Motivational Interviewing with Families, Adolescents and Substance Use: Practice Lessons from Professor Doug Smith
Motivational Interviewing with Families, Adolescents and Substance Use: Practice Lessons from Professor Doug Smith
Glenn Hinds MI Practice Companion
Working with families introduces challenges that do not always arise in one-to-one conversations. Family members may have different goals, different understandings of what is happening and different levels of willingness to participate. Parents may feel frightened or exhausted. Adolescents may feel blamed, controlled or required to attend. Practitioners can easily find themselves under pressure to decide who is right and move quickly towards a solution.
In this episode of Talking to Change, Glenn Hinds and Dr Sebastian Kaplan speak with Professor Doug Smith about using Motivational Interviewing with families, adolescents and people experiencing concerns related to substance use.
This Practice Companion explores key themes from their conversation, connects them with established Motivational Interviewing principles and translates them into practical learning for students and practitioners. Where useful, it also draws on broader practice insights that complement, rather than redefine, MI.
Listen to the full conversation
Listen to Glenn Hinds and Sebastian Kaplan’s full conversation with Professor Douglas C. Smith on Talking to Change: A Motivational Interviewing Podcast.
▶ Listen to Episode 97 – Motivational Interviewing with Families
In this Practice Companion
Applying Motivational Interviewing in family conversations
Motivational Interviewing can help a person explore their own reasons for and against change. In family conversations, practitioners may hear several perspectives at once. Each person brings their own concerns, hopes and motivations, while their responses to one another can influence how openly change is discussed.
A young person may feel ambivalent about reducing their substance use. A parent may desperately want the substance use to stop, but communicate that concern through repeated advice, interrogation or criticism. As pressure increases, the young person may become more likely to defend their behaviour or withdraw from the conversation. Both may want things to improve while becoming caught in an interaction that leaves each feeling unheard.
Applying MI in this setting does not require the practitioner to decide which family member is right. The practitioner can instead help each person express and hear the needs, concerns, hopes and motivations beneath their position. This reflects the MI spirit of partnership, acceptance, compassion and empowerment.
Using reflective listening in family conversations
Reflective listening is central to Motivational Interviewing and can be especially useful when several people bring strong emotions and different perspectives to a conversation. Open questions can help people tell their stories, but a succession of questions may begin to feel like an investigation. Well-chosen reflections communicate understanding, bring forward meaning and help family members hear one another’s perspectives more clearly.
A practitioner might reflect to a parent: “You are angry about what has happened, and part of that anger may come from feeling frightened about where this could lead.” To an adolescent, they might say: “You want your parents to recognise that you are trying, even though you are not ready to make all the changes they want.”
These responses do more than repeat what someone has said. They offer a considered hypothesis about meaning, emotion or intention, which the person can confirm, correct or develop. For more on this skill, see Reflective Listening in Motivational Interviewing.
Listen: Family engagement, moving beyond blame
Doug describes how blame can make engagement with families difficult, and how an MI approach grounded in respect and deep empathy can help create a different kind of conversation.
Avoid becoming the family referee
Families may invite the practitioner to take sides. A parent may want the practitioner to tell an adolescent that their behaviour is dangerous. The adolescent may expect the practitioner to confirm that their parents are unreasonable. Partners may each present evidence that the other person is the source of the problem.
When a practitioner appears to take one person’s side, other family members may feel judged or become less willing to engage. Applying MI in a family conversation involves maintaining partnership with each person while acknowledging genuine concerns. Acceptance does not mean approving of every behaviour or treating every perspective as equally safe. Practitioners retain their responsibilities for risk, safeguarding and professional ethics.
Practitioners can state concerns clearly, explain their responsibilities and remain curious about how each person understands the situation. When appropriate, they can ask permission before offering information and invite the family’s response afterwards. Where information must be provided, openness about why it is necessary can help preserve partnership and autonomy.
This connects with the Fixing Reflex, where our understandable urge to correct or persuade can lead people to defend their current position more strongly.
Supporting autonomy when attendance is not voluntary
A person’s choices may be constrained when family members depend upon and influence one another, but their autonomy does not disappear. Parents may set boundaries. Services may hold legal or safeguarding responsibilities. Young people may attend because a parent, court, school or service requires them to do so.
External pressure may secure attendance, but additional pressure within the conversation can lead to argument, superficial agreement, silence or withdrawal. An MI-consistent approach names the constraints clearly, distinguishes requirements from choices and offers only choices that are genuine.
With an adolescent, a practitioner might say: “Coming here was not entirely your choice. Given that you are here, what would make this conversation useful for you?”
This does not remove the external requirement or pretend that the meeting is wholly voluntary. It acknowledges the young person’s experience and gives them meaningful influence over what can still be decided.
Listen for change talk across family members
In Motivational Interviewing, practitioners listen for change talk: language that favours movement towards a particular change. In family conversations, several people may express change talk, sometimes about different behaviours or aspects of the family interaction.
A parent might recognise that constant checking or repeated confrontation is making matters worse. A young person might acknowledge that they would communicate more openly if every conversation did not become an argument. Each statement points towards a possible change, but neither represents a complete plan or guarantees that the family shares the same goal.
The practitioner might gather the emerging possibilities in a tentative summary: “I’m hearing that neither of you wants this pattern to continue and that you would both like fewer arguments. One possibility you have raised is less frequent checking. Another is speaking more openly when conversations feel calmer. Have I understood that correctly?”
A summary can highlight possible common ground without manufacturing agreement. The practitioner should check its accuracy and help the family decide whether there is a shared focus from which to move forward.
This also requires distinguishing change talk from sustain talk. Practitioners should attend separately to discord, which signals strain in the working relationship rather than language for or against a particular change.
Listen: Change talk between family members
Doug explores what becomes possible when change talk is heard not only from an individual, but between family members as they respond to one another.
Do not rush from engagement into planning
Families often arrive wanting action. Practitioners may also feel pressure to produce a plan quickly. However, a plan developed before people feel heard or before there is a sufficiently clear focus may attract little genuine commitment, especially when an adolescent feels blamed or one family member has been identified as “the problem”.
Engaging is not simply a box to tick before moving on to the real work. It remains part of the work throughout the conversation. The four MI tasks are not rigid stages. Focusing, evoking and planning may develop while engagement continues, and practitioners may need to return their attention to engagement whenever strain or disconnection emerges.
Questions that may help the family develop direction include: “Where would each of you find it most useful to begin?”, “What feels possible, even if the whole situation cannot change immediately?” and “What would tell you that things were moving in a better direction?”
Listen: Avoiding the superfluous engagement trap
Doug considers the point at which continued engagement can become superfluous, and why MI also asks practitioners to offer direction and help develop a useful focus while continuing to respect autonomy.
Understand substance use within the young person’s wider life
When a young person uses alcohol or other drugs, adults may understandably focus on stopping the behaviour. The risk is that substance use becomes the only concern anyone notices, while other parts of the young person’s life, identity and experience receive less attention.
Exploring the function and meaning of substance use is a broader practice principle that fits well with a curious, accepting stance and MI’s emphasis on evocation. What does the young person value or enjoy about it? Does it offer relief, belonging, excitement, confidence, sleep or temporary escape? What disadvantages or concerns do they already recognise? How does it fit, or conflict, with what matters to them?
Understanding the perceived benefits does not mean approving of harmful behaviour or minimising risk. It allows practitioners to respond to the young person’s actual experience, address safety honestly and explore other ways of meeting important needs. It may also help the young person voice their own concerns and reasons for considering change.
Explore more in our Knowledge Centre resource on Motivational Interviewing in Substance Use.
Reluctance is information
A young person or family member who appears reluctant may be described as resistant, unmotivated or difficult. These labels locate the difficulty within the person. A more useful question is: What might they be reluctant about?
Reluctance is not a single MI construct. It may involve sustain talk about a particular change, discord within the working relationship, uncertainty about the focus of the conversation or an understandable response to pressure and limited choice. Distinguishing among these possibilities helps the practitioner decide how to respond.
The person may fear being blamed. They may believe the decision has already been made. Previous contact with services may have felt punitive. They may see no benefit in speaking honestly or may worry about what will happen if they do.
Rather than confronting the reluctance, practitioners can explore it through reflective listening: “You have good reasons for being cautious about this conversation.” Or: “You are not convinced that talking to another professional will make any difference.”
An accurate, non-judgemental reflection communicates acceptance and may reduce the person’s need to defend their position. It remains a hypothesis that the person can confirm, correct or develop.
End by returning motivation to the family
An effective ending does not depend upon the practitioner delivering an inspiring speech. A carefully chosen summary can gather the family’s own concerns, hopes, strengths, change talk and agreed next steps. Where uncertainty remains, the summary should acknowledge it rather than making commitment sound stronger than it is.
For example: “You have both said that you want home to feel calmer. You have recognised that checking, shouting and withdrawing have kept the same cycle going. You have agreed to try one conversation while things are calm, and either of you can pause it if it becomes heated. You are hopeful that this could help, although you are not yet sure how easy it will be.”
The practitioner can then check the summary: “What have I missed or misunderstood?” and “Where does this leave each of you?”
The reasons for change, decisions and next steps belong to the family. The practitioner’s role is to help family members hear them clearly without overstating agreement or readiness.
Practice takeaways
- Attend to the family interaction while continuing to hear each person’s individual perspective.
- Use reflective listening to communicate understanding, bring forward meaning and help family members hear one another more clearly.
- Maintain partnership with each person without becoming neutral about risk, safeguarding or professional responsibilities.
- Name external requirements honestly, distinguish requirements from choices and offer only choices that are genuine.
- Listen for each person’s change talk in relation to a particular change; do not manufacture a shared goal.
- Treat engaging as an ongoing task, develop a sufficiently clear focus and avoid rushing into planning.
- Explore the meaning, perceived benefits and disadvantages of substance use while addressing risk and safety honestly.
- Treat reluctance as information and distinguish among sustain talk, discord, uncertainty about focus and responses to pressure.
- End with an accurate summary that acknowledges uncertainty, checks understanding and returns decisions and next steps to the family.
Episode guide
- 0:00 – Glenn and Sebastian introduce the episode and key themes
- 3:58 – Doug Smith’s route into Motivational Interviewing
- 8:39 – Moving from individual practice to work with adolescents and families
- 13:18 – Family engagement, blame, empathy and what MI contributes
- 20:47 – Motivational Interviewing with Families: why Doug wrote the book
- 30:40 – Change talk across family relationships
- 33:48 – Individual, family and multi-level target behaviours
- 43:45 – Bringing structure and focus into family conversations
- 46:02 – Practitioner direction, autonomy and the “superfluous engagement trap”
- 1:00:22 – Current research and where MI with families might go next
- 1:04:30 – End of episode
Show notes and episode resources
Professor Douglas C. Smith, Ph.D., LCSW, is Professor of Social Work at the University of Illinois at Urbana-Champaign and Director of the Center for Prevention Research and Development (CPRD). His research focuses on improving treatments for adolescents and young adults experiencing substance use disorders. He is the author of Emerging Adults and Substance Use Disorder Treatment and Motivational Interviewing with Families.
- Contact: smithdc@illinois.edu
- Book: Motivational Interviewing with Families, Guilford Press
- Talking to Change listener offer: Guilford Press is offering listeners 15% off Motivational Interviewing with Families using promotional code AU2E. The special offer is valid in the U.S. and Canada only.
For the complete episode show notes, guest information and full audio, visit Episode 97 – Motivational Interviewing with Families.
Continue learning
This Practice Companion has explored themes from the conversation with Professor Doug Smith, connected them with established Motivational Interviewing principles and added broader practice interpretation where helpful. Listen to the full episode to hear Doug’s ideas in their original context.
Listen to the full conversation
Talking to Change Episode 97: Motivational Interviewing with Families with Professor Douglas C. Smith.
Explore related MI resources
Continue with the Motivational Interviewing Knowledge Centre, including MI Skills & Practice, MI in Education and Youth Work and MI in Substance Use.
Discover related podcast conversations
- Episode 83 – MI with Couples – Tyrel Starks explores Motivational Interviewing when more than one person is part of the change conversation, including relationship functioning, seeking consensus and evoking change talk.
- Episode 13 – MI with CBT and Health Behaviour Change with Adolescents – Sylvie Naar discusses MI with adolescents and young adults, including autonomy, change talk and the application of MI across complex health behaviour contexts.
- Episode 10 – Affirmations in Motivational Interviewing – Tim Apodaca explores affirmations, curiosity, goals and values, with specific discussion of using MI with adolescents and families.
Develop your MI practice
Explore Motivational Interviewing training for organisations with Glenn Hinds.
Continue with Talking to Change
Podcast: podcast@glennhinds.com
Glenn: glenn@glennhinds.com
Sebastian: sebkaplan34@gmail.com
Follow Talking to Change on Bluesky
Listen: Browse the full Talking to Change podcast listening archive.
Support the podcast
Learn: Explore Talking to Change episodes and learning resources on glennhinds.com.
