Sustain Talk Research Articles

Clinician motivational interviewing skills in 'simulated' and 'real-life' consultations differ and show predictive validity for 'real life' client change talk under differing integrity thresholds.

Accurate and reliable assessment of clinician integrity in the delivery of empirically supported treatments is critical to effective research and training interventions. Assessment of clinician integrity can be performed through recording simulated (SI) or real-life (RL) consultations, yet research examining the equivalence of these data is in its infancy. To explore the strength of integrity assessment between SI and RL samples in Motivational Interviewing (MI) consultations, this article examines whether Motivational Interviewing Treatment Integrity (MITI) assessments differ between SI and RL consultations and reviews the predictive validity of SI and RL MI skills categorisations for RL client response language. This study first compared MITI coding obtained in SI and RL consultations for 36 veterinary clinicians. Multilevel models of 10 MITI behaviour counts and four MITI global scores were run using MLwiN 3.02 to assess if a significant difference existed between SI and RL MITI data, with consultation within clinician within cohort (A and B) as nested random effects. Second, we investigated the effect of SI and RL MI skills groupings on rate of RL client response talk using three multivariable regression models. Two Poisson regression models, with random intercepts for farm and veterinarian and offset for number of minutes of the recordings, were estimated in the statistical software R using the package glmmTMB for the two response variables Change Talk and Sustain Talk. A logistic regression model, with the same random intercepts, with the response variable Proportion Change Talk was also estimated using the same package. Veterinary clinicians were less MI consistent in RL consultations, evidenced through significantly lower global MITI Cultivating Change Talk (p < 0.001), Partnership (p < 0.001) and Empathy (p = 0.003) measures. Despite lower objective MI skills groupings in RL consultations, ranking order of veterinary clinicians by MI skills was similar between contexts. The predictive validity of SI and RL MI skills groupings for RL client Change Talk was therefore similar, with significantly more RL client Change Talk associated with veterinarians categorised in the highest grouping ('moderate') in both SI (p = 0.01) and RL (p = 0.02) compared to untrained veterinarians in each respective context. Findings suggest SI and RL data may not be interchangeable. Whilst both data offer useful insights for specific research and training purposes, differing contextual MI skills thresholds may offer a more equitable assessment of clinician RL client-facing MI integrity. Further research is needed to explore the applicability of these findings across health contexts.

Adaptive framing of sustainability in CEO letters

PurposeThis study provides insights into the external powers that can influence business leaders' communication on sustainability. It shows how the socio-political context manifested in national and transnational policies, regulations and other socio-political events can influence the CEO talk about sustainability.Design/methodology/approachThis study adopts an interpretative and qualitative method of analysis using the lenses of the theoretical concepts of framing and legitimacy, analysing CEOs’ letters from 10 multinational industrial companies based in Sweden, over the period of 2008–2019.FindingsThe results show that various discourses of sustainability, emerging from policies and regulatory initiatives, socio-political events and civil society activism, are reflected in the ways CEOs frame sustainability over time. This article reveals that CEOs not only lead the discourse of profitable sustainability, but they also slowly adapt their sustainability talk to other discourses led by the policymakers, regulators and civil society. This pattern of a slow adaptation is especially visible in a period characterised by increased discourses of climate urgency and regulations related to social and environmental sustainability.Research limitations/implicationsThe theoretical frame is built by integrating the concepts of legitimacy and framing. Appreciating dynamic notions of legitimacy and framing, the study suggests a novel view of reporting as a film series, presenting many frames of sustainability over time. It helps the study to conceptualise CEO framing of sustainability as adaptive framing. This study suggests using a dynamic notion of adaptive framing in future longitudinal studies of corporate- and accounting communication.Practical implicationsThe results show that policymakers, regulators and civil society, through their initiatives, influence the CEOs' framing of sustainability. It is thus important for regulators to substantiate sustainability-related discourses and develop conceptual tools and language of social and environmental sustainability that can lead CEO framing more effectively.Originality/valueThe study engages with Goffman's notion of dynamic framing. Dynamic framing suggests a novel view of reporting as a film series, presenting many frames of sustainability over time and conceptualises CEO framing of sustainability as adaptive framing.

CEO talk of sustainability in CEO letters: towards the inclusion of a sustainability embeddedness and value-creation perspective

PurposeThis paper aims to examine how CEO talk of sustainability in CEO letters evolves in a period of increased expectations from society for companies to increase their transition towards becoming more sustainable and to better account for progress and performance within the sustainability areas.Design/methodology/approachBy adopting an interpretive textual approach, the paper provides a careful analysis of how CEO talk of sustainability in CEO letters of large listed Swedish companies developed during 2008–2017.FindingsThe talk of sustainability is successively becoming more elaborated, proactive and multidimensional. CEOs frame their talk by adopting different perspectives: the distinct environmental, the performance and meso, the product-market-oriented and the sustainability embeddedness and value creation. The shift towards an embeddedness and value-creation perspective in the later letters implies that the alleged capitalistic and short-sighted focus on shareholder value maximisation might be changing towards a greater focus on sustainability embeddedness as an important goal for succeeding with the transition towards a sustainable business.Practical implicationsThe findings are relevant for policymakers and government bodies when developing policies and regulations aimed at improving the positive impact of companies on global sustainable development. Findings are also useful for management teams when structuring their sustainability talk as a response to external pressure.Social implicationsThe findings provide relevant input on how social norms, values and expectations are shaping the corporate discourse on sustainability.Originality/valueThe findings of this study contribute to an increased understanding of the rhetorical response in influential CEO letters to the surrounding sustainability context, including new national and international policies as well as sociopolitical events and discourses related to sustainability. This offers a unique frame of reference for further interpretational work on how CEOs frame, engage in and shape the sustainability discourse.

Measuring a motivational interviewing practice orientation in criminal justice practitioners: initial validation of the response style screening questionnaire.

The use of collaborative communication techniques by criminal justice practitioners has been identified as a component of core correctional practices (CCPs). Criminal justice agencies and programs are investing in motivational interviewing (MI) training for their staff with varying intensity, follow-up coaching, and expectations for integration into practice. The present article describes the development and initial validation of the Response Style Screening Questionnaire (RSSQ), a practitioner completed tool assessing an MI-consistent practice orientation. Over three studies, we examined the factor structure, reliability, and correlations between the scale and self-reported and behavioral validity indicators. Study 1 examined the factor structure of the RSSQ with a sample of 825 criminal justice practitioners. In Study 2, data from 350 probation officers completing the RSSQ alongside measures of work-orientation and attitudes was used to conduct a confirmatory factor analysis and an initial assessment of its construct validity. In Study 3, correlations between the RSSQ and audio recorded office visits of 33 probation officers coded for MI and relationship building skills examined the scale's criterion validity. In Study 1, an exploratory factor analysis with an oblique rotation yielded 18 items on four factors. In Study 2, four and five factor models were tested, with the 4-factor model of Study 1 yielding the best fit. Two of the 4 factor-derived subscales reflect styles inconsistent with MI: (1) Confrontational style, and (2) Sustain Talk style; while the remaining two reflect styles consistent with MI: (3) Eliciting style, and (4) Change Talk style. Confrontational style scores were correlated with a work-orientation reflecting probation as a law enforcement endeavor, while Eliciting and Change Talk scores were correlated with a behavior change and resource broker work-orientations. In Study 3, Confrontational and Sustain Talk style scores were negatively correlated with a variety of MI skills and CCPs displayed on audio recordings, while Change Talk style scores were positively correlated with use of such skills. Overall, the findings suggest the RSSQ is a potentially useful new practitioner self-report tool for assessing an MI practice orientation.

Beyond Change Talk and Sustain Talk: Identity Construction and Therapeutic Change in Motivational Interviewing

Motivational interviewing (MI) has established itself as an evidence-based practice, but little is known about what occurs in a MI session from a qualitative perspective. This study utilized discourse analysis and conversation analysis to examine how MI facilitated therapeutic change in a seminal video-recorded training session by William Miller, a founder of MI, with a client with alcohol and cigarette use issues. Results revealed identity construction as a mechanism both the client and the therapist engaged in. The client negotiated normalcy out of a stigmatized subject position of a person with addiction via two pathways: Ascribing himself qualities embedded in individualism discourses and othering. The therapist discursively saved the client’s face through validation and normalization, strengthening the therapeutic rapport. Finally, the therapist used selective reflection to enlist the client in co-constructing an identity in the direction of change. The findings highlight the importance of understanding the complex interactions and therapeutic change in MI through the lens of identity construction. Practical implications are discussed.

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).

Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis.

BackgroundDown Your Drink (DYD) is a widely used unguided web-based alcohol moderation program for the general public based on cognitive behavioral therapy (CBT) and motivational interviewing (MI); it provides users with many opportunities to enter free-text responses.ObjectiveThe aim of this study was to assess participants’ use of key CBT and MI components, the presence of change talk and sustain talk within their responses, and whether these data are associated with drinking outcomes after 3 months.MethodsAn exploratory secondary data analysis was conducted on data collected in 2008 from the definitive randomized trial of DYD (N=503). Past week alcohol use at baseline and 3-month follow-up were measured with the TOT-AL. Covariates included baseline alcohol use, age, gender, education level, and word count of the responses. Use of MI and CBT components and presence of change talk and sustain talk were coded by two independent coders (Cohen κ range 0.91-1). Linear model regressions on the subsample of active users (n=410) are presented along with a negative binomial regression.ResultsThe most commonly used component was the listing of pros and cons of drinking. The number of listed high-risk situations was associated with lower alcohol use at 3-month follow-up (Badj −2.15, 95% CI −3.92 to −0.38, P=.02). Findings on the effects of the percentage of change talk and the number of listed strategies to deal with high-risk situations were inconsistent.ConclusionsAn unguided web-based alcohol moderation program can elicit change talk and sustain talk. This secondary analysis suggests that the number of listed high-risk situations can predict alcohol use at 3-month follow-up. Other components show inconsistent findings and should be studied further.

Sustainability in Management Education: Where It Has Been, Is Now, and Is/Can Be Headed

This 2020 Academy of Management Symposium (AoM) intends to build on our understanding of, and advance the progress that has been made in, incorporating Sustainability in Management Education (SiME), over the past three decades. To accomplish this, we have assembled a dynamic team of multidisciplinary academics, scholars and leaders who are shaping a story of sustainability within their institutions, classrooms, and communities. These academics have been invited to present on their current research as their work extends a variety of stakeholders’ perceptions examining the topic of SiME metrics and assessment. They represent different demographics, a variety of collaborative research efforts, and membership to different AOM divisions. Together, these presentations will make an attempt to: a) advance a greater understanding of the range and extent of SiME teaching practices, including evidence of effective methods and techniques, b) provide a discussion on reported challenges in course and program design and integration, and c) share research on business students experience with SiME and the professionalization of the field and its reported impacts. We aim to facilitate an invigorating and interactive learning experience and exchange for those interested in SiME integration at multiple interfaces. Civic Responsibility in Higher Education – Are Socially-Engaged Students Any Different from Others? Presenter: Michael Wihlenda; Global Ethic Institute Presenter: Taiga Brahm; U. of Tuebingen Teaching Strong Sustainability: An Experiential Course on Leadership in the Anthropocene Presenter: Rae Andre; Northeastern U. Designing Effective Sustainability Assignments: How and Why Definitions of Sustainability Impact Presenter: Matthew Urdan; PhD Student Presenter: Patrice Luoma; Quinnipiac U. Sustainability in Management Education: Theoretical Lenses and Research Discourses Presenter: Shelley F. Mitchell; Hult International Business School Presenter: Jorge Alexis Arevalo; William Paterson U. We Academics Should Walk Our Sustainability Talk Presenter: Patricia Kanashiro; Loyola U. Maryland Presenter: Gordon P. Rands; Western Illinois U. Presenter: Mark Starik; Walden U.

Say it aloud: Measuring change talk and user perceptions in an automated, technology-delivered adaptation of motivational interviewing delivered by video-counsellor

Motivational Interviewing is a widely used counselling technique. A fundamental principle of this technique is that hearing oneself argue for change strengthens motivation. This study presents the first analysis of participants' dialogue with an automated motivational interviewer. The objective was to explore communication with, and perceptions of, a technology-delivered adaptation of motivational interviewing (TAMI) delivered by a pre-recorded video-counsellor. Eighteen participants undertook the video interview and evaluated it after one week. Interviews were scored for change and sustain talk. Participants' written evaluations were subjected to thematic analysis. Interviews lasted 10 min 30s (SD 3 min 0 s). Change talk was observed in a mean of 16 of 25 responses (SD 3.35, range 11–21). Sustain talk was less frequent (mean = 3.4 replies, SD = 2.5, range 0 to 8). Participants disliked seeing their own image in the webcam and desired a personalised interaction where each question depended on the answer given to the previous one. Positive appraisals included space to think about motivation and plans, and hearing themselves voicing goals. A brief, generic, automated TAMI elicited change talk and was perceived as motivating.

Walking the Sustainability Talk: If Not Us, Who? If Not Now, When?

This essay centers on the personal sustainability behaviors of faculty as related to research, teaching, and service, as well as those behaviors that go far beyond these typical faculty responsibilities. We argue that faculty personal engagement with sustainability can lend credibility to this topic as faculty can set a good example for students, colleagues, and other stakeholders within their respective networks. We draw on the United Nations 17 Sustainable Development Goals to suggest several ideas that faculty could adopt as part of their sustainability plans. Moreover, we offer multiple recommendations as to how faculty might leverage these experiences in the classroom and beyond.

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.

A sequential analysis of motivational interviewing technical skills and client responses

BackgroundThe technical hypothesis of Motivational Interviewing (MI) proposes that: (a) client talk favoring behavior change, or Change Talk (CT) is associated with better behavior change outcomes, whereas client talk against change, or Sustain Talk (ST) is associated with less favorable outcomes, and (b) specific therapist verbal behaviors influence whether client CT or ST occurs. MI consistent (MICO) therapist behaviors are hypothesized to be positively associated with more client CT and MI inconsistent (MIIN) behaviors with more ST. Previous studies typically examine session-level frequency counts or immediate lag sequential associations between these variables. However, research has found that the strongest determinant of CT or ST is the client's previous CT or ST statement. Therefore, the objective of this paper was to examine the association between therapist MI skills and subsequent client talk, while accounting for prior client talk. MethodsWe analyzed data from a manualized MI intervention targeting both alcohol misuse and sexual risk behavior in 132 adults seen in two hospital emergency departments. Transcripts of encounters were coded using the Motivational Interviewing Skills Code (MISC 2.5) and an additional measure, the Generalized Behavioral Intervention Analysis System (GBIAS). Using these measures, we analyzed the association between client talk following specific classifications of MICO skills, with the client's prior statement as a potential confounder or effect modifier. ResultsWith closed questions as the reference category, therapist simple reflections and paraphrasing reflections were associated with significantly greater odds of maintaining client talk as CT or ST. Open questions and complex reflections were associated with significantly greater odds of CT following ST, were not associated significantly with more ST following ST, and were associated with more ST following CT (i.e., through an association with less Follow Neutral). ConclusionsSimple and paraphrasing reflections appear to maintain client CT but are not associated with transitioning client ST to CT. By contrast, complex reflections and open questions appeared to be more strongly associated with clients moving from ST to CT than other techniques. These results suggest that counselors may differentially employ certain MICO technical skills to elicit continued CT and move participants toward ST within the MI dialogue.

Towards an understanding of self-directed language as a mechanism of behavior change: A novel strategy for eliciting client language under laboratory conditions

IntroductionChange talk (CT) and sustain talk (ST) are thought to reflect underlying motivation and be important mechanisms of behavior change (MOBCs). However, greater specificity and experimental rigor is needed to establish CT and ST as MOBCs. Testing the effects of self-directed language under laboratory conditions is one promising avenue. The current study presents a replication and extension of research examining the feasibility for using simulation tasks to elicit self-directed language. MethodsFirst-year college students (N=92) responded to the Collegiate Simulated Intoxication Digital Elicitation, a validated task for assessing decision-making in college drinking. Verbal responses elicited via free-response and structured interview formats were coded based on established definitions of CT and ST, with minor modifications to reflect the non-treatment context. Associations between self-directed language and alcohol use at baseline and eight months were examined. Additionally, this study examined whether a contextually-based measure of decision-making, behavioral willingness, mediated relationships between self-directed language and alcohol outcome. ResultsHealthy talk and unhealthy talk independently were associated with baseline alcohol use across both elicitation formats. Only healthy talk during the free-response elicitation was associated with alcohol use at follow up; both healthy talk and unhealthy talk during the interview elicitation were associated with 8-month alcohol use. Behavioral willingness significantly mediated the relationship between percent healthy talk and alcohol outcome. ConclusionsFindings support the utility of studying self-directed language under laboratory conditions and suggest that such methods may provide a fruitful strategy to further understand the role of self-directed language as a MOBC.

The language of change among criminal justice clients: Counselor language, client language, and client substance use outcomes.

Counselor and client language have been identified as mechanisms of change in motivational interviewing (MI) counseling sessions. This study evaluated whether language patterns exhibited during MI sessions with substance users in the community would also be found during MI sessions with substance users in the criminal justice system. Forty audio recordings of MI sessions with substance-using probationers were coded and analyzed sequentially using the Motivational Interviewing Skills Code (MISC) 2.5. Analyses examined the relationship between counselor and client language, and the relationship between client language and client substance use after 2 months. Counselor MI inconsistent language was associated with decreased change talk (lnOR=-0.76, p<.05) though not with increased sustain talk. Both sustain talk (b=-4.591, t=-18.634 p<.001) and MI inconsistent language MIIN (b=-4.419, t=-19.886, p<.001) were positively associated with substance use at 2 months. Sustain talk early in the session (i.e., during deciles 1 and 2) was significantly greater among clients who reported using substances at 2 months, compared to clients who did not use substances. These findings are broadly consistent with previous literature documenting the association between counselor language, client language, and client outcome.

Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior.

Homeless young adults exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors. This study is a secondary analysis of data collected in a randomized clinical trial of AWARE, a new 4 session group motivational interviewing intervention. AWARE mainly focused on alcohol use and sexual risk behavior given focus group feedback. We used sequential coding to analyze how the group process affected both AOD use and sexual risk behavior at 3-month follow up among homeless young adults by examining facilitator behavior and participant change talk (CT) and sustain talk (ST). We analyzed 57 group session digital recordings of 100 youth (69% male, 74% heterosexual, 28% non-Hispanic white, 23% African American, 26% Hispanic, 23% multiracial/other; mean age 21.75). Outcomes included importance and readiness to change AOD use and risky sexual behavior, AOD use and consequences, number of partners and unprotected sex, and condom self-efficacy. Sequential analysis indicated that facilitator open-ended questions and reflections of CT increased Group CT. Group CT was associated with a lower likelihood of being a heavy drinker 3 months later; Group ST was associated with decreased readiness and confidence to change alcohol use. There were no associations with CT or ST for drug use or risky sexual behavior. Facilitator speech and peer responses were related to CT and ST during the group sessions with this high risk population, which were then associated with individual changes for alcohol use. Further research is needed to explore associations with drug use and sexual risk behavior. (PsycINFO Database Record

Psychometric properties of the Motivational Interviewing Treatment Integrity coding system 4.2 with jail inmates

Motivational Interviewing (MI) is an evidence-based approach shown to be helpful for a variety of behaviors across many populations. Treatment fidelity is an important tool for understanding how and with whom MI may be most helpful. The Motivational Interviewing Treatment Integrity coding system was recently updated to incorporate new developments in the research and theory of MI, including the relational and technical hypotheses of MI (MITI 4.2). To date, no studies have examined the MITI 4.2 with forensic populations. In this project, twenty-two brief MI interventions with jail inmates were evaluated to test the reliability of the MITI 4.2. Validity of the instrument was explored using regression models to examine the associations between global scores (Empathy, Partnership, Cultivating Change Talk and Softening Sustain Talk) and outcomes. Reliability of this coding system with these data was strong. We found that therapists had lower ratings of Empathy with participants who had more extensive criminal histories. Both Relational and Technical global scores were associated with criminal histories as well as post-intervention ratings of motivation to decrease drug use. Findings indicate that the MITI 4.2 was reliable for coding sessions with jail inmates. Additionally, results provided information related to the relational and technical hypotheses of MI. Future studies can use the MITI 4.2 to better understand the mechanisms behind how MI works with this high-risk group.

Global Education through Youth Virtual Media Production

New media and technology have become ubiquitous in the daily life of many young people in the U.S. and virtual worlds present new localities for youth to explore and learn about global issues and make connections with people around the world. This study investigated one youth virtual media production program Sustainability Talk as an innovative approach to global education. Findings revealed that students gained new understandings about global issues and expressed youth perspectives on sustainability through a virtual talk show. However, pedagogies that can facilitate critical inquiries around global media were needed to ensure effective global learning. Designing a coherent program structure that provides more support to help youth learn digital production skills and global issues conjointly is essential for preparing young active global citizens in the mediated public space of mediapolis.

Therapist and client discussions of drinking and coping: a sequential analysis of therapy dialogues in three evidence-based alcohol use disorder treatments.

Research into the active ingredients of behavioral interventions for alcohol use disorders (AUD) has focused upon treatment-specific factors, often yielding disappointing results. The present study examines common factors of change in motivational enhancement therapy, cognitive-behavioral therapy and 12-Step facilitation therapy by (1) estimating transitional probabilities between therapist behaviors and subsequent client Change (CT) and Sustain (ST) Talk and (2) examining therapist skillfulness as a potential predictor of transition probability magnitude. Secondary data analysis examined temporal associations in therapy dialogues. United States: data were from Project MATCH (Matching Alcoholism Treatments to Client Homogeneity) (1997). One hundred and twenty-six participants who received motivational enhancement therapy, cognitive-behavioral therapy or 12-Step facilitation therapy. Therapist behaviors were measured in three categories (exploring, teaching, connecting) and client statements included five categories (CT-distal, ST-distal, CT-proximal, ST-proximal, neutral). Therapist skillfulness was measured using a five-point ordinal scale. Relative to chance, therapist exploratory behaviors predicted subsequent client discussion of distal, drinking behavior [odds ratio (OR)=1.37-1.78, P<0.001] while suppressing discussion of proximal coping and neutral content (OR=0.83-0.90, P<0.01). Unexpectedly, therapist teaching suppressed distal drinking language (OR=0.48-0.53, P<0.001) and predicted neutral content (OR=1.45, P<0.001). Connecting behaviors increased both drinking and coping language, particularly language in favor of change (CT OR=1.15-1.84, P<0.001). Analyses of exploring and connecting skillfulness revealed that high skillfulness maximized these behaviors effect on client responses, but not teaching skillfulness. In motivational enhancement therapy, cognitive-behavioral therapy, and 12-Step facilitation therapy for alcohol use disorders, the therapists who explore and connect with clients appear to be more successful at eliciting discussion about change than therapists who engage in teaching behavior. Therapists who are more skilled achieve better results than those who are less skilled.

Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?

ObjectiveTo identify individual therapist behaviors which elicit client change talk or sustain talk in motivational interviewing sessions. MethodMotivational interviewing sessions from a single-session alcohol intervention delivered to college students were audio-taped, transcribed, and coded using the Motivational Interviewing Skill Code (MISC), a therapy process coding system. Participants included 92 college students and eight therapists who provided their treatment. The MISC was used to code 17 therapist behaviors related to the use of motivational interviewing, and client language reflecting movement toward behavior change (change talk), away from behavior change (sustain talk), or unrelated to the target behavior (follow/neutral). ResultsClient change talk was significantly more likely to immediately follow individual therapist behaviors [affirm (p=.013), open question (p<.001), simple reflection (p<.001), and complex reflection (p<.001)], but significantly less likely to immediately follow others (giving information (p<.001) and closed question (p<.001)]. Sustain talk was significantly more likely to follow therapist use of open questions (p<.001), simple reflections (p<.001), and complex reflections (p<.001), and significantly less likely to occur following therapist use of therapist affirm (p=.012), giving information (p<.001), and closed questions (p<.001). ConclusionsCertain individual therapist behaviors within motivational interviewing can either elicit both client change talk and sustain talk or suppress both types of client language. Affirm was the only therapist behavior that both increased change talk and also reduced sustain talk.

Motivational Interviewing Post-Stroke: An Analysis of Stroke Survivors' Concerns and Adjustment.

Our earlier research demonstrated that participation in four sessions of motivational interviewing (MI) early post-stroke has a positive impact on stroke survivors' mood. However, the theoretical underpinnings of MI in supporting adjustment (rather than its traditional use in supporting behavior change) require clarification. This article describes a content analysis of MI transcripts for 10 participants in our previous study, to identify the focus of discussions (patient "concerns") and potential effective components of our MI approach. Patients' post-stroke concerns were shown in 16 categories, including frustration, family impact, and getting well. There was a pattern of change discourse across sessions: "Sustain talk" (reasons for not changing) reduced from Session 1 onward, "change talk" (intent to change) increased then reduced, and "change expressed" (changes achieved) increased from Sessions 1 to 4. MI facilitates healthy adjustment post-stroke in some patients, in turn affecting mood, but clarification of how this effect is achieved requires further exploration.