# Motivation and emotion/Book/2024/Treatment motivation in juvenile delinquency

* Multimedia presentation (3 min)

## Overview

* Scenario
* Alex is a 17-year-old male who has been struggling with drug use for almost the past two years. It initially started as occasional experimentation, but it quickly spiraled into regular use. This led to frequently missing school, declining health, and strained relationships with family and friends where he often lashes out. Recently, after a night out with his friends, Alex had a run-in with police after being caught for driving with cannabis in his system. Alex had his provisional license suspended and will likely be issued a court attendance notice. This incident has caused conflict between Alex and his parents, yet despite several warnings, Alex does not see a reason to change his behaviour. He claims that it was a one-time mistake and denies how serious the situation is, claiming that he has everything under control and that his parents are just overreacting.
Juvenile delinquency is a significant social issue which researchers are continuously evaluating to work out what contributes to negative juvenile behaviour, and the best treatment practices (Carl et al., 2020). Premature treatment termination is one of the most significant concerns that is linked to re-offending, as well as negative social and psychological outcomes for the individual (Carl et al., 2020). It should also be noted that juvenile offenders differ significantly from adult or mature offenders, meaning it is important to tailor treatment to the specific needs of young people to reduce repetition of negative or antisocial behaviours (Richards, 2011). Treatment motivation is vital to this process as it sets up for positive treatment engagement, commitment and outcomes. However, justice involved youth often lack motivation to engage with treatment as they do not recognise that their behaviour is problematic or severe enough to seek help, often believing that they are able to take control on their own. This makes it extremely important to tailor treatment in a way that works to increase motivation and help the individual understand the importance of treatment (Sturgess et al., 2016).
* Focus questions:
* What is treatment motivation?
* What is the role of treatment motivation for juvenile delinquents?
* Why is motivation important for effective treatment outcomes?
* What are the factors that act as barriers to treatment motivation?
* How can treatment motivation be enhanced for justice involved youth?

## Understanding treatment motivation in juvenile delinquency

Treatment motivation is a significant factor that interacts with external catalysts (such as treatment) and environmental factors to influence readiness to change. Having a level [say what?] treatment motivation is often necessary to turn potential treatment effects into actual behavioural change (van der Helm et al., 2018).
Treatment motivation can be defined as an individual’s readiness and willingness to change their behaviour, and considers whether there are characteristics present that are likely to promote effective engagement in treatment and positive behavioural change (Sturgess et al., 2016). It is quite common for justice involved juveniles to display poor treatment motivation as they typically believe that there is no reason for change (van der Helm et al., 2014). However, treatment motivation is crucial for engaging and retaining juveniles in treatment programs, particularly in settings like youth correctional facilities (van der Helm et al., 2018).
Table 1. Factors which differentiate juvenile offenders from adult offenders :
| Brain development | Differences in brain developmental means that children and adolescents are less capable of making well-reasoned decisions and controlling impulses compared to adults (Queensland Government Statistician’s Office & Queensland Treasury, 2021). Therefore, juveniles tend to commit more impulsive and opportunistic offences. |
| Peer pressure/influence | Due to being more reward-driven and the desire for social acceptance, juveniles are more susceptible to peer pressure and social influence and are more likely to engage in risky behaviours despite being aware of potential consequences (Richards, 2011) |
| Moral understanding | While adolescents can make moral decisions, they may not fully understand the long-term consequences of their behaviour, especially if it they do not have responsibilities such as supporting a family, maintaining a job, or other commitments that give them 'something to lose' by engaging in risky behaviour (Queensland Government Statistician’s Office & Queensland Treasury, 2021). |

## Theoretical perspectives on treatment motivation

There are many motivational theories which deepen our understanding of what drives human behaviour. When it comes to treatment motivation, the Transtheoretical model of change and Self-determination theory seem to be the most prominent in research (Hashemzadeh et al., 2019; Kennedy & Gregoire, 2009).

### Self-determination theory

Self-determination theory (SDT) suggests that fulfilling three basic psychological needs including autonomy, competence and relatedness is important for enhancing motivation (see figure 2). SDT also focuses on how intrinsic versus extrinsic motivation influences individual behaviour (Ryan & Deci, 2000). Intrinsic motivation relates to internal rewards, while extrinsic motivation is linked to external rewards or avoiding negative consequences, and both play a role in treatment motivation (O'Grady et al., 2022).
In a study of young adults who were justice-involved due to substance use, O’Grady et al (2020) found that juveniles with intrinsic reasons for addressing substance misuse, such as bettering themselves and being accepted by family had a greater drive and motivation to engage in treatment. However, intrinsic motivation was not always present, especially in offenders who were legally required to seek treatment, rather than treatment being a personal choice (Polaschek, 2009). In this case, clinicians often depend on the presence of extrinsic motivators such as being able to go home if one is admitted to a treatment facility, or the desire to avoid conflict and legal consequences (O'Grady et al., 2022)
SDT also suggests that fostering an individual's sense of autonomy and ensuring they have say in their treatment can be quite effective in keeping them engaged in treatment (Polaschek, 2009). Additionally, in their study of residents in forensic youth care facilities, van der Helm et al. (2018) found that having a supportive and positive group environment was associated with increased treatment motivation (van der Helm et al., 2018). This aligns with SDT's idea that a nurturing a supportive and non-judgemental environment helps meet the basic need of relatedness, therefore increasing motivation and drive to engage in treatment (van der Helm et al., 2018). Overall, an offender’s own intrinsic motivation along with autonomy and a sense of connection are extremely important factors in treatment motivation (Polaschek, 2009).

### Transtheoretical model of change

On the other hand, the Transtheoretical model of change[fix link] (TTM), also known as the stages of change model, suggests that during behavioural change, individuals can move through a number of stages which are aligned to their willingness to take action (Hashemzadeh et al., 2019). The TTM is used in treatment by providing a structured framework for understanding and supporting behaviour change, as well as assessing an individual’s readiness and commitment to change at any point (Hashemzadeh et al., 2019).
Previously, the TTM has been questioned for its usefulness in offender treatment. Researchers have argued that human behaviour is too complex to be categorized into just a few stages which might not accurately represent the complexity of behavioural change (Casey et al., 2010). Additionally, the model was also developed to help understand and treat addictive behaviour, meaning it may not be entirely relevant to delinquent or criminal behaviour (Casey et al., 2010).
However, despite these critiques, a large amount of research suggests that the stages of change can predict how motivated an individual is to seek and engage with treatment (Kennedy & Gregoire, 2009). For example, those in precontemplation and contemplation stages are typically less motivated for treatment and often have poor treatment outcomes compared to individuals who present in more advanced stages of change (van der Stouwe et al., 2018). Essentially, different treatment strategies are effective at different stages of the TTM, and tailoring treatment depending on which stage an offender is in will help to make treatment more effective (see figure 3). For example, treatment methods that focus on changing behaviour may be more suitable for active change phases, while techniques focussed on cognition and changing thought patterns may be more suitable for those in the precontemplation and contemplation phases (van der Stouwe et al., 2018). However, an important factor to note is that these stages do not always happen in order, making it vital for clinicians to be adaptable and tailor treatment to their client’s current stage or level of readiness, rather than following certain orders (van der Stouwe et al., 2018).

## Barriers to treatment motivation

There are various barriers to treatment motivation for justice involved youth, which can arise from the individual themselves, their environment and community, and the individuals directly involved in their treatment (McBrayer et al., 2024).

### Staff perception and trust

Young offenders often hold the belief that they are being judged by staff, expecting disrespect due to the nature of their behaviour or crimes (Sturgess et al., 2016). This is an extremely common barrier to treatment that often discourages young people from opening up and completing treatment programs. Hence, young offenders have expressed that having a clinician who displays empathy, humour and a genuine approach is comforting, which promotes a strong therapeutic alliance and engagement in treatment (Papalia et al., 2022).
* Time to reflect
* Think about a time when you felt judged or misunderstood in a challenging situation. How did that impact your willingness to address the issue?
* Did you avoid discussing it because you were afraid of how others might perceive you?
* Did you isolate yourself or feel frustrated because no one understood you?
* Did you perhaps question your ability to make good decisions?

### Denial

Denial or minimisation of problematic behaviour is also a significant barrier to treatment motivation and engagement (Sturgess et al., 2016). Those in denial that their actions are problematic are more likely to refuse treatment, especially if they feel it was forced upon them or they were not provided with much information about what the treatment process will look like (Sturgess et al., 2016). In their study of 34 families with justice-involved children and their treatment providers, Elkington et al. (2020) found that the offender’s families or caregivers also often minimise the true impacts of their child’s behaviour, often driven by the belief that their child can "do no wrong" (Elkington et al., 2020). More so, distrust in the system was also identified as a barrier, with many families hesitant to engage due to negative experiences in the past and fears of negative outcomes, such as children being separated from their family (Elkington et al., 2020).

### Poor treatment perception

Finally, poor treatment perception is another prominent factor in research which has been found to decrease treatment motivation (Carl et al., 2020; McBrayer et al., 2024). During interviews of justice involved youth, McBrayor et al. (2024) found that a significant amount of individuals report that treatment is unnecessary, and that they are able to overcome problems independently (McBrayer et al., 2024). Motivation was also low in individuals who were sceptical about the usefulness of treatment, often expressing that treatment programs do not address or relate to real-life challenges (McBrayer et al., 2024). Consistent with the TTM model, it has also been found a mismatch between the treatment program and the offender’s learning style, cognitive capacity and level of readiness to change can cause even highly motivated individuals to feel strained, out-of-place, or even bored, leading to treatment disengagement (Carl et al., 2020; Hashemzadeh et al., 2019).

## Strategies to enhance treatment motivation

When it comes to enhancing treatment motivation, motivational interviewing (MI) is the most prominent in research literature (Pederson et al., 2021). Along with MI, increasing treatment satisfaction by tailoring treatment approaches to the individuals cognitive and personal needs, as well as nurturing social support and involving family in the recovery process where feasible have been shown to increase an individual's motivation and commitment to treatment (Creaney, 2014; van der Helm et al., 2014).

### Motivational interviewing

MI is a counselling approach which focuses on reducing resistance to treatment and drawing out an individual's own goals and motivations for change (Pederson et al., 2021). It is a client-centred approach which encourages individuals to identify and express their reasons for contemplating behaviour changes, a concept often referred to as "change talk" (Pederson et al., 2021). It also emphasizes that clinicians can actively influence a client’s motivation and guide them towards prosocial behaviour, rather than expecting an individual to already have a certain level of readiness (Kennedy & Gregoire, 2009).
The stages of change model also emerged alongside MI and has become a tool for assessing progress and readiness in MI interventions (Kennedy & Gregoire, 2009). For instance, individuals in the precontemplation stage of the TTM may respond better to MI as it can prompt and elicit motivation to change, compared to approaches such as cognitive-behavioural therapy (CBT). This is because CBT assumes at least some level of awareness about the problematic behaviour, which may not be present in those still in the precontemplation stage (Casey et al., 2010). Therefore, by focusing on eliciting and exploring reasons for change, MI can be more effective in initiating the intention to change for unmotivated individuals (Casey et al., 2010).
However, while MI has been found to be quite effective for justice-involved individuals, predominantly for substance abuse, very few controlled studies about MI have been conducted in correctional settings and more evidence is needed in this area (Stein et al., 2020).
* Example:
* After his run-in with the police, Alex's parents suggested he see a psychologist. Initially, he hated the idea, but eventually agreed in order to get his parents off his back. Alex was afraid of being judged by the psychologist and struggled to open up in their first few sessions. Despite his reluctance, his therapist employed motivational interviewing, and helped Alex recognise that finishing high school and considering further education was important to him. He expressed that he wanted to pursue a career in the arts, which required him to maintain a stable and healthy lifestyle. He also identified wanting to work on his relationships with family and friends, who were worried about him. By clarifying these goals, Alex's motivation strengthened as he began to realise how his behaviour could impact his personal goals and future.

### Control and tailored approaches

Control and tailored approaches are also common strategies to increase treatment motivation (Sturgess et al., 2016). Increased treatment motivation in young offenders has been linked to autonomy and control, whereby when individuals are involved in decision-making and treated with respect, it is more likely that they will engage with treatment and develop the motivation to change (Creaney, 2014; Sturgess et al., 2016). This is especially important in the case that an individual is detained or treatment is mandated by the court as choice and control are removed to a large extent, which can decrease intrinsic sources of motivation (Sturgess et al., 2016). Involving individuals in the process and direction of treatment is a great way to remedy this issue and increase their self-esteem (Creaney, 2014). As outlined by SDT, this is because participation and autonomy fosters a feeling of ownership and responsibility, making young people more invested in their treatment outcomes (Creaney, 2014).

### Family and community involvement

Finally, individuals who have social support from family and peers have been found to have better treatment retention, outcomes and better abilities to cope with difficult situations (Zwecker et al., 2018). Treatment programs that work to reconnect families and involve parents in the treatment process are also shown to increase treatment completion and decrease relapse or reoffending (Simons et al., 2017). In designing a family-centred care programme for adolescents in short-term stay groups in Dutch juvenile justice institutions, Simons et al. (2017) found that implementing structured communication between treatment facilitators and parents contributed to retention and treatment completion. Communication strategies included providing regular progress updates to parents, conducting family therapy sessions and family activities (Simons et al., 2017). This was likely effective because positive relationships with family, mentors, and friends can be protective, while associations with other offenders can worsen criminal or antisocial behaviour (Zwecker et al., 2018). Although it is important to note that some relationships can have negative outcomes due to poor family trust and dynamics, positive family engagement often helps young offenders stay accountable to treatment and court obligations, provides protection, guidance, and emotional support (Simons et al., 2017). Family involvement can also reinforce the value of treatment and aids in a smooth transition back home if the individual was involved in placement or detention (Zwecker et al., 2018).
Quiz
1
The effectiveness of a treatment program for juveniles largely depends on the individual's motivation to participate:
True
False
2
Treatment motivation is primarily influenced by external factors such as legal consequences and family pressure:
True
False
3
Juveniles with high self-efficacy are more likely to engage in and benefit from treatment programs:
True
False :

## Conclusion

Treatment motivation is crucial for justice involved youth as it determines their level of engagement and commitment, and influences the outcome of treatment programs (van der Helm et al., 2018). However, there are many individual, environmental and psychological factors which can act as barriers to motivation including a lack of self-efficacy, denial, and poor perceptions of treatment effectiveness (Carl et al., 2020). Fortunately, there are many theoretical models including self-determination theory and the transtheoretical model that provide insight into human motivation, and inform strategies which clinicians and treatment facilitators can implement to help increase motivation (Ryan & Deci, 2020; van der Helm et al., 2018). These strategies include motivational interviewing, which helps identify and draw out personal goals and reasons for changing, which is useful when first initiating treatment (Pederson et al., 2021). More so, involving the individual in decision-making, tailoring treatment programmes to their specific needs and facilitating social support from family and friends gives individuals a sense of autonomy and understanding, motivating them to engage and remain in treatment for longer (Coviello et al., 2013; Creaney, 2014)[improve clarity]. Simply initiating treatment for negative behaviour does not mean that it will result in a positive outcome. In order for treatment to be effective, the individual must recognise that there is a need for change and be motivated to take action to change their negative behavioural patterns.