Client Language Research Articles

Learning & motivational talk in smoking cessation interventions: An examination of session language in two randomized trials

ObjectivesMotivational Interviewing (MI), a client-centered approach that seeks to evoke and resolve ambivalence, and health education (HE), which provides health information and advice, may both provide some benefit to unmotivated smokers. In HE, it is possible that client language reflective of new learning, or “learning talk” (LT), and rejection of health advice, or “rejection talk,” (RT), may uniquely reflect intent of subsequent behavior change. MethodsThis project utilized MI and HE sessions from two randomized clinical trials (RCTs), one in a low-income, diverse community civilian sample of 255 unmotivated smokers, and the other in a sample of Veterans with mental illness who were unmotivated smokers (n = 55).Mixed methods approaches were utilized to reliably code sessions using the Motivational Interviewing Skill Code 2.5 (MISC 2.5)1 and a refined Learning Talk coding system2. ResultsReliability of LT and RT codes ranged from fair to excellent (ICCs from 0.43–0.93). ConclusionLT appears to be a unique construct and its impact on post-session changes in smoking is warranted. Practice implicationsThis system can be used in a study to code existing interventions for smokers using both MI and HE techniques and relate in-session client LT to subsequent smoking behaviors.

Why Motivational Interviewing Is a Person-Centered Approach

Abstract: Background: The original developers of motivational interviewing (MI) describe the foundation of their therapeutic method in the person-centered tradition of Carl Rogers. Although MI is sometimes interpreted as a cognitive-behavior therapy (CBT), it did not derive from learning theory and has from the beginning been understood and expounded as a person-centered approach (PCA). Method: Narrative and conceptual review. Results: As with Rogers’s original method, the development of MI has been guided by empirical science based on the close observation of clinical practice. It is a behavioral approach in the broad sense of behavioral science. The underlying attitude or spirit with which MI is practiced is unambiguously humanistic in emphasizing partnership, acceptance, compassion, and empowerment. MI focuses on specific observable elements of therapeutic relationship that predict better client outcomes. Various behavioral scientists have distinguished MI from CBT both conceptually and with distinct clinical procedures. The psychological content of MI overlaps substantially with PCA practices such as accurate empathy and also with therapist skills often described as common or nonspecific factors in psychotherapy. Its component processes are engaging, focusing, evoking, and planning. The evoking process of MI distinguishes it from both CBT and nondirective PCA, involving MI-specific technical skills focused on specific client language known as change talk and sustain talk. Conclusions: Like PCA more generally, MI has found broad applications in helping professions well beyond counseling and psychotherapy such as health care, education, pastoral care, conflict resolution, and leadership. Possible historic reasons for confusing MI with CBT are explored.

APPLICATION OF LEARNING TO LISTEN METHOD TO PATIENT WITH DYSAUDIA

Dysaudia is a speech disorder associated with auditory feedback problems, which can occur due to hearing loss. Articulation is an important part of speech, and children with hearing problem need immediate help to improve their slow pronunciation skills due to hearing loss. One method of treating deaf children is to Learning to Listen. By relying on the remaining hearing, this method aims to help children detect sounds and associate sounds with objects. Methods: One-subject experiment, using a one-group pre-post test design. The participant was an 8-year-old boy with hearing loss who received speech therapy. Data were collected through interviews with the client's mother, direct observation of the client, tests, and study document. Speech therapy was conducted in 10 sessions by training the client receptive language at the word level. Comparing the client's language acquisition ability before and after therapy. Results: In the evaluation after speech therapy, there was an increase of 100% Conclusion: The listening training method is considered effective in improving the receptive language skills of children with hearing problem Recommendations: To find out whether the Learning to Listen Method is effective in improving pronunciation skills in deaf children, it is hoped that additional research can be carried out on this method.

How do women talk about self-funded breast cancer genetic testing?: Small stories and stance-taking strategies.

Genetic testing for breast cancer genes is an experience which is inextricably linked with health communication practices and the broader social context in which it occurs. Linguistic approaches can provide perspective on how women seeking self-funded BRCA1/2 gene testing represent their experiences, knowledge, roles, choices and emotions through the way they talk. A discursive constructionist epistemology and narrative theoretical framework informed the applied linguistics methodology. Analysis of 'small stories' and stance-taking was performed on eight transcripts of audio-recorded telephone interviews with women at low to moderate risk of carrying BRCA1/2 pathogenic variants who self-funded genetic testing. We found a high prevalence of 'small stories' including accounts of events, hypotheticals, habitual narratives, and stories which combined multiple genres. Stance-taking was a means by which participants constructed personal identities in the conversational context, such as that of a responsible person. Via stance-taking strategies, participants also actively negotiated the conversational agenda, for example expressing different degrees of alignment with the interviewer's orientation towards emotions. This study provides a basis for recognizing linguistic markers in genetic counseling interactions about genetic testing for breast cancer genes. Enhanced awareness of client language choice, and the ways in which small stories and stance can signify the client's evaluation of experience and choices, alignment with the genetic counselor's questions/statements, and investment in the conversation, has potential to improve the therapeutic interaction.

‘I’m sure at some point we’ll be switching’: planning and enacting an interview language policy with multilingual participants

ABSTRACT When conducting interviews with multilinguals, researchers make (often invisible) decisions about the interview language(s). Whilst the research design may require a particular approach in some cases, linguists generally recommend giving participants a choice or interviewing them in their first language. There are ethical and methodological reasons for considering this, such as the implications for self-expression – including emotion communication – and therefore data generation and analysis. This paper offers methodological reflections about planning and conducting a research interview in which the researcher and participant knowingly share two languages, shining a light on the process of building linguistic flexibility into a study. The case study is an interview conducted in French and English, which explored a bilingual client's language use in psychotherapy. The paper gives practical insights into offering a choice of language(s) and planning for the possibility of a multilingual interview (i.e. code-switching). It considers how to mitigate language insecurities before illustrating how the interview language(s) may be negotiated in interaction. I argue for researchers to set clear interview language policies which foreground inclusivity, and show in the process that interviews can become multilingual exchanges, in which both interlocutors experience linguistic freedom.

Centering and decentering client disclosures: A qualitative study of therapists' responses to clients' experiences of discrimination.

Clients who are societally marginalized because of their identities may seek support from therapists to process experiences of discrimination and oppression. Therapist navigation of these cultural conversations is a crucial skill. However, there is limited research examining how therapists immediately respond to clients when they disclose experiences of discrimination. In this study, 66 participants watched two brief videos of fictitious clients disclosing experiences of covert and overt discrimination. Participants watched one of two video vignettes, with one focusing on a White lesbian woman client and another focusing on a Black woman client. After watching each video, participants were asked to respond to clients as if they were the clients' therapist. We used reflexive thematic analysis to code participant responses, which spanned three themes: (a) invalidation and decentering of client's emotions, appraisals, and experiences; (b) incongruence and avoidance of client's language around identities; and (c) empathic attunement and centering of client emotions, appraisals, and experiences. While some participant responses were interpreted as emotionally aligning with the client, other participant responses were coded as minimizing or questioning client experiences of discrimination or using language incongruent with how the client self-identified. We discuss implications for research, training, and practice in navigating conversations about discrimination with psychotherapy clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward Causal Understanding of Therapist-Client Relationships: A Study of Language Modality and Social Entrainment.

The relationship between a therapist and their client is one of the most critical determinants of successful therapy. The working alliance is a multifaceted concept capturing the collaborative aspect of the therapist-client relationship; a strong working alliance has been extensively linked to many positive therapeutic outcomes. Although therapy sessions are decidedly multimodal interactions, the language modality is of particular interest given its recognized relationship to similar dyadic concepts such as rapport, cooperation, and affiliation. Specifically, in this work we study language entrainment, which measures how much the therapist and client adapt toward each other's use of language over time. Despite the growing body of work in this area, however, relatively few studies examine causal relationships between human behavior and these relationship metrics: does an individual's perception of their partner affect how they speak, or does how they speak affect their perception? We explore these questions in this work through the use of structural equation modeling (SEM) techniques, which allow for both multilevel and temporal modeling of the relationship between the quality of the therapist-client working alliance and the participants' language entrainment. In our first experiment, we demonstrate that these techniques perform well in comparison to other common machine learning models, with the added benefits of interpretability and causal analysis. In our second analysis, we interpret the learned models to examine the relationship between working alliance and language entrainment and address our exploratory research questions. The results reveal that a therapist's language entrainment can have a significant impact on the client's perception of the working alliance, and that the client's language entrainment is a strong indicator of their perception of the working alliance. We discuss the implications of these results and consider several directions for future work in multimodality.

The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults

IntroductionMotivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DataData are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. MethodThe study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment – Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. ResultsThe pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. ConclusionsAnalyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.

A Mixed-Method Comparison of Therapist and Client Language across Four Therapeutic Approaches

This paper illustrates a methodological approach that combines computerized text analysis, quantitative analysis, and qualitative discourse analysis in comparing large bodies of therapeutic language. More specifically, it explores how language use in psychotherapy is associated with different therapeutic approaches and therapeutic roles (i.e., therapists and clients). The dataset consisted of 155 therapeutic sessions (over 1,057,000 words) that are illustrative of four approaches, i.e., psychoanalysis, humanistic therapy, Cognitive Behavioral Therapy (CBT), and eclectic therapy. The transcripts were divided according to therapeutic approaches and therapeutic roles and processed using Linguistic Inquiry Word Count (LIWC) in terms of four summary variables, i.e., analytical thinking, clout, emotional tones, and authenticity. A series of mixed-effects models with session as the random effect was fitted, and the statistical patterns were illustrated using linguistic examples and discussed from a discourse analytic perspective. The approach demonstrates methodological strengths in exploring large-scale data and expanding the research scope permitted by traditional discourse analysis. The findings underline professional knowledge and institutionalized roles as key factors influencing the use of therapeutic language, providing meaningful insights for the clinical understanding and future research into therapeutic language.

Differential mechanisms of change in motivational interviewing versus health education for smoking cessation induction.

Objective: To determine if Motivational Interviewing (MI) versus health education (HE) elicited different types of client language and whether these differences were associated with outcomes in a randomized clinical trial (RCT) for cessation induction among people who smoke with low motivation to quit. Methods: A secondary data analysis was conducted using data from the MI and HE arms of a trial in which people who smoke (N = 202) with low desire to quit were randomly assigned to four sessions of MI, HE or brief advice. Mediation analyses examined two types of client language: change talk (CT) and a novel form of client speech called "learning talk" (LT). Outcomes were assessed at baseline, 3 and 6 months. Results: With HE as the reference group, MI resulted in greater CT (OR = 3.0, 95% CI: 1.7-5.5) which was associated with better outcomes (average d = .34, SD = .13) and HE resulted in greater LT (OR = .05, 95% CI: .02-.10) which was also associated with better outcomes (average d = .42, SD = .08). Indirect parallel mediation effects on quit attempts were significant for both MI-CT (OR = 1.4, 95% CI: 1.1-1.7) and HE-LT (OR = .4, 95% CI: .2-.7). Conclusions: MI and HE were both efficacious via different pathways to change, confirming the utility of MI in this RCT as well as highlighting the potential of HE based on the "5R's" for smoking cessation. These findings emphasize the value of exploring theorized mechanisms of action of interventions evaluated in RCTs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Windows of cultural opportunity: A thematic analysis of how cultural conversations occur in psychotherapy.

A cultural opportunity is 1 of 3 pillars within multicultural orientation framework; it is defined as a moment in therapy when aspects of a client's background emerge, which can be deeply explored to better understand the salient aspects of a client's cultural identities. Research on cultural opportunities provides evidence that clients desire cultural conversations. However, no study to date has examined what cultural opportunities sound like in therapy and how therapists and clients utilize these opportunities. Accordingly, the purpose of this study was to examine the ways in which cultural conversations emerge during the first psychotherapy session and how clients and therapists engage in these cultural conversations. Psychotherapy sessions from diverse therapist-client pairings at a university counseling center (n = 22) were analyzed using (reflexive) thematic analysis. Qualitative findings revealed 4 themes around how cultural opportunities emerge (e.g., windowpane of feeling) and 3 themes in how they are responded to (e.g., look out the same window: using client's language to explore culture). Implications for therapist training and supervision are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Performance of Korean-English bilinguals on an adaptation of the screening bilingual aphasia test.

The use of standardized tests specifically designed for and normed on bilingual groups is crucial for the accurate diagnosis and language profiling of bilingual speakers with aphasia. Currently, there is a dearth of norms and supporting psychometric data for the few available bilingual aphasia assessments. The only available aphasia test for Korean-English (KE) bilinguals is the Korean-English Bilingual Aphasia Test (KE-BAT). The absence of bilingual normative data for the KE-BAT limits its clinical and research utility. (1) To revise the original screening KE-BAT to clarify ambiguities in its instructions and stimuli; and (2) to examine subtest and item performance across the two languages for the revised screening KE-BAT with a local sample of highly proficient KE bilinguals. The original screening KE-BAT was first revised to replace unrecognizable drawings, address ambiguities in the instructions and stimuli, and increase the number of items on naming subtests. This revised test is henceforth referred to as the adapted screening KE-BAT (AS KE-BAT). A total of 21 neurologically healthy, highly proficient and college-educated KE bilinguals (19-34 years old) were recruited from a large city in the United States. Participants completed three measures of language proficiency and the AS KE-BAT including the KE translation test (Part C). Total and subtest scores were compared across the two languages, and individual item accuracy was calculated. Incorrect responses of low scoring items were examined. Performance was comparable across Korean and English for all subtests, except for the spontaneous speech subtest. The item accuracy of 17 items (7% of total items) in the AS KE-BAT fell to < 80%, and four items (1.6% of total items) had an accuracy < 60%. Incorrect responses of low scoring items were caused by phoneme misperception, lexical substitution and morphosyntactic L2 patterns. The results of the study highlight the importance of empirically examining the performance of neurotypical bilinguals on bilingual aphasia assessments to establish their psychometric properties. Based on the small-sized local bilingual normative sample obtained in this study, appropriate cut-off criteria, recommendations for clinical interpretation and further modifications of the AS KE-BAT are proposed. What is already known on the subject The pair of English and Korean aphasia assessments (e.g., Western Aphasia Battery-Revised; WAB-R) (Kertesz 2012) and Korean Western Aphasia Battery (Kim and Na 2001) cannot be used to assess language impairments in KE bilinguals with aphasia since these tests have not been designed for and normed on the bilingual group. Clinical utility of the Korean-English Bilingual Aphasia Test (KE-BAT), which is the only resource currently available to assess KE bilinguals with aphasia, is greatly compromised by the lack of KE bilingual normative data. What this study adds to existing knowledge This study provides cut-off scores, comparability of test performance and item difficulty metrics and it identifies additional ways in which items and spontaneous speech scoring of the adapted screening KE-BAT (AS KE-BAT) could be modified. Suggested guidelines allow improved interpretations of the linguistic performance of local KE bilinguals with aphasia who have a similar demographic and linguistic background. What are the potential or actual clinical implications of this work? The AS KE-BAT with cut-off criteria of 95% for Part B and 80% for Part C is suitable for the language assessment of highly proficient and young KE bilinguals with a high level of education and it yields comparable performance across the two languages. Clinicians may decide to adjust spontaneous speech scoring criteria if the client's language history is suggestive of code-switching and use the item difficulty data to guide test item selection for this group of bilinguals.

Motivational Interviewing Produces Change Talk in Smokers with Serious Mental Illness

Objective Change talk, or client language that is consistent with making a behavioral change, has been found to improve the efficacy of motivational interviewing (MI). It is not known, however, if change talk helps to explain MI’s effect on instigating a quit attempt in smokers with serious mental illness. Methods: We measured change talk in smokers with a serious mental illness (SMI) randomized to receive either a single session adaptation of motivational interviewing or an interactive education intervention. We evaluated relationships between treatment condition, proportion of change talk, and study outcomes of quit attempts and willingness to follow up on treatment provider referrals. Results: Participants receiving the adaptation of motivational interviewing had higher proportions of change talk than participants in the interactive education condition. However, total proportion of change talk did not mediate the relationship between treatment and outcome, nor did it predict making a quit attempt or following up on a referral to contact a treatment provider. Conclusions: Our study found that motivational interviewing has the same change talk augmenting effect in individuals with SMI as those without SMI. Given that anhedonia, negative affect, and depressive symptoms are a major part of serious mental illnesses, it is encouraging that MI can generate change talk in this population. Future smoking cessation intervention trials with larger samples should investigate whether greater amounts of change talk lead to increased quit attempts in this population.

Integration of motivational interviewing and behavioral economic theories to enhance brief alcohol interventions: Rationale and preliminary examination of client language.

Motivational interviewing (MI) is a widely disseminated evidence-based therapeutic approach for engaging clients and motivating health behavior change, especially risky substance use. Refinement of MI theory over the past few decades has provided empirical evidence that the technical component of MI (in-session client language) is a promising mechanism of behavior change (MOBC). However, heterogeneous and small to moderate effect sizes suggest the need for refinement of MOBC measurement and consideration of other types of client language. The current article presents a complementary integration of current MI theory and behavioral economic (BE) mechanisms to further understanding of in-session factors associated with subsequent behavior change. In this paper, we define some of the key MOBCs from MI and BE theories, describe our integrated framework, and present preliminary findings from a pilot study of the effectiveness and MOBCs of a novel BE-informed application of MI in risky college student drinkers. Results from preliminary coding development suggest that BE-informed measures of client language better predict response to a brief intervention in risky college students than traditional change talk measures. We posit that BE theory can offer insight into meaningful session content beyond the current MI constructs of change talk and sustain talk, which in turn may serve to enhance development of clinical practice and inform scientific investigations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Multimodal Automatic Coding of Client Behavior in Motivational Interviewing.

Motivational Interviewing (MI) is defined as a collaborative conversation style that evokes the client's own intrinsic reasons for behavioral change. In MI research, the clients' attitude (willingness or resistance) toward change as expressed through language, has been identified as an important indicator of their subsequent behavior change. Automated coding of these indicators provides systematic and efficient means for the analysis and assessment of MI therapy sessions. In this paper, we study and analyze behavioral cues in client language and speech that bear indications of the client's behavior toward change during a therapy session, using a database of dyadic motivational interviews between therapists and clients with alcohol-related problems. Deep language and voice encoders, i.e., BERT and VGGish, trained on large amounts of data are used to extract features from each utterance. We develop a neural network to automatically detect the MI codes using both the clients' and therapists' language and clients' voice, and demonstrate the importance of semantic context in such detection. Additionally, we develop machine learning models for predicting alcohol-use behavioral outcomes of clients through language and voice analysis. Our analysis demonstrates that we are able to estimate MI codes using clients' textual utterances along with preceding textual context from both the therapist and client, reaching an F1-score of 0.72 for a speaker-independent three-class classification. We also report initial results for using the clients' data for predicting behavioral outcomes, which outlines the direction for future work.

Client and Therapist Psychotherapy Sentiment Interaction Throughout Therapy

Examining language used in psychotherapy can provide benefits for therapy outcomes and understanding therapeutic processes. Sentiment analysis is a type of content analysis using Natural Language Processing that can be applied to analyze the degree of positive or negative sentiment of therapist and client language in actual therapy sessions. Therapy transcripts were coded for degree of positive and negative sentiment at each exchange between therapist and client. Hierarchical linear models were constructed to evaluate change in sentiment within and across therapy sessions and the relationship between therapist and client sentiment. Results indicate that there was significant interaction effect, with increases in positive sentiment across therapy sessions, while positive sentiment tended to decrease within sessions. There was also found to be no difference, and instead significant correlation, between therapist and client sentiment in therapeutic dialogue over time, suggesting that client and therapist sentiment seemed to correspond over time.

Collaborative Case Conceptualization: Client Knows Best

There appears to be a link between high-quality case conceptualization and therapy outcomes. Unfortunately, case conceptualization is a complex skill that appears to lag behind other cognitive-behavioral therapy skills development. Two simple forms of case conceptualization are illustrated that could prove easy for therapists to learn. As an added benefit, they collaboratively engage clients in their construction, which can lead to greater client understanding, empowerment, and treatment adherence. Each offers a better understanding of presenting difficulties using client language and provides a platform to collaboratively devise treatment plans. The five-part model can be used with any combination of client issues to broadly describe current difficulties in terms of links among thoughts, behaviors, physical reactions, moods, and environmental/situational factors. A second model, called “box/arrow in/arrow out,” helps clients identify triggers and maintenance factors for specific issues of concern. Each model is illustrated with a case example and discussion of how client strengths can be linked with that model of case conceptualization and the treatment plans that follow. To make it easier for therapists to learn and apply these conceptualization approaches, this article details the steps involved in each and highlights standard therapist questions and statements that can be used to prompt client engagement in co-construction of these models.

Rolling with resistance: A client language analysis of deliberate practice in continuing education for psychotherapists

AbstractContinuing education workshops have been criticised for focusing on knowledge rather than skill acquisition by a focus on didactic teaching methods. A recent randomised controlled trial conducted by Westra et al. (2020) demonstrated that a deliberate practice (DP) training workshop for responding to ambivalence and resistance resulted in longer‐lasting skill acquisition than the same workshop in a traditional, more didactic format. The present study examined whether this same DP workshop was also efficacious at the level of client motivational language in 4‐month post‐testing interviews used to assess trainee skill in the Westra et al. parent study. Sixty therapists from the community (30 = DP and 30 = traditional) conducted an interview with either an ambivalent simulator or an ambivalent community volunteer. Interviews were coded for interviewee motivational language using the Motivational Interviewing Skills Code (MISC 1.1; Glynn &amp; Moyers, 2009). Counterchange talk (CCT) was further classified into either Ambivalent‐CCT (uttered to disclose conflict about change) or Resistant‐CCT (statements against change uttered to oppose the therapist). Results revealed a significant difference between training groups, with the DP group eliciting less Resistant‐CCT than the traditional training group. This study provides further support for the use of DP training for potentially creating more productive conversations by minimising Resistant‐CCT; a form of speech that has been found to be negatively associated with client outcomes.

Development of a Model Architecture for Job Scheduling

Job scheduling has a long history. Job schedulers have been one of the major component of IT infrastructure since the early mainframe system, at first, stacks of punched cards were processed one after the other, hence the term batch processing. The aim of a job scheduler was to arrange, control and optimize work and workload in a production process. The study aimed at achieving a job scheduler that can assign jobs to available resources in such a way that workload leveling can be achieved. The objectives of the study included to; ascertain the existing schedule system, design a model platform for job scheduling, implement the model platform for job scheduling, and test and deploy the model platform for job scheduling. The study adopted the spiral development model. The proposed system was developed using java script which is a client scripting language which is used for creating web and windows application and it has almost all online application since the system is an online system. The developed application was tested with field Meta data and the outcome was according to specification and of desired output. The application was hosted on three different servers, one server for the frontend, another server for the backend and the third server for the database, hosting on the three different servers did the magic by making the system faster and easy to optimize.

Dairy veterinarians’ skills in motivational interviewing are linked to client verbal behavior

Veterinarians often give advice in a persuasive form, a style that has been shown to evoke resistance to change in clients experiencing psychological ambivalence (i.e. those who see both advantages and disadvantages to changing). With this style of communication, veterinarians run the risk of counteracting their purpose to encourage clients to follow recommendations. Motivational interviewing (MI) is a client-centered communication methodology that aims to facilitate clients’ internal motivation to change. In MI, Change Talk represents clients’ own statements expressing consideration of, motivation for or commitment to behavior change and has been shown to be strongly correlated with behavior change. Sustain Talk is corresponding statements related to maintaining the status quo. The aim of this exploratory study was to evaluate the potential of MI to facilitate behavior change in veterinary herd health management (VHHM) by investigating the effect of dairy cattle veterinarians’ MI skills on client Change and Sustain Talk. We recorded VHHM consultancies on 170 Swedish cattle farms performed by 36 veterinarians, randomly distributed into 2 groups: MI veterinarians (n = 18) had received 6-month training in MI and control veterinarians (n = 18) had not received any training. Veterinarians’ MI skills were assessed using the Motivational Interviewing Treatment Integrity coding system 4.2.1 and categorized as poor_untrained, poor_trained, near moderate and moderate. Client communication was coded using the Client Language Easy Rating coding system. The effect of MI skills on Change Talk, Sustain Talk and Proportion of Change Talk (Change Talk divided by the sum of Sustain Talk plus Change Talk) was investigated using cross-classified regression models with random intercepts for veterinarian and client (farm). The models also included additional explanatory variables (e.g. type of veterinarian and client’s satisfaction with the consultation). The veterinarian’s MI skills were associated with the client’s Change Talk, but results regarding Sustain Talk or Proportion of Change Talk were inconclusive. Clients of veterinarians reaching the highest (i.e. moderate) MI skills expressed 1.5 times more Change Talk than clients of untrained veterinarians. Clients of general large animal practitioners expressed less Sustain Talk than clients of animal health veterinarians and had higher Proportion of Change Talk. Results indicate that learning to practice MI may be one means to improve adherence to veterinary recommendations and to improve efficiency in VHHM services.