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ObjectiveIn 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.MethodA 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).ResultsTherapist 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.ConclusionsThis 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

Objective: Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change. Method: Client speech from 149 sessions from Project MATCH were analyzed. A cluster analysis of the percent change talk during the first decile of the session identified three motivational groups: opposed, ambivalent, and ready. The change in percent change talk (C-PCT) across the session was calculated for each group. Zero-inflated negative binomial analysis was used to test whether the effect of C-PCT on end-of-treatment drinking varied between motivational groups. Results: The count part of the model revealed a significant interaction between C-PCT and membership in the ambivalent group (b = −17.710, 95% CI [−25.775, −9.645], p <.001), only for those who received MI. Favorable C-PCT was associated with less drinking (b = −15.735, p =.004). Only baseline drinking was a significant predictor of abstinence at follow-up (b =.032, 95% CI [0.012, 0.051], p =.001). Conclusion: A putative MI mechanism—improved client motivational language—appears most important for clients who express ambivalence in the opening minutes of the session, with minimal value for those who do not. What is the public health significance of this article?: This study suggests that alcohol treatment counselors can improve their use of popular interventions, such as Motivational Interviewing, based on what clients say about their motivation to change their drinking at the start of the session. [ABSTRACT FROM AUTHOR]

Motivational Interviewing began as a treatment for substance misuse and has strong empirical support as an intervention for these disorders. It is very common for MI to be combined with other types of treatment when it is used for substance abuse, and this article focuses on one example of this: the COMBINE Research Project. We examine the Combined Behavioral Intervention (CBI), which integrated MI and cognitive-behavioral strategies as well as several other approaches. The intervention is described and conceptual issues regarding the integration of MI with other treatments is explored.

Client speech in favor of change within motivational interviewing sessions has been linked to treatment outcomes, but a causal chain has not yet been demonstrated. Using a sequential behavioral coding system for client speech, the authors found that, at both the session and utterance levels, specific therapist behaviors predict client change talk. Further, a direct link from change talk to drinking outcomes was observed, and support was found for a mediational role for change talk between therapist behavior and client drinking outcomes. These data provide preliminary support for the proposed causal chain indicating that client speech within treatment sessions can be influenced by therapists, who can employ this influence to improve outcomes. Selective eliciting and reinforcement of change talk is proposed as a specific active ingredient of motivational interviewing. (Contains 7 tables and 2 figures.)

Motivational interviewing (MI) is a clinical method for helping people to resolve ambivalence about change by evoking intrinsic motivation and commitment. Based on our research and experience in providing training on MI, practitioners acquire expertise in this method through a sequence of eight stages: (1) openness to collaboration with clients' own expertise, (2) proficiency in client-centered counseling, including accurate empathy, (3) recognition of key aspects of client speech that guide the practice of MI, (4) eliciting and strengthening client change talk, (5) rolling with resistance, (6) negotiating change plans, (7) consolidating client commitment, and (8) switching flexibly between MI and other intervention styles. These key skills are acquired roughly in order, with earlier steps representing logical prerequisites for later stages of skill acquisition.

Although many studies have shown that motivational interviewing (MI) is effective in reducing problem behaviors, few have investigated purported causal mechanisms. Therapist interpersonal skills have been proposed as an influence on client involvement during MI sessions and as a necessary precursor to client commitment language. Using the Motivational Interviewing Skills Code (MISC; Version 1.0) rating system, the authors investigated 103 unique MI sessions for substance abuse and found that therapist interpersonal skills were positively associated with client involvement as defined by cooperation, disclosure and expression of affect. An unexpected finding indicated that behaviors inconsistent with MI enhanced the impact of therapist interpersonal skills upon client involvement. Drawbacks to the study include a potential sampling bias and uneven reliability of the variables measured.

The Evaluating Methods for Motivational Enhancement Education trial evaluated methods for learning motivational interviewing (MI). Licensed substance abuse professionals (N = 140) were randomized to 5 training conditions: (a) clinical workshop only; (b) workshop plus practice feedback; (c) workshop plus individual coaching sessions; (d) workshop, feedback, and coaching; or (e) a waiting list control group of self-guided training. Audiotaped practice samples were analyzed at baseline, posttraining, and 4, 8, and 12 months later. Relative to controls, the 4 trained groups showed larger gains in proficiency. Coaching and/or feedback also increased posttraining proficiency. After delayed training, the waiting list group showed modest gains in proficiency. Posttraining proficiency was generally well maintained throughout follow-up. Clinician self-reports of MI skillfulness were unrelated to proficiency levels in observed practice.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2005.12.003 Byline: Theresa B. Moyers, Tim Martin Keywords: Motivational enhancement therapy; Motivational interviewing; Project MATCH Abstract: Client language in favor of change is hypothesized to be a causal mechanism for motivational interviewing (MI), and specific therapist behaviors are prescribed to elicit such speech. This project examined 38 motivational enhancement therapy sessions from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), using a sequential behavioral coding system to investigate the relationship between therapist behaviors and client speech. Conditional probabilities were calculated between MI-consistent (MICO) therapist behaviors, MI-inconsistent (MIIN) therapist behaviors, and immediately subsequent client speech. MICO behaviors were more likely to be followed by self-motivational statements, whereas MIIN behaviors were more likely to be followed by client resistance. These results lend support to the importance of therapist behaviors in shaping client speech during MI sessions. Author Affiliation: Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131-1161, USA Article History: Received 11 August 2005; Revised 12 December 2005; Accepted 18 December 2005

Objective: Current standards for clinical trials require that behavioral interventions be thoroughly specified, that clinicians be well trained and closely supervised and that performance be carefully monitored to ensure and document treatment fidelity. This article describes procedures developed and implemented for this purpose in the COMBINE Study, a multisite trial combining medications and behavioral interventions for alcohol dependence. Method: Two behavioral treatments were tested in COMBINE: a Medical Management (MM) protocol to accompany the delivery of trial medications and a Combined Behavioral Intervention (CBI) designed as a comprehensive and flexible evidence-based psychotherapy. Results: Information is provided concerning (1) screening and qualifications of practitioners, (2) training and certification in the interventions, (3) on-site supervision and coordination of the two treatments, (4) central monitoring and coding of treatment sessions and (5) maintenance and documentation of treatment fidelity. Conclusions: Both interventions were delivered with fidelity. Problems encountered and important choices made in the implementation of training and quality assurance for CBI and MM are briefly described., CLINICAL TRIALS of behavioral interventions, whether single or multisite, face significant challenges in ensuring and documenting the fidelity of the treatments to be tested (Carroll et al., 1994). In meeting [...]

This report presents reliability, validity and sensitivity indices for the Motivational Interviewing Treatment Integrity (MITI) scale. Factor analysis of MI treatment sessions coded with the Motivational Interviewing Skills Code (MISC) was used to derive 10 elements of MI practice, forming the MITI. Canonical correlation revealed that the MITI captured 59% of the variability in the MISC. Reliability estimates for the MITI were derived using three masked, independent coders. Intra-class coefficients ranged from .5 to .9 and were generally in the good to excellent range. Comparison of MITI scores before and after MI workshops indicate good sensitivity for detecting improvement in clinical practice as result of training. Implications for the use of this instrument in research and supervision are discussed.

This article applies the motivational interviewing approach to resistance, which is conceptualized as the product of an interaction between the therapist and client rather than a static client characteristic. The underlying principles of motivational interviewing also are discussed, as are the overall therapeutic goals when using this approach. Sources of the resistance between the therapist and client are reviewed, as well as specific recommendations for responding. The motivational interviewing approach to resistance is applied to each of the three case vignettes. Keywords: motivational interviewing; resistance; psychotherapy; empathy

Motivational Interviewing (MI) is comprised of a client-centered relationship and a clear intention on the part of the practitioner to influence behavior change. This study explores MI trainers' decisions about their use of directionality in MI as they instruct others in the method. 111 MI trainers were asked to select content they would include in a hypothetical MI training. Almost half of trainers chose to teach trainees to "always maintain an attitude of equipoise", a strategy that is contradicted by MI theory and empirical data. This finding suggests a theoretical rift within the MI community with implications for substance use counseling. [ABSTRACT FROM AUTHOR]

Purpose: This randomized controlled study examines the efficacy of two innovative methods to teach beginning motivational interviewing (MI) skills: live supervision (LS), a small group experiential learning interaction with standardized client actors and in-the-moment guidance from a supervisor, and a coding learning (CL) method, where students in a classroom setting are introduced to MI skill development via learning to code MI practice behaviors. Methods: Seventeen social work students in a child welfare training program were randomized to receive either LS or CL training method. Changes in MI knowledge, attitudes, and MI skill were assessed through self-report and observational measures pretraining, posttraining, and at 5 months follow-up, after a semester of learning-as-usual. Results: Both training groups demonstrated an improvement in MI knowledge and attitudes from pretest to follow-up. MI skill gain within groups varied for specific MI skills. Discussion: Implications for maximally efficient MI training are advanced. [ABSTRACT FROM AUTHOR]