Therapist Motivational Interviewing Research Articles

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes.

We investigated the technical model of motivational interviewing (MI) in a dual-outcome intervention (i.e., alcohol, sexual risk; N = 164; 57% female). We identified latent classes of client change statements, based on the proportion of change talk (CT) over the session. We then examined whether outcomes were related to CT class, and whether the relations between MI skill and outcomes varied by CT class. We found three classes of alcohol-CT and two classes of sexual risk-CT. While CT class membership did not predict outcomes directly, greater therapist MI-consistent skill was associated with fewer heavy drinking days in the increasing alcohol-CT class. For sexual risk outcomes, therapist MI-consistent skill was associated with reduced odds of condomless sex for the low sexual risk-CT class. The relation of therapist MI consistency to outcomes appears to be a function of client CT during the session.

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.

Effects of motivational interviewing fidelity on substance use treatment engagement in primary care

ObjectivePrimary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting. MethodsWe coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit. ResultsAutonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09–0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement. ConclusionWe did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement. Practice implicationsTraining providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.

Effect of a significant other on client change talk in motivational interviewing.

To examine significant-other (SO) and therapist behaviors as predictors of client change language within motivational interviewing (MI) sessions. Participants from an emergency department received a single session of MI that included SO participation (N = 157). Sessions were coded using therapy process coding systems. Sessions were subdivided into 10 equal deciles to facilitate sequential analyses. Multilevel modeling was used to examine the relationships among the following variables: therapist MI-consistent and MI-inconsistent behaviors; client change talk and sustain talk; and SO Support Change and SO Against Change. Therapist MI-consistent and MI-inconsistent behaviors failed to predict either client change talk or sustain talk at the decile level. Global measures of therapist MI spirit and acceptance were associated with lower levels of client sustain talk (p = .002 and p < .001, respectively). Higher levels of SO Support Change were more likely to be followed by higher levels of client change talk (p < .001) and lower levels of client sustain talk (p < .001). SOs who engaged in behaviors that discouraged the patient's drinking in the 6 months prior to the intervention had higher levels of SO Support Change language (p = .02). When analyzed at the aggregate level, therapist behavior was significantly associated with client change talk, but effect sizes were quite modest. Within-session SO behavior impacts client verbalizations regarding changes in alcohol use. Results raise questions about the role of therapist behavior when an SO is present.

How does brief motivational intervention work? A mediation analysis

Little is known about exactly which elements of alcohol brief motivational intervention (BMI) make it work. A causal chain between therapist motivational interviewing behaviors, subsequent client change talk (CT), and actual behavior change has been postulated. Other researchers have proposed the notion of a working alliance between counselor and client to explain better outcomes. However, these links have never been tested within a single mediation framework. We investigated the articulation of counselor behaviors, CT, working alliance, and six-month alcohol use outcomes (drinks per week at follow-up adjusted for drinks per week at baseline) during BMI with young men using regression analyses. There were no direct links from counselor skills to alcohol outcomes. Some counselors skills predicted more CT (MI-consistent behaviors frequency [p = 0.02] and MI spirit rating [p = 0.04]) as did working alliance (p more ADN > better outcomes). Adding a step in this model, we showed that the percent of MI-consistent behaviors and the MI spirit, empathy, and acceptance ratings predicted better working alliance scores (all p < 0.01). As the final step, we will calculate the mediated effects in these models. We found that MI skills and behaviors predicted a better working alliance, which, in turn, predicted more ADN change talk, which, in turn, predicted better alcohol use outcome. This gives support to previous findings but also highlights the importance of working alliance. Such findings might give precious clues for clinicians by giving an indication of the most determinant elements in BMI.

The Relationship Between Baseline Drinking Status, Peer Motivational Interviewing Microskills, and Drinking Outcomes in a Brief Alcohol Intervention for Matriculating College Students: A Replication

The purpose of this study was to replicate and extend previous findings (Tollison et al., 2008) on the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. This study used a larger sample size, multiple follow-up time-points, and latent variable analyses allowing for more complex models to be tested in a sample with different characteristics than Tollison et al. Matriculating students who participated in high school sports (N=327) took part in a Brief Alcohol Screening and Intervention for College Students led by peer facilitators trained in motivational interviewing (MI). Participants were assessed pre- and immediately postintervention on contemplation to change, as well as pre-, 5months, and 10months postintervention on drinking quantity. Independent coders used the Motivational Interviewing Treatment Integrity scale (Moyers, Martin, Manuel, & Miller, 2003) to evaluate therapist MI adherence. Contrary to our previous study, results indicated that a higher number of open questions was positively related to increases in drinking, especially for heavier drinkers. Congruent with the previous study, more simple reflections was positively related to increases in drinking. Finally, this study revealed that heavier baseline drinking was associated with more simple reflections. There were no significant results found for changes in contemplation. Results corroborate previous findings that the excessive use of simple reflections may be indicative of countertherapeutic outcomes while raising questions about the relationship between the frequency of open questions and therapeutic outcomes.

Community Program Therapist Adherence and Competence in a Motivational Interviewing Assessment Intake Session

Background: Teaching community program therapists to use motivational interviewing (MI) strategies for addictions treatment with sufficient frequency (i.e., adherence) and skill (i.e., competence) is a priority and challenge for the field. The development of psychometrically valid MI integrity measures that can be used for supervision and evaluation and be both sensitive and robust across clinical situations is needed. Objective: This article examines the performance of the Independent Tape Rating Scale (ITRS) () when used to evaluate the delivery of MI within a one-session assessment intake (). Methods: Audiotapes of 315 sessions of therapists in MI and counseling-as-usual conditions were rated according to the ITRS by raters blind to treatment condition. Results: Results indicate that community therapists were successfully trained and supervised to use MI within an assessment intake session, with MI adherence and competence that was discriminable from counseling-as-usual practices. Increased therapist MI adherence and competence was associated with increases in an index of client motivation for change, though unrelated to treatment outcome. Conclusions and Scientific Significance: The ITRS appears to be a valid instrument for measuring therapist MI adherence and competence within an assessment intake.

Questions and Reflections: The Use of Motivational Interviewing Microskills in a Peer-Led Brief Alcohol Intervention for College Students

The purpose of this study was to examine the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. First year students ( N = 67) took part in a Brief Alcohol Screening and Intervention for College Students (BASICS) led by peer facilitators trained in MI and BASICS. Participants were assessed pre- and 2 weeks post-intervention on contemplation to change, as well as, pre- and 3 months post- intervention on drinking quantity. Independent coders used the Motivational Interviewing Treatment Integrity scale (MITI, Moyers, Martin, Manuel, & Miller, 2003) to evaluate therapist MI adherence. Peer facilitators met beginning proficiency in MI on scores of empathy, the ratio of MI adherent behaviors to non-adherent behaviors and the ratio of open questions to total questions as defined by the MITI. Results indicated that a higher number of closed questions was related to less contemplation and a higher number of open questions was related to more contemplation post intervention. A higher number of simple reflections was associated with increased drinking at the 3 month assessment, however, complex reflections were found to attenuate the effect of simple reflections on changes in drinking. These findings highlight the importance of competent reflective listening skills and the need for continual training and supervision for peer facilitators.