group, Motivational Enhancement Therapy (MET) has been found to be an effective counseling approach (Miller, Zweben, DiClemente, & Rychtarik, 1995). MET can be brief in duration and designed for counseling clients at all levels of motivation and readiness to change. MET has been found particularly useful with individuals considered "difficult," "resistant," and "unmotivated" (Aubrey, 1998). For these reasons, MET appears to be a well-suited counseling approach for adolescents (Lawendowski, 1998).

The purpose of this article is to provide an orientation to MET, which is a brief psychotherapeutic approach intended to increase the probability that a student will begin and maintain a specific change plan aimed at reducing a problem behavior (Miller & Rollnick, 1991, 2002). The following four topics are addressed:

1. The complexity and misconceptions of counseling adolescents

2.An introduction to MET &MET strategies for supporting change

4.Case examples illustrating the application of MET

For the purposes of this article, the terms student and client will be used interchangeably to describe anyone whom PSCs may counsel in a change process including students, teachers, parents, and other school personnel.

COMPLEXITY AND MISCONCEPTIONS OF COUNSELING ADOLESCENTS

Adolescents need to be differentiated from adults and young children due to the unique transformations they are going through: their cognitive skills are becoming more powerful; new types of relationships are developing; they are becoming better at distinguishing feelings; and they are acquiring greater ability to reflect feelings (Vernon, 1993). Adolescence is a period of intense heightened narcissism and self-preoccupation (Lambie & Rokutani, 2002). PSCs need to match their counseling techniques and style to these distinctive needs.

Establishing a safe and trusting counseling relationship is the foundation for support and change (Rogers, 1995). It can be difficult to establish this relationship with adolescents who have historically questioned society's beliefs and values (Katz, 1997). It is not surprising, therefore, that they tend to mistrust counselors and often manifest this reaction crudely, intensely, provocatively, and for prolonged periods. To reduce such potential mistrust, it is helpful to let students know that mistrust is to be expected and that it is natural and healthy not to disclose and trust immediately (Kaplan & Sadock, 1998).