Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?

Apodaca, Timothy R.; Jackson, Kristina M.; Borsari, Brian; Magill, Molly; Longabaugh, Richard; Mastroleo, Nadine R.; Barnett, Nancy P.

doi:10.1016/j.jsat.2015.09.001

Cited by 76 publications

(73 citation statements)

References 11 publications

(17 reference statements)

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“…In other words, if momentum in the direction for or against change is the therapist's goal, these interventions may be optimal. This pattern of associations has been found in other sequential analyses, including with other heavy drinking clients recruited in the ED (Houck et al, 2010) and with heavy drinking, mandated, college students (Apodaca et al, 2016). Additionally, the use of simple reflections and paraphrasing may be critical to understanding and clarifying topics being presented by participants.…”

Section: Discussionsupporting

confidence: 74%

A sequential analysis of motivational interviewing technical skills and client responses

Laws

Magill

Mastroleo

et al. 2018

Journal of Substance Abuse Treatment

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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.

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Section: Discussionsupporting

confidence: 74%

A sequential analysis of motivational interviewing technical skills and client responses

Laws

Magill

Mastroleo

et al. 2018

Journal of Substance Abuse Treatment

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“…Further, under conditions of Skillful Connecting, Change Talk was more likely after Explore behaviors while Sustain Talk was less likely. This is consistent with recent sequential analysis work on MI, showing that affirmations in particular predicted Change Talk and suppressed Sustain Talk [65]. …”

Section: Discussionsupporting

confidence: 92%

Therapist and client discussions of drinking and coping: a sequential analysis of therapy dialogues in three evidence-based alcohol use disorder treatments

et al. 2016

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Background and aims Research into the active ingredients of behavioral interventions for alcohol use disorders (AUD) has focused on treatment-specific factors often yielding disappointing results. The present study examines common factors of change in motivational enhancement therapy, cognitive-behavioral therapy, and twelve-step facilitation therapy by 1) estimating transitional probabilities between therapist behaviors and subsequent client Change (CT) and Sustain (ST) Talk and 2) examining therapist skillfulness as a potential predictor of transition probability magnitude. Design Secondary data analysis examined temporal associations in therapy dialogues. Setting USA: data were from Project MATCH (1997). Participants N = 126 participants who received Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation Therapy. Measurements Therapist behaviors were measured in three categories (Exploring, Teaching, Connecting) and client statements included five categories (CT-Distal, ST-Distal, CT-Proximal, ST-Proximal, Neutral). Therapist skillfulness was measured using a 5-point ordinal scale. Findings Relative to chance, therapist exploratory behaviors predicted subsequent client discussion of distal, drinking behavior (OR = 1.37 to 1.78, p < .001) while suppressing discussion of proximal coping and neutral content (OR = .83 to .90, p < .01). Unexpectedly, therapist teaching suppressed distal drinking language (OR = .48 to .53, p < .001) and predicted neutral content (OR = 1.45, p < .001). Connecting behaviors increased both drinking and coping language, particularly language in favor of change (CT OR = 1.15 to 1.84, p < .001). Analyses of exploring and connecting skillfulness revealed that high skillfulness maximized these behaviors effect on client responses, but not teaching skillfulness. Conclusions In motivational enhancement therapy, cognitive-behavioral therapy, and twelve-step facilitation therapy for alcohol use disorders, the therapists who explore and connect with clients appear to be more successful at eliciting discussion about change then therapists who engage in teaching behavior. Therapists who are more skilled achieve better results than those who are less skilled.

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“…Of the eight studies that examined both change and sustain talk, all studies found positive correlations between increased therapist empathy and MI spirit with client change and sustain talk except one small negative correlation between empathy and sustain talk (Apodaca et al, 2016). After a sensitivity analysis, no study, when removed, significantly altered the results.…”

Section: Discussionmentioning

confidence: 99%

A multivariate meta-analysis of motivational interviewing process and outcome.

Pace¹,

Dembe²,

Soma³

et al. 2017

Psychology of Addictive Behaviors

106

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Motivational interviewing (MI) theory proposes a process whereby a set of therapist behaviors has direct effects on client outcomes as well as indirect effects through in-session processes such as client change talk. Despite clear empirical support for the efficacy of MI across settings, the results of studies evaluating proposed links between MI process and outcome have been less clear. In the present study, we used a series of multivariate meta-analyses to test whether there are differential relationships between specific MI-consistent and MI-inconsistent therapist behaviors, MI therapist global ratings, client change language, and clinical outcomes. Among 19 primary studies (N = 2,614) included in the analysis, we found a significant relationship between MI-consistent therapist behaviors and increased client change talk, yet MI-consistent therapist behaviors were also significantly related to increased client sustain talk. Higher therapist global ratings (empathy and MI spirit) were significantly related to increased MI-consistent behaviors, decreased MI-inconsistent behaviors, increased client change talk, yet also to increased client sustain talk. Therapist global ratings were not significantly related to clinical outcomes. Client sustain talk was a significant predictor of worse clinical outcomes, while client change talk was unrelated to outcome. Variability within the correlations indicated that some individual MI therapist behaviors were differentially related to therapist global ratings of empathy and MI spirit. Similar to past research, present findings confirm some hypothesized MI process outcome relationships, while failing to confirm others. Clinical implications and future areas of research are discussed.

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Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing?

Cited by 76 publications

References 11 publications

A sequential analysis of motivational interviewing technical skills and client responses

A sequential analysis of motivational interviewing technical skills and client responses

Therapist and client discussions of drinking and coping: a sequential analysis of therapy dialogues in three evidence-based alcohol use disorder treatments

A multivariate meta-analysis of motivational interviewing process and outcome.

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