Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T07:53:58.829Z Has data issue: false hasContentIssue false

Deconstructing Proficiency in Motivational Interviewing: Mechanics of Skilful Practitioner Delivery During Brief Simulated Encounters

Published online by Cambridge University Press:  09 July 2010

Bryan Hartzler*
Affiliation:
University of Washington, USA
Blair Beadnell
Affiliation:
University of Washington, USA
David B. Rosengren
Affiliation:
University of Washington, USA
Chris Dunn
Affiliation:
University of Washington, USA
John S. Baer
Affiliation:
University of Washington, USA
*
Reprint requests to Bryan Hartzler, Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA. E-mail: [email protected]

Abstract

Background: Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. Aims: This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was “MI-proficient”, and to distinguish those temporal patterns from those observed in encounters with “MI-inconsistent” delivery. Method: Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter's quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. Results: Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. Conclusions: Findings are generally consistent with seminal descriptions of MI (Miller and Rollnick, 1991, 2002), and document temporal aspects of skilful MI delivery in brief encounters.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amrhein, P. C. (2004). How does motivational interviewing work? What client talk reveals. Journal of Cognitive Psychotherapy: An International Quarterly, 18, 323336.CrossRefGoogle Scholar
Amrhein, P. C., Miller, W. R., Yahne, C. E., Palmer, M. and Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71, 862878.CrossRefGoogle ScholarPubMed
Apodaca, T. R. and Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction, 104, 705715.CrossRefGoogle ScholarPubMed
Bachelor, A. and Horvath, A. (1999). The therapeutic relationship. In Hubble, M. A., Duncan, B. L. and Miller, S. D. (Eds.), The Heart and Soul of Change: what works in therapy. Washington, DC: American Psychological Association.Google Scholar
Baer, J. S., Rosengren, D. R., Dunn, C., Wells, E., Ogle, R. and Hartzler, B. (2004). An evaluation of workshop training in motivational interviewing for addiction and mental health clinicians. Drug and Alcohol Dependence, 73, 99106.CrossRefGoogle ScholarPubMed
Baer, J. S., Wells, E. A., Rosengren, D. B., Hartzler, B., Beadnell, B. and Dunn, C. (2009). Context and tailored training in technology transfer: evaluating motivational interviewing training for community counselors. Journal of Substance Abuse Treatment, 37, 191202.CrossRefGoogle ScholarPubMed
Ball, S. A., Martino, S., Nich, C., Frankforter, T. L., Van Horn, D., Crits-Cristoph, P., Woody, G. E., Obert, J. L., Farentinos, C. and Carroll, K. M. (2007). Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. Journal of Consulting and Clinical Psychology, 75, 556567.CrossRefGoogle ScholarPubMed
Brehm, S. S. and Brehm, J. W. (1981). Psychological Reactance: a theory of freedom and control. New York: Academic Press.Google Scholar
Burke, B. L., Arkowitz, H. and Dunn, C. (2002). The efficacy of motivational interviewing. In Miller, W. R. and Rollnick, S. (Eds.), Motivational Interviewing: preparing people for change (2nd ed., pp. 217250). New York: Guilford Press.Google Scholar
Burke, B. L., Arkowitz, H. and Menchola, M. (2003). The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843861.CrossRefGoogle ScholarPubMed
Carroll, K. M., Ball, S. A., Nich, C., Martino, S., Frankforter, T. L., Farentinos, C., Kunkel, L. E., Mikulich-Gilbertson, S. K., Morgenstern, J., Obert, J. L., Polcin, D., Snead, N. and Woody, G. E. (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multi-site effectiveness trial. Drug and Alcohol Dependence, 28, 301312.CrossRefGoogle Scholar
Cicchetti, D. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6, 284290.CrossRefGoogle Scholar
Connors, G. J., Carroll, K. M., DiClemente, C. C., Longabaugh, R. L. and Donovan, D. M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65, 588598.CrossRefGoogle ScholarPubMed
Dunn, C., Deroo, L. and Rivara, F. P. (2001). The use of brief interventions adapted from motivational interviewing across behavioural domains: a systematic review. Addiction, 96, 17251742.CrossRefGoogle ScholarPubMed
Elvins, R. and Green, J. (2008). The conceptualization and measurement of therapeutic alliance: an empirical review. Clinical Psychology Review, 28, 11671187.CrossRefGoogle ScholarPubMed
Farber, B. A. and Lane, J. S. (2002). Positive regard. In Norcross, J. C. (Ed.), Psychotherapy Relationships that Work: therapist contributions and responsiveness to patients (pp. 175194). New York: Oxford University Press.Google Scholar
Gaume, J., Gmel, G. and Daeppen, J. B. (2008). Brief alcohol interventions: do counsellors’ and patients’ communication characteristics predict change? Alcohol and Alcoholism, 43, 6269.CrossRefGoogle ScholarPubMed
Gaume, J., Gmel, G., Faouzi, M. and Daeppen, J. B. (2008). Counsellor behaviours and patient language during brief motivational interventions: a sequential analysis of speech. Addiction, 103, 17931800.CrossRefGoogle Scholar
Gifford, E. V., Ritsher, J. B., McKellar, J. D. and Moos, R. H. (2006). Acceptance and relationship context: a model of substance use disorder treatment outcome. Addiction, 101, 11671177.CrossRefGoogle Scholar
Green, J. (2006). Annotation: The therapeutic alliance: a significant but neglected variable in child mental health treatment studies. Journal of Child Psychology and Psychiatry, 47, 425435.CrossRefGoogle ScholarPubMed
Hartzler, B., Baer, J. S., Rosengren, D. B., Dunn, C. and Wells, E. A. (2007). What is seen through the looking glass: the impact of training on practitioner self-rating of motivational interviewing skills. Behavioural and Cognitive Psychotherapy, 35, 431445.CrossRefGoogle Scholar
Hartzler, B., Rosengren, D. B. and Baer, J. S. (2009). Motivational interviewing. In Cohen, L. M., Collins, F. L., Young, A. M., McChargue, D. E. and Leffingwell, T. R. (Eds.), The Pharmacology and Treatment of Substance Abuse: evidence- and outcomes-based perspectives (pp. 579604). Washington, DC: Taylor and Francis.Google Scholar
Hedeker, D. and Gibbons, R. D. (2006). Longitudinal Data Analysis. Hoboken, NJ: Wiley.Google Scholar
Hettema, J., Steele, J. and Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91111.CrossRefGoogle ScholarPubMed
Horvath, A. O. and Greenberg, L. S. (1994). The Working Alliance. New York: Wiley-Interscience.Google Scholar
Hougaard, E. (1994). The therapeutic alliance: a conceptual analysis. Scandinavian Journal of Psychology, 35, 6785.CrossRefGoogle ScholarPubMed
Karpiak, C. P. and Benjamin, L. S. (2004). Therapist affirmation and the process and outcome of psychotherapy: two sequential analytic studies. Journal of Clinical Psychology, 60, 659676.CrossRefGoogle ScholarPubMed
Madson, M. B. and Campbell, T. C. (2006). Measures of fidelity in motivational enhancement: a systematic review. Journal of Substance Abuse Treatment, 31, 6773.CrossRefGoogle ScholarPubMed
Madson, M. B., Campbell, T. C., Barrett, D. E., Brondino, M. J. and Melchert, T. P. (2005). Development of the motivational interviewing supervision and training scale. Psychology of Addictive Behaviors, 19, 303310.CrossRefGoogle ScholarPubMed
Madson, M. B., Loignon, A. C. and Lane, C. (2009). Training in motivational interviewing: a systematic review. Journal of Substance Abuse Treatment, 36, 101109.CrossRefGoogle ScholarPubMed
Martino, S., Ball, S. A., Gallon, S. L., Hall, D., Garcia, M., Ceperich, S., Farentinos, C., Hamilton, J. and Hausotter, W. (2006). Motivational Interviewing Assessment: supervisory tools for enhanced proficiency. Oregon: Northwest Frontier Addiction Technology Transfer Center, Oregon Health and Science University.Google Scholar
Martino, S., Haeseler, F., Belitsky, R., Pantalon, M. and Fortin, A. H. (2007). Teaching brief motivational interviewing to year three medical students. Medical Education, 41, 160167.CrossRefGoogle ScholarPubMed
Meier, P. S., Barrowclough, C. and Donmall, M. C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction, 100, 304316.CrossRefGoogle ScholarPubMed
Miller, W. R. (2000). Motivational Interviewing Skill Code: coders manual. University of New Mexico Center on Alcoholism Substance Abuse, and Addictions website: http://casaa-0031.unm/edu/.Google Scholar
Miller, W. R. and Moyers, T. B. (2006). Eight stages in learning motivational interviewing. Journal of Teaching in the Addictions, 5, 317.CrossRefGoogle Scholar
Miller, W. R., Moyers, T. B., Arciniega, L., Ernst, D. and Forcehimes, A. (2005). Training, supervision, and quality monitoring of the combined study behavioral interventions. Journal of Studies on Alcohol, Supplement, 15, 188195.CrossRefGoogle Scholar
Miller, W. R., Moyers, T. B., Ernst, D. and Amrhein, P. (2008). Manual for the Motivational Interviewing Skill Code (misc) Version 2.1. University of New Mexico Center on Alcoholism Substance Abuse, and Addictions website: http://casaa-0031.unm/edu/.Google Scholar
Miller, W. R. and Rollnick, S. (1991). Motivational Interviewing: preparing people to change addictive behavior. New York: Guilford Press.Google Scholar
Miller, W. R. and Rollnick, S. (2002). Motivational Interviewing: preparing people for change (2nd ed.). New York: Guilford Press.Google Scholar
Miller, W. R. and Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129140.CrossRefGoogle ScholarPubMed
Miller, W. R. and Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64, 527537.CrossRefGoogle Scholar
Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J. and Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Counseling and Clinical Psychology, 72, 10501062.CrossRefGoogle ScholarPubMed
Moyers, T. B. and Martin, T. (2006). Therapist influence on client language during motivational interviewing sessions. Journal of Substance Abuse Treatment, 30, 245251.CrossRefGoogle ScholarPubMed
Moyers, T. B., Martin, T., Catley, D., Harris, K. J. and Ahluwalia, J. S. (2003). Assessing the integrity of motivational interviewing interventions: reliability of the motivational interviewing skills code. Behavioural and Cognitive Psychotherapy, 31, 177184.CrossRefGoogle Scholar
Moyers, T. B., Martin, T., Christopher, P. J., Houck, J. M., Tonigan, J. S. and Amrhein, P. C. (2007). Client language as a mediator of motivational interviewing efficacy: where is the evidence? Alcoholism: Clinical and Experimental Research, 31 (S3), 4047.CrossRefGoogle ScholarPubMed
Moyers, T. B., Martin, T., Houck, J. M., Christopher, P. J. and Tonigan, J. S. (2009). From in-session behaviors to drinking outcomes: a causal chain for motivational interviewing. Journal of Consulting and Clinical Psychology, 77, 11131124.CrossRefGoogle ScholarPubMed
Moyers, T. B., Martin, T., Manuel, J. K., Hendrickson, S. M. L. and Miller, W. R. (2005). Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment, 28, 1926.CrossRefGoogle ScholarPubMed
Moyers, T. B., Martin, T., Manuel, J. K. and Miller, W. R. (2004). Motivational Interviewing Treatment Integrity (miti) Coding System. The University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions, http://casaa-0031.unm/edu/.Google Scholar
Moyers, T. B., Miller, W. R. and Hendrickson, S. M. L. (2005). How does motivational interviewing work? Therapist interpersonal skill predicts client involvement within motivational interviewing sessions. Journal of Consulting and Clinical Psychology, 73, 590598.CrossRefGoogle ScholarPubMed
Moyers, T. B. and Rollnick, S. (2002). A motivational interviewing perspective on resistance in psychotherapy. Journal of Clinical Psychology, 58, 185193.CrossRefGoogle ScholarPubMed
Perepletchikova, F., Hilt, L. M., Chereji, E. and Kazdin, A. E. (2009). Barriers to implementing treatment integrity procedures: survey of treatment outcome researchers. Journal of Consulting and Clinical Psychology, 77, 212218.CrossRefGoogle ScholarPubMed
Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships as developed in a client-centered framework. In Koch, P. (Ed.), The Study of a Science (Vol. 3, pp. 184256). New York: McGraw-Hill.Google Scholar
Rollnick, S. and Miller, W. R. (1995). What is motivational interviewing? Behavioral and Cognitive Psychotherapy, 23, 325334.CrossRefGoogle Scholar
Rosengren, D. B., Hartzler, B., Baer, J. S., Wells, E. A. and Dunn, C. (2008). The video assessment of simulated encounters-revised (vase-r): reliability and validity of a revised measure of motivational interviewing skills. Drug and Alcohol Dependence, 97, 130138.CrossRefGoogle ScholarPubMed
Shaffer, H. J. and Simoneau, G. (2001). Reducing resistance and denial by exercising ambivalence during the treatment of addiction. Journal of Substance Abuse Treatment, 20, 99105.CrossRefGoogle ScholarPubMed
Siegfried, J. (1995). Therapeutic and Everyday Discourse as Behavior Change. Norwood, NJ: Ablex Publishing Corporation.Google Scholar
Vader, A. M., Walters, S. T., Prabhu, G. C., Houck, J. M. and Field, C. A. (in press). The language of motivational interviewing and feedback: counselor language, client language, and client drinking outcomes. Psychology of Addictive Behaviors.Google Scholar
Vasilaki, E. I., Hosier, S. G. and Cox, W. M. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol and Alcoholism, 41, 328335.CrossRefGoogle ScholarPubMed
Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S. J., Renz, C., Rau, L., Lewis, D., Leimberger, J. and Somoza, E. (2008). Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. Journal of Substance Abuse Treatment, 35, 161173.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.