Does readiness to change predict in‐session motivational language? Correspondence between two conceptualizations of client motivation

Abstract

Client language reflecting motivation for changing substance use (i.e. change talk) has been shown to predict outcomes in motivational interviewing. While previous work has shown that change talk may be elicited by clinician behaviors, little is known about intrapersonal factors that may elicit change talk, including clients' baseline motivation for change. The present study tested whether in-session change talk differs between clients based on their readiness for change. First-session audio recordings from Project MATCH, a large multi-site clinical trial of alcohol treatments. Project MATCH out-patients (n = 69) and aftercare patients (n = 48) receiving motivational enhancement therapy (MET). Client language from first-session MET was coded using the Sequential Code for Observing Process Exchanges. Readiness and stages of change were assessed using both categorical and dimensional variables derived from the University of Rhode Island Change Assessment and the Stages of Change Readiness and Treatment Eagerness Scale, administered prior to first treatment sessions. Stage of change scales followed some of the expected correspondence with change talk, although the associations were generally small in magnitude and inconsistent across measures and treatment arms. Higher overall readiness did not predict more overall change talk, contemplation had mixed associations with preparatory change talk, and preparation/action did not predict commitment language. Motivational language used in initial sessions by people receiving counselling for excessive alcohol consumption does not appear to be associated with readiness to change as construed by the Transtheoretical Model.