A sequential analysis of motivational interviewing technical skills and client responses

Abstract

Background: The 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. Methods: We 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. Results: With 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). Conclusions: Simple 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.

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

“…For example, one study has found that affirming statements made by the therapist is the only MICO response which both increased change talk and decreased sustain talk in the context of reducing hazardous drinking in a student population [ 53 ]. A second study has shown that open questions and complex reflections are associated with changes from sustain talk and change talk (and vice versa) compared to simple reflections and paraphrasing [ 54 ]. Similarly, aggregate measures of change and sustain talk may contain subtypes of language that are differentially related to outcome following MI [ 55 , 56 ].…”

A Sequential Analysis of Clinician Skills and Client Change Statements in a Brief Motivational Intervention for Young Adult Heavy Drinking

“…That is, the relationship between an elicitation and its response may partially be a function of the state of the conversation prior to the elicitation. Future research would do well to take this possibility into account, although recent findings indicate that some clinician elicitations may actually have the effect of breaking such momentum and shifting the direction of discussion (Laws et al, 2018). Another limitation is the assumed directionality of the present analyses, which emphasized the effect of the clinician on the client even though a conversation is a bidirectional phenomenon.…”

Exploring client messages in a therapist-guided internet intervention for alcohol use disorders – A content analysis

“…Also, the interaction of client and therapist behaviors (i.e. sequential analysis) has been studied using MI concepts ( Apodaca et al, 2016 ; Berman et al, 2019 ; Drage et al, 2019 ; Laws et al, 2018 ).…”