Motivational Interviewing Spirit Research Articles

Assessing REflective simulation-based e-Training on motivational interviewing among multidisciplinary healthcare practitioners [RESeT-MI]: a mixed methods pilot study

BackgroundMany health science curricula have integrated behavioral modification techniques in their plans. Motivational Interviewing is one such technique. Educational interventions to promote Motivational Interviewing have had limited success. Integrating simulation-based learning in health science curricula might offer a platform whereby students can train in well controlled environments with increased authenticity, provision of standardized experiences and the capacity for immediate feedback to participants. Using motivational interviewing as an exemplar, the purpose of this study was to assess the impact of a simulation-based reflective e-training program on knowledge, attitudes, and confidence in Motivational Interviewing among healthcare practitioners from diverse healthcare disciplines. A secondary aim was to explore whether self-reflection can promote reflective learning.MethodsThis was a mixed-method study design. Fifteen participants from different health disciplines were included in the quantitative phase of the study, the simulated interview, and the reflective assignments while five participated in the focus group. Pre and post tests were used to examine the effect of training on knowledge, attitudes, and confidence in Motivational Interviewing. Assessment of Motivational Interviewing Treatment Integrity [MITI] scores in a simulation-based scenario was used. A qualitative content analysis of a focus group provided a more in-depth understanding of the participants experiences. Excerpts from reflective assignments were analyzed using Transformative Learning Theory concepts.ResultsA Wilcoxon test showed that the training elicited a change in confidence in performing Motivational Interviewing [Z= -2.766, p = 0.006], median scores increased from 29 to 34. A quarter of technical scores and half of the relational scores indicated good competence. Participants reflected content transformation through feelings of empowerment and satisfaction when they were successful in engaging and motivating clients. Process transformation was evident in reflections on how to improve core skills specifically reflective listening. Reflections on Motivational Interviewing spirit related values showed premise transformation, which may indicate attitude changes.ConclusionA simulation-based e-training program on Motivational Interviewing represents an important educational modality for training in the health disciplines. Results of this study provide evidence supporting the integration of reflective simulation-based e-training into the education curricula of health disciplines in MI and beyond.

Virtual Motivational Interviewing (VIMINT) to support physical activity: Experiences of older adults and counsellors.

The aim of this study was to explore the experiences of older adults and counsellors involved in virtual motivational interviewing (MI). This study was part of the Virtual Motivational INTerviewing (VIMINT) feasibility trial of virtual MI for physical activity in older adults. A descriptive qualitative design utilized content analysis. Seven older adults and three counsellors were interviewed. Four categories were developed: (i) Benefits and limitations of using technology (ii) Relationships between older adults and counsellors (iii) MI skills and spirit and (iv) Effects of virtual MI. Older adults and counsellors reported that receiving/delivering MI virtually was convenient and flexible. They described reduced non-verbal communication in virtual MI. Virtual MI facilitates interpersonal relationships, and counsellors reported that MI skills and spirit can be applied virtually. This study showed that virtual MI offers potential benefits with some limitations. The findings could inform future research involving virtual delivery of MI.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

Motivational interviewing experiences from a community health worker-led HIV prevention and care intervention in rural Uganda: a qualitative study

ABSTRACT Motivational Interviewing (MI) and Community Health Workers (CHWs) are increasingly utilized in global settings to improve HIV outcomes, yet research exploring implementation strategies using MI and CHWs is lacking. We examined the experiences of CHWs and their clients in a counseling intervention which used MI-informed counseling to increase engagement in HIV prevention and treatment. This study was nested within the mLAKE cluster-randomized trial in a high HIV prevalence fishing community in rural Rakai District, Uganda. We conducted in-depth interviews with purposively-sampled CHWs (n = 8) and clients (n = 51). Transcripts were analyzed thematically to characterize CHWs’ implementation of the intervention. Main themes identified included use of specific MI strategies (including evocation, guidance towards positive behavior change, active listening, and open-ended questions), and MI spirit (including collaboration, power-sharing, trust, and non-judgmental relationship building). Through these specific MI mechanisms, CHWs supported client behavior change to facilitate engagement with HIV services. This study provides evidence from a low-resource setting that CHWs with no previous experience in MI can successfully implement MI-informed counseling that is well-received by clients. CHW-led MI-informed counseling appears to be a feasible and effective approach to increase uptake of HIV prevention and care services in low-resource, HIV endemic regions.

Veterinary communication can influence farmer Change Talk and can be modified following brief Motivational Interviewing training.

Current veterinary communication skills training often focuses on the strategies necessary to successfully transfer information and promote shared decision making rather than inspiring client motivation to engage in behaviour change(s). One evidence-based communication methodology with a specific focus on enhancing conversations about change is Motivational Interviewing (MI), which is perceived by veterinarians to be highly relevant to their profession. We examined whether veterinarians who experienced brief (4–5 hours) MI training (BMIT) were able to change their communication behaviours to be more MI consistent. Fourteen veterinarians recorded 31 veterinary herd health consultations before (n = 15) and after (n = 16) BMIT to allow pre-post intervention analysis of veterinarian and farmer verbal behaviour. Additionally, using a sequential linguistic analysis of 3885 veterinarian-farmer communication events within these consultations, the influence of veterinarians’ verbal behaviours on farmers’ response language was explored. Analysis of veterinary consultations undertaken before and after BMIT revealed that veterinarians changed their communication style to be more consistent with the MI methodology, including more use of reflection statements, a more empathic and partnership-oriented consultation style and greater emphasis on clients’ own language in favour of change goals. In response, farmers contributed more to the conversation and discussed more herd health-related changes. Sequential linguistic analysis suggested that following a veterinarian emphasising something positive about the farmer (e.g. efforts, strengths), seeking collaboration or emphasising farmer choice, farmers were subsequently more likely to express arguments in favour of change (‘Change Talk’), especially phrases indicative of commitment. This study offers the first evidence of the potential value of a BMIT experience to enhance veterinary communication skills, although conscious and disciplined use of MI principles, strategies and Spirit–an ethos of compassion, acceptance, partnership and evocation—requires longer and more complex training. Further studies examining the longevity and consistency of these verbal behaviour changes following BMIT are required.

Mechanism of Changes within Motivational Interviewing in Relation to Dietary Behavior Outcome of Diabetics Patients in Thailand

Background: For diabetics, healthy eating or dietary management is essential. Motivational interviewing (MI) is found to be effective for facilitating Thai clients with diabetics to change their dietary behavior. At present, little is known about what therapeutic processes and mechanisms improvements occur within MI. Objective: To explain the mechanism within MI in relation to dietary behavior outcome. Materials and Methods: The present study was a qualitative study that explored mechanism of change within the MI program conducted in diabetic clients and use the self-determination theory (SDT) as a lens to explore the mechanism of change within MI. A qualitative approach was adopted in the present study. Results: The mechanisms that influenced the change in dietary control of the diabetic clients were the patient perception of competence, a sense of autonomy, and therapist-patient relationship. These three kinds of perceptions are found to be related to therapist’s skills and techniques used in the MI program. Conclusion: The present study result reveals the most promising mechanisms of MI is the patient perception of competence, sense of autonomy, and therapist-patient relationship. There is a need to ensure that a relational ingredient of MI focused on empathy and the interpersonal spirit of MI will be employed by MI counselor consistently. MI self-supervision tool might be a good option to assist MI counselors adhere to MI spirit. Keywords: Motivational interviewing program; Diabetes clients; Diet behavior

Fidelity of motivational interviewing in an oral health intervention with caregivers of young children.

The aim of this study was to assess the fidelity of a motivational interviewing (MI) intervention with caregivers of young children in primary healthcare in Southern Brazil. Seven trained interventionists conducted one MI session with each caregiver at their home. The sessions were audio-recorded and a randomly selected subset (n = 109) was coded by a single reviewer using the Motivational Interviewing Treatment Integrity 3.1.1. criteria (MITI 3.1.1.). This instrument establishes parameters of MI proficiency for beginners and experts measuring the global ratings of five MI principles (evocation, collaboration, autonomy/support, direction and empathy), the global MI spirit score, and the behavior counts of MI basic skills: to inform, to ask, and to listen. The mean global MI spirit rating was 4.0 (95%CI 3.9-4.1). Mean MI principle scores ranged from 3.8 (95%CI 3.7-3.9) to 4.3 (95%CI 4.2-4.4). The overall reflection-to-question ratio was 0.9 (95 CI 0.8-1.0), % open questions was 76.3 (95%CI 73.1-79.6), % complex reflections was 66.1 (95%CI 63.1-69.1), and % MI-adherent information was 94.1 (95%CI 93.5-94.5). Interventionists with higher scores conducted more and longer sessions than those with lower scores (p = 0.012). Those with beginner proficiency had a higher proportion of caregivers changing their oral health knowledge (p = 0.005). In conclusion, a good degree of MI fidelity was found, with higher fidelity among interventionists who conducted more interviews and spent more time talking with caregivers.

Process evaluation of motivational interviewing interventions for behaviour change in health: A scoping review

Introduction: Motivational interviewing is an evidence-based, collaborative style of counselling which addresses ambivalence by strengthening a person’s own motivation and commitment to change. This is achieved by utilising motivational interviewing spirit (partnership, autonomy, collaboration, and evocation) and skills (open questions, affirmations, reflections, and summaries). Since motivational interviewing is not trademarked, many practitioners claim to implement it while missing these key elements.

5.23 Understanding Parent-Child Communication in the Context of ADHD

Adolescents with ADHD are at higher risk for health risk behaviors and adverse consequences. Their parents, in turn, experience greater parenting stress and lower quality of life. The objective of this study is to conduct a needs assessment of parent-adolescent communication (PAC) in this population, which will in turn be used to develop a parenting skills class that includes motivational interviewing (MI) skills to address the challenges in PAC in a developmentally appropriate way. We recruited 22 parents and 17 adolescents through outpatient clinics in an urban safety net health system. Participants engaged in interviews about PAC and a health risk discussion. In addition, they answered surveys covering demographic information, parenting stress, parenting styles, adolescent symptom burden, and MI. There are many notable sample characteristics. Twenty-seven percent of parents had taken a parenting class for children with ADHD or for divorced parents in the past; 87% of parents reported that they were having a close and supportive relationship with their adolescents; and 50% of parents felt that a parenting class should target PAC. Other common concerns included coping with mental health problems, behavioral issues, and how to provide support for the adolescents. Fifty-five percent of parents are interested or extremely interested in taking a parenting class designed for the parents of teenagers with ADHD. The Helpful Responses Questionnaire was scored on 3 dimensions of MI (MI Spirit [SP], MI Skills [MI], and promoting change talk [CT]) according to MI adherent responses (1), neutral responses (0), or MI nonadherent responses of persuasion and confrontation (–1). The average scores were –0.67 for SP, –0.79 for MI, and –0.55 for CT. Parents scored an average of 4.6 out of 16 on the MI Knowledge and Attitudes Test (MIKAT). The majority of the parents had an involved and positive parenting style as measured by the Alabama Parenting Questionnaire. Parents expressed a high level of interest in taking a parenting class that targets PAC. The parents have a low level of knowledge of or alliance with MI, despite positive and involved styles. Future directions include qualitative analysis of the parent and adolescent interviews to guide the development of a parenting class including MI skills for parents.

Motivational interviewing technical and relational skills, change talk, and alcohol outcomes-A moderated mediation analysis.

Objective: Change talk has been proposed as a mechanism of change in motivational interviewing (MI) by mediating the link between MI technical skills and behavioral outcomes. We tested the influence of therapists' relational skills on this mediation model. Method: Secondary analysis of a randomized controlled trial of individual brief MI for heavy drinking among 20-year-old-Swiss young men, where the MI group (n = 179) significantly reduced drinking compared to an assessment-only control. We coded MI sessions and derived: therapists' MI technical skills, clients' change talk (CT) and sustain talk (ST), and global relational ratings (empathy and MI spirit). We tested moderated mediation models with technical skills as the independent variable, CT and ST as parallel mediators, predicting drinking at 3-month follow-up (controlling for baseline drinking), and relational skills as moderators of the path from technical skills to client mediators. Results: Conditional indirect effects were significant for overall MI technical skills, open questions, and simple reflections (i.e., more of these behaviors related to more ST, which was related to more drinking) when relational skills were low. In contrast, there was a significant conditional indirect effect for complex reflections when relational skills were high (i.e., more complex reflections related to less ST). Conclusions: This study provides partial support for the MI technical and relational process models. Interestingly, support was found regarding the negative side of client ambivalence (ST) in this highly precontemplative sample. Accordingly, MI therapists should work cautiously with ST when clients are at early stages of motivational readiness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Motivational Interviewing Intervention for Adolescents in Accelerated High School Curricula: Applicability and Acceptability in a Second Sample.

The paper describes the applicability and acceptability of a selective intervention-Motivation, Assessment, and Planning (MAP)-for high school students that was developed based on the principles of motivational interviewing (MI) and tailored to the unique needs and strengths of students taking accelerated coursework, specifically Advanced Placement (AP) and International Baccalaureate (IB) classes. In addition to detailing the intervention in terms of MI spirit, processes, and relational and technical skills, we report applicability and acceptability data from a second iteration of MAP implementation in eight AP/IB programs in a Southeastern state during spring 2018. We analyzed quantitative and qualitative acceptability data from 121 high school freshmen (97 from AP and 24 from IB courses), as well as the seven MAP coaches who were trained using the Motivational Interview Training and Assessment System (Frey et al. 2017). To gain perspectives from the intended end users of the refined MAP, 12 school counselors and school psychologists who were not trained in MAP evaluated the intervention and provided qualitative and quantitative data on applicability and acceptability. All three stakeholder groups (students, coaches, and school mental health staff) rated and described the intervention as highly acceptable and appropriate for addressing the social-emotional needs of adolescents in AP/IB classes.

Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV

Antiretroviral therapy (ART) for HIV requires strict regimen adherence. Motivational interviewing (MI) can improve ART adherence. MI process studies have rarely focussed on ART adherence. Such studies may facilitate MI modifications to improve outcomes. This study employed a single group pre and post-test design with 62 adults with HIV (16 female; mean age 40 years). Therapist use of MI-consistent (MICO) methods, MI spirit, and client change and sustain talk were coded from an MI session. Relationships were assessed with ART schedule adherence. MICO methods positively correlated with change and sustain talk and were negatively associated with proportion of change talk. No variables were associated with ART adherence change. Mediation analysis did not support the MI model of change. This may be due to the fact that ART adherence is determined by both motivational and non-motivational factors. It may also be that bidirectional relationships exist between therapist and client speech.

Pilot Randomized Trial of a Recovery Navigator Program for Survivors of Critical Illness With Problematic Alcohol Use.

Objective:Many survivors of critical illness have problematic alcohol use, associated with risk of death and hospital readmission. We tested the feasibility, acceptability, treatment fidelity, and potential efficacy of a customized alcohol intervention for patients in ICUs. The intervention was delivered by a Recovery Navigator using principles of motivational interviewing and shared decision-making.Design:Pilot randomized trial.Setting:Two urban ICUs in Denver, CO.Patients:Patients with problematic alcohol use were enrolled prior to hospital discharge.Interventions:Patients were randomly assigned to usual care, single-session motivational interviewing and shared decision-making, or multisession motivational interviewing and shared decision-making.Measurements and Main Results:We assessed feasibility via enrollment and attrition, acceptability via patient satisfaction (Client Satisfaction Questionnaire-8), fidelity via observation and questionnaires, and potential efficacy via group means and CIs on measures of alcohol use, psychiatric symptoms, cognition, and other alcohol-related problems. Over 18 months, we offered the study to 111 patients, enrolled 47, and randomized 36; refusals were mainly due to stigma or patients' desire to handle problems on their own. Groups were similar at baseline, and 67% of patients met criteria for alcohol use disorder. Average patient satisfaction was high (mean = 28/32) regardless of group assignment. Sessions were delivered with 98% adherence to motivational interviewing principles and excellent motivational interviewing spirit; patients perceived the intervention to be more autonomy supportive than usual care. Group means after 6 months suggested that patients receiving the intervention might improve on measures such as alcohol use, psychiatric symptoms, legal problems, and days of paid work; however, they did not receive more substance use treatment. All results were nonsignificant due to small sample size.Conclusions:A Recovery Navigator intervention was feasible and acceptable for delivering high-fidelity brief interventions to ICU patients. Changes in alcohol-related problems with motivational interviewing and shared decision-making were nonsignificant but clinically meaningful in size. A full-scale randomized trial of motivational interviewing and shared decision-making is warranted.

Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program.

Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs' and patients' experiences through interviews and semi-structured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants' mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs' successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs' interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention. Trial registration: ISRCTN62728852.

Guiding Change: Using Motivational Interviewing Within Organizations

This contribution to the journal “Gruppe. Interaktion. Organisation. (GIO)” portraits Motivational Interviewing (MI) as a useful communication approach for evoking change readiness among employees. In today’s complex and dynamic business environment, organizations should be capable of adaptively responding to external demands. Such an organizational setup requires employees to constantly cope with change. However, eliciting change-supportive mindsets and behaviors is challenging. First, to better understand employees’ psychological responses when confronted with change, we review change-related attitudes, whereby we emphasize ambivalence as employees’ most common response when confronted with change. Next, we explain how the MI spirit, the MI process, and methods used by MI practitioners form the MI gestalt. Furthermore, to illustrate how MI extends existing inquiry approaches, we discuss how the focus of MI on the language of change may help to improve change agents’ communication skills and make MI an evidence-based communication approach. Moreover, we exemplify how MI can be applied at the individual, group, and organizational levels. For these practical applications, we note how MI can improve existing management practices such as appraisal interviews (individual level), team meetings (group level), and job crafting (organizational level). Finally, we outline the questions that further research needs to address to better understand how MI can be more effectively interwoven into organizational structures.

Evaluating a Motivational Interviewing Workshop for Medical Students at Queen’s University

Motivational interviewing (MI), a partnership-based counselling style, has increasingly been used to promote behaviour change among adults. Despite its potential to support behaviour change, there is a lack of research examining the most effective ways to train health care practitioners to use MI when working with patients. The purpose of this research was to evaluate uptake of MI skills following a one-day MI workshop that was developed in partnership with Exercise is Medicine for second year medical students enrolled at Queen’s University. The workshop focused on developing a basic understanding of the MI spirit, the phases of MI, and the ways in which MI may be used in different behavioural contexts. Participants (n=69) were asked to complete a pre and post-questionnaire that explored their knowledge of MI and their current perceptions of MI in addition to completing the Helpful Responses Questionnaire (HRQ), a validated MI assessment tool. A process evaluation was also conducted for each facilitator to measure fidelity to MI during the workshop. Results from the process and outcome evaluations are currently being evaluated. Results from this study will help determine whether a one-day workshop format is an appropriate delivery method for teaching MI techniques. Future research is needed to determine if medical students utilize information gained in their medical practice.

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators. A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3,025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change). Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = -.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators. This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials. (PsycINFO Database Record

Exploring the Experience of Motivational Interviewing Training to Improve Communication Skills in Parents of Adolescent Children

Purpose: The study’s aim was to describe the experience of motivational interviewing (MI) training for parents with adolescents. Methods: Focus group interviews were carried out with 12 mothers in 3 groups who participated in the MI training. The study had a qualitative descriptive design, and qualitative content analysis was used. Results: Data analysis was separated into 4 domains: acceptance, relational skills, self-reflection, and rebuilding relationships. Seven categories and 11 subcategories included (1) enhancing acceptance and empathy, (2) recognizing the importance of the MI spirit and applying core skills, (3) improving self-expression and self-control of negative emotions and behavior, (4) recognizing self-problems, and (5) true communication and recovery of trust. Conclusion: Through MI training, participants have experienced not only the enhancement of their communication skills but also personal modifications (in self-acceptance, self-reflection, and self-control) and positive interpersonal relationships (rebuilding relationships). In addition, participants have realized the importance of listening and reflection in such experiences. Reflection training has provided participants meaningful experiences. Our key insight from these findings is that skill is not most important in communication training. MI elements such as acceptance, collaboration, and a respectful attitude are more likely to be used than conventional communication skills.

A multivariate meta-analysis of motivational interviewing process and outcome.

Motivational interviewing (MI) theory proposes a process whereby a set of therapist behaviors has direct effects on client outcomes and indirect effects through in-session processes (e.g., client change talk). Despite clear empirical support for the efficacy of MI across settings, the results of studies evaluating proposed links between MI process and outcome have been less clear. In the present study, we used a series of multivariate meta-analyses to test whether there are differential relationships between specific MI-consistent and MI-inconsistent therapist behaviors, MI therapist global ratings, client change language, and clinical outcomes. Based on 19 primary studies (N = 2,614), we found a significant relationship between MI-consistent therapist behaviors and greater client change talk, as well as greater client sustain talk. Higher therapist global ratings (empathy and MI spirit) were significantly related to increased MI-consistent behaviors, decreased MI-inconsistent behaviors, increased client change talk, yet also increased client sustain talk. Therapist global ratings were not significantly related to clinical outcomes. Client sustain talk was a significant predictor of worse clinical outcomes, while client change talk was unrelated to outcome. Variability within the correlations indicated that MI-consistent and MI-inconsistent therapist behaviors were differentially related to therapist global ratings of empathy and MI spirit. Similar to past research, present findings provide equivocal support for hypothesized MI process outcome relationships. Clinical implications and future areas of MI mechanism research are discussed. (PsycINFO Database Record

Motivational Interviewing

Motivational interviewing (MI) has been established as an efficacious clinical approach for treating a range of emotional and behavioral concerns, both alone and in combination with other interventions. MI is a method of communication designed to increase intrinsic motivation and commitment to change. The MI method is consistent with self-determination theory that suggests that patient’s internalize motivation when he or she feels relatedness, competence, and autonomy support. MI is specified by an underlying perspective or spirit, a flow of processes, and a set of skills. MI spirit is defined by partnership, acceptance, compassion, and evocation. MI processes include engaging, focusing, evoking, planning, and maintaining. The primary MI skills are reflections, open questions, and providing information or advice in an MI style. This review presents an overview of these components with real-world examples. MI is grounded in research and highly applicable across many settings. The practitioner seeking to incorporate MI into practice will better facilitate behavior change and maximize human potential in diverse populations. This review contains 5 figures, 6 tables, and 55 references. Key words: behavior change adolescents, cognitive-behavioral therapy, medication adherence, mental health, motivational interviewing, obesity, self-determination theory, smoking, substance use