A sequential analysis of motivational interviewing technical skills and client responses

Area of Science:

• Behavioral Science
• Clinical Psychology
• Health Psychology

Background:

• Motivational Interviewing (MI) hypothesizes that client Change Talk (CT) predicts better outcomes, while Sustain Talk (ST) predicts less favorable ones.
• Therapist behaviors are thought to influence client CT or ST, with MI-consistent (MICO) behaviors promoting CT and MI-inconsistent (MIIN) behaviors promoting ST.
• Previous research often overlooked the sequential nature of client talk, despite prior CT or ST being a strong predictor of subsequent client statements.

Purpose of the Study:

• To investigate the association between therapist MI skills and subsequent client talk (CT or ST).
• To account for the influence of prior client talk (CT or ST) when examining therapist skill effects.
• To understand how specific therapist verbal behaviors impact client's inclination towards change or resistance.

Main Methods:

• Analysis of transcripts from a manualized MI intervention for alcohol misuse and sexual risk behavior in 132 adults.
• Coding of transcripts using the Motivational Interviewing Skills Code (MISC 2.5) and the Generalized Behavioral Intervention Analysis System (GBIAS).
• Examination of the association between therapist MICO skills and subsequent client talk, controlling for prior client talk.

Main Results:

• Therapist simple reflections and paraphrasing reflections were associated with maintaining client CT or ST.
• Open questions and complex reflections showed a greater likelihood of CT following ST.
• Complex reflections and open questions were associated with more ST following CT, potentially via reduced Follow Neutral statements.

Conclusions:

• Simple and paraphrasing reflections may sustain existing client CT but do not appear to shift ST to CT.
• Complex reflections and open questions show potential for facilitating client transitions from ST to CT.
• Counselors might strategically use specific MICO skills to elicit continued CT and encourage movement from ST within MI sessions.