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

Abstract

Objective 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. Method A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3025 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). Results 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 intra-personal moderators. Conclusions 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.

A sequential analysis of motivational interviewing technical skills and client responses

“…In the present study, results suggest that specific MI techniques function differently in their association with subsequent client statements about change. Specifically, open questions and complex reflections are most likely to be associated with a transition from ST to CT. Open questions are also associated with more ST after CT, which is consistent with correlational relationships reported in recent meta-analyses (Magill et al, 2014; Magill et al, 2018; Pace et al, 2017; Romano et al, 2017). Open questions can have no valence (“Tell me about your drinking”) or can explicitly solicit CT or ST (“Tell me some of the things you like about drinking” vs “What are some of the not so good things about drinking?”).…”

REMIT: Development of a mHealth theory-based intervention to decrease heavy episodic drinking among college students

“…Therapists using MI-consistent (MICO) skills (also termed microskills) demonstrated the ability to evoke change language in college students (Apodaca and Longabaugh 2009;Apodaca et al 2014;Borsari et al 2015). This result was confirmed by three recent meta-analyses of MI sessions with other populations Romano and Peters 2016;Magill et al 2017). Thus, REMIT developers incorporated the evidencebased MICO language into the app.…”

What does empathy sound like in social work communication? A mixed‐methods study of empathy in child protection social work practice

“…MI is a collaborative, person-centred style of communication originating in substance misuse therapy (Rollnick & Miller, 1995) and is widely considered a good fit with social work values (Hohman, 2012). This recent programme of research has operationalized the MI framework, which has been used extensively elsewhere (Magill et al, 2018) to analyse and support the development of social worker communication skills. This recent programme of research has operationalized the MI framework, which has been used extensively elsewhere (Magill et al, 2018) to analyse and support the development of social worker communication skills.…”