Temporal variation in facilitator and client behavior during group motivational interviewing sessions.

Abstract

There is considerable evidence for Motivational interviewing (MI) in changing problematic behaviors. Research on the causal chain for MI suggests influence of facilitator speech on client speech. This association has been examined using macro (session-level) and micro (utterance-level) measures; however, effects across sessions have largely been unexplored, particularly with groups. We evaluated a sample of 129 adolescent group MI sessions, using a behavioral coding system and timing information to generate information on facilitator and client speech (CT: change talk) within 5 successive segments (quintiles) of each group session. We hypothesized that facilitator speech (open-ended questions and reflections of CT) would be related to subsequent CT. Repeated measures analysis indicated significant quadratic and cubic trends for facilitator and client speech across quintiles. Across quintiles, cross-lagged panel analysis using a zero-inflated negative binomial model showed minimal evidence of facilitator speech on client CT, but did indicate several effects of client CT on facilitator speech, and of client CT on subsequent client CT. Results suggest that session-level effects of facilitator speech on client speech do not arise from long-duration effects of facilitator speech; instead, we detected effects of facilitator speech on client speech only at the beginning and end of sessions, when open questions respectively suppressed and enhanced client expressions of CT. Findings suggest that clinicians must remain vigilant to client CT throughout the group session, reinforcing it when it arises spontaneously and selectively employing open-ended questions to elicit it when it does not, particularly towards the end of the session.

Therapist and Client Interactions in Motivational Interviewing for Social Anxiety Disorder

“…The effectiveness of open questions on eliciting change language throughout the session could also be examined. For example, one study found that open questions suppressed CT at the beginning of a group MI sessions, but enhanced CT at the end of the session (Houck et al., ).…”

Brief Motivational Interviewing and Normative Feedback for Adolescents: Change Language and Alcohol Use Outcomes

“…Interaction effects were probed using simple slopes analysis, using procedures described by Preacher and colleagues (Preacher, Curran, & Bauer, 2006). Finally, to examine the effects of feedback on therapist MI skill, within the NF group we split each CACTI file at the time of the first NF utterance using procedures developed by the second author (Houck, Hunter, Benson, Cochrum, & Rowell, 2015) and computed behavior counts and summary scores separately for each segment. MI skill was evaluated using standard summary measures including the number of MI-consistent (MICO) and MI-inconsistent behaviors (MIIN), each scaled as described above, as well as the percentage of MI-consistent utterances (%MIC; i.e., MICO/(MICO + MIIN)).…”

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

“…In addition, CT utterances were associated with significant decreases in past 30 day alcohol use, heavy drinking in the past 30 days, and intentions to use alcohol three months later (D'Amico et al, 2015). Two other studies from this same sample of youth highlighted the importance of facilitator speech for increasing CT at the beginning and end of the group session (Houck et al, 2015), and showed that particular subtypes of CT in the group setting, such as reasons (e.g., I should cut back on my use because my grades are dropping) and commitment (e.g., I stopped seeing him so I wouldn’t smoke), were strongly related to improved AOD outcomes for group members (Osilla et al, 2015). Finally, a 2016 study described a new coding scheme to assess adolescent verbal behavior during group sessions for high school students, finding that it was possible to assess language at the group level when coding live, while the group was occurring.…”

“…There are only five published studies to date (D'Amico et al, 2015; Engle et al, 2010; Houck et al, 2015; Ladd, Tomlinson, Myers, & Anderson, 2016; Osilla et al, 2015) that have analyzed the group process by coding the speech that occurs during the group and examining how this speech relates to behavior change. Four of these studies were conducted with at-risk youth; however, none of them examined how speech during the group may affect both AOD behavior and risky sexual behavior.…”