By Nur Ashabiena Binte Mohd Ashraff and Sumathi D/O Krishna Kumar

Working with adolescents can give us a sense of satisfaction but at the same time, it can also cause us to experience the following, especially when they are displaying any forms of inappropriate behaviours, which are not socially acceptable:

  • We dread seeing a particular group of adolescents.
  • We always feel lousy and ineffective at the end of each lesson.
  • We always feel that we are working harder than them.
  • We always feel that they do not understand the seriousness of their behaviours or problems as much as we do.
  • We are constantly trying our best to convince them to change.

It is important for us to be able to recognise these signs early. This will allow us to take a step back and reflect on and modify the strategy that we are currently using to help these adolescents change positively. These warning signs imply that the current strategy that we have implemented is no longer effective and there is a need for change. However, it is also important for us to reflect on the way we interact and respond to them so that we are able to understand how we might be the cause or creator of this resistance towards us. 


How We Create Resistance

Generally, we often label this group of adolescents as ‘stubborn’, ‘difficult’, ‘oppositional’ and ‘defiant’ without realizing that resistance is a part and parcel of any person’s journey of change and it usually occurs when there is not a match between the adolescents’ and our goals, as well as, their readiness for change. Figure 1 shows the four Rs which explain the reasons why people, in general, resist change.

resistance

In addition to these reasons, there are also other factors which can create resistance in these adolescents. Some of these factors are shown in Figure 2.

resistance2

 

Stages of Change

The different stages of change are reflected in Figure 3 - Transtheoretical Model (Stages of Change).

stages

 

Figure 4. Explanation of the Transtheoretical Model of Change describes what each of the stage means and the respective aims of the intervention.

Stage Explanation Aims of Intervention
Precontemplation The adolescent is not considering change or has rejected change
  • Get adolescent to start thinking about change
  • Highlight risk
  • Identify where adolescent can go to for help when he/she is ready
Contemplation The adolescent is considering change
  • Explore ambivalence by subtly highlighting the disadvantages of the status quo and the advantages of change              
Preparation The adolescent is looking at ways to make the change occur
  • Set goals and create a realistic plan
Action Adolescent takes positive steps towards making the change
  • Provide targeted intervention
  • Encourage the positive steps towards change
Maintenance Adolescent continues to sustain the changes in his/ her life (3 to 6 months)
  • Develop a relapse prevention plan
  • Follow-up          
Relapse The adolescent has a relapse and reverts back to previous behaviour
  • Review what triggered the relapse
  • Provide intervention to target the issues that contributed to the relapse

 

Strategies

These aims of intervention can be achieved by adopting the following strategies as shown in Figure 5. Strategies to promote change.

strategies

 

Motivational Approach consists of four principles and they are:

  • Empathise with the client
  • Develop discrepancy
  • Do not fight resistance
  • Enhance self-belief

We can demonstrate a motivational approach with this group of adolescents by:

  • Asking open-ended questions
  • Using affirmations so as to build self-efficacy
  • Reflective listening
  • Summarising what has been said

Based on Figure 4, Adolescents are considered the most reluctant at these two stages of change; pre-contemplation and contemplation. The following are some techniques that might help adolescents to consider changing their ways.

 

Figure 6. Techniques for adolescents at the pre-contemplation and contemplation stage.

Techniques Explanation
Ask questions that increase Desire and Reason talk Recognise the disadvantages of the status quo, and the advantages of change                
Querying extremes Ask adolescent to describe the extremes of:
  • Their concerns
  • Other people’s concerns
  • The consequences that might ensue
  • The consequences if they pursue change
How was life like before the problem behaviour? To help adolescent remember life before the problem behaviour and to compare them with the present situation
How would life be like without the problem behaviour? To help adolescent envision a changed future, to imagine life after a change
Develop discrepancy
  • Providing information
  • Explore goals and values
Decisional balance
  • Explore the pros and cons of the available alternatives (e.g. stop smoking vs. continue smoking)
  • Advantages and disadvantages of each option
Increase Ability and Need Talk

Ability: Hold some optimism about change

Need: Have an intention to change

  • Scaling questions

 

While all these techniques may help to encourage adolescents to think of or consider change, it is also important for us to help them set goals and create a realistic plan once they enter the preparation stage by increasing commitment talk, which can be achieved through these 8 steps:

  • Get the adolescent to make a commitment to participate in the intervention
  • Ask for permission to discuss how to proceed
  • Confirm the adolescent’s goal
  • Ask for adolescent’s guess on what might be helpful for their change process
  • Seek adolescent’s permission to offer a menu of options
  • Ask for the adolescent’s preference
  • Set the specifics of the plan
  • Summarise the plan

Finally, while we are putting in our best effort in trying to manage reluctant adolescents with problem behaviours, it is also important for us to recognise the signs of compassion fatigue and burnout and adopt appropriate self-care techniques to overcome them, which can be attained by asking ourselves the following questions:

  • What is one thing you like to eat or drink?
  • What is one thing you like to smell?
  • What is one thing you like to look at?
  • What is one thing you like to listen to?
  • What is one thing you like to touch?

These questions help us to develop our own self-care plan to enhance our mental, emotional and psychological well-being; thus allowing us to manage our stress better and at the same time maintain our professionalism while working with reluctant adolescents.