Talking with teens starts with listening to teens

The Pediatric Insider

© 2012 Roy Benaroch, MD

To get teens where you want them to go, you have to start with where they are.

A common scenario: a parent brings me a 16 year old, and wants me to get him to stop smoking. Or get better grades. Or stop being such an angry beast. The parents are at their wits’ end, and want me to fix him. Now!

Teenagers (and adults) don’t work that way. They’ll change, sure. When they want to. So the trick is to guide them along a path that will encourage good decisions. Sometimes that’s not so easy for parents or pediatricians. One good technique that can help starts with listening—does the teenager even want to change? And if he doesn’t, where along the path is he right now?

This technique is part of what’s called “motivational interviewing”, a method to encourage people to make positive changes in their lives by working together. It’s not meant to involve threats, coercion, rewards, or punishments–  so it might seem a little different from the way parents may be used to talking with their kids. This isn’t an adult telling a child what to do, but rather two adults talking about changes and how and when to make good decisions.

People go through five phases as they decide to change a habit. How to talk to teens depends on where along this path they currently are.

1.Never. This is before a teenager even thinks he has a problem.  When does he want to make a change? Never. Some people call this stage denial.

2.Later. The teenager sees that a problem exists, but isn’t ready to do anything about it. Maybe they’ll make a change later.

3.Soon. By now, the teenager has decided that it would be good to change, and plans to. Soon. Not now, but soon.

4.Now. The teen has decided he want to change, and is ready and willing to do something about it now.

5.Always. It’s difficult to sustain a good habit. How do you keep up your decision, always?

These stages have to be passed, one by one. And if you really want to help, you need to listen to the teenager to figure out what stage he’s on now. You can then—gently—see if you can guide him to the next stage, or at least further along the current stage. But if someone is at stage 2—willing to see that there is a problem, but not yet even thinking about when he’ll make a change—it will not help to talk about stage 4 or 5. That would like speaking a foreign language. You’ll be so far apart that nothing will be accomplished.

As an example, let me illustrate a few  scenarios with a teenager who’s getting failing grades. These are the kinds of statements the teenager might make at the first two stages:

Never: “What are you talking about? My grades are fine. They’re good enough. I don’t know why you’re hassling me.”

This teenager doesn’t even perceive that there is a problem. You might be able to help him realize that where he’s at now isn’t going to be the best place for him, by asking about what kind of job he wants as an adult. The first step from here is to get him to stage 2, discussing this with an understanding that it is a problem.

Later: “Yeah, I know. I’ll pick up my grades before I graduate. Plenty of time.”

Change is at least something that’s being considered, though it’s too far away to realistically push now. You may be able to talk about how grades right now will have an impact on choices in the future—these grades count, so let’s think about whether it might be a good idea to try to address this sooner, rather than later.

Parents don’t always like to hear this, but those darn teenagers make up their own minds at their own pace. It would be great if we could just reach into their heads to help them avoid making the same mistakes we did—but it doesn’t work that way. The most successful approach is to nudge them along a path that will lead to success, starting with where they already are.

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