Dealing with resistant and risk-taking youth can be a special challenge for the child and adolescent mental health specialist. It may be particularly difficult to motivate change when the young patient is engaged in behaviors, such as substance abuse, sexual risk-taking, or driving fast cars, that are positively reinforced by social, developmental, or biological conditions. Motivational interviewing (MI) is an effective approach for raising problem awareness and facilitating change exploration with individuals who may be resistant, stuck, or not yet "ready" to make behavioral changes. MI uses a client centered, collaborative approach that follows a particular set of principles and uses a certain set of skills and techniques (Miller and Rollnick 1991). While MI has been primarily studied with adults, it is now being used with children and adolescents seen in a variety of settings including pediatric practice, schools, juvenile justice settings, and emergency rooms (Feldstein and Ginsburg 2006).