Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor–client interactions

Motivational Interviewing (MI) is a client-centered communication style with the aim to resolve client ambivalence within a change-related counseling. Its potential benefit for career counseling has been discussed by several scholars but no empirical research has investigated MI in this context so far. The current study used process measures from MI to investigate dynamic interactions within a career counseling intervention. Overall, we analyzed two videotaped sessions of 14 unique counselor–client dyads. Verbal behavior of counselors and clients were coded with two observational coding schemes from MI (one for counselors and one for clients, respectively). Behavior profiles of counselors were compared with benchmarks of good MI. Furthermore, client verbal ambivalence was compared between sessions. Finally, we conducted lag sequential analyses to analyze temporal dynamics between counselor behavior and immediate client verbal responses across N = 6883 behavioral events. Our results showed, first, behavior profiles of career counselors did significantly differ from recommended counseling benchmarks of good MI practice. Second, as assumed on the basis of past studies, client ambivalence decreased across sessions. Third, MI consistent counselor behaviors showed a positive sequential association with client positive career talk, whereas MI inconsistent counselor behaviors showed the reverse pattern. Our results suggest that counseling behaviors recommended from MI are facilitating career interventions. We discuss how trainings in MI could amend career counseling interventions and provide ethical implications when integrating MI into career counseling programs.     

Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Ambivalence and Alliance Ruptures in Cognitive Behavioral Therapy for Generalized Anxiety

Client ambivalence about change (or motivation) is regarded as central to outcomes in cognitive behavioral therapy (CBT). However, little research has been conducted to examine the impact of client ambivalence about change on therapy process variables such as the therapeutic alliance. Given the demonstrated limitations of self-report measures of key constructs such as ambivalence and motivation, the present study instead employed a newly adapted observational measure of client ambivalence. Client statements regarding change (change talk (CT) and counter-change talk (CCT)) were coded in early (session 1 or 2) therapy sessions of CBT for generalized anxiety disorder. The frequency of CT and CCT was then compared between clients who later experienced an alliance rupture with their therapist, and clients who did not. The results showed that clients in dyads who later experienced an alliance rupture expressed significantly more CCT at the outset of therapy than clients who did not later experience an alliance rupture. However, CT utterances did not significantly differ between alliance rupture and no-rupture groups. CCT may strain the alliance because clients expressing higher levels of CCT early in therapy may be less receptive to therapist direction in CBT. Consequently, it is recommended that clients and therapists work together to carefully address these key moments in therapy so as to prevent alliance rupture and preserve client engagement in therapy.     

An Exploration of Young Clients' Experiences in Counseling With Post‐Master's Counselors

This phenomenological study adds to current literature about clients' meaningful experiences in counseling by exploring the experiences of eight young clients (ages 8–18) in individual counseling with post‐master's counselors in an outpatient setting. Interviews with these clients revealed the following six themes: (a) the process of growth, (b) having a safe place to talk, (c) counselor accepts and meets the client where they are, (d) counseling is a team effort, (e) supportive accountability from the counselor, and (f) understanding self and others. The final theme includes two subthemes: learning coping and emotion management skills, and learning better ways to communicate and behave. Findings and implications for counselors are discussed.     

Prospective Associations of Coping Styles With Depression and Suicide Risk Among Psychiatric Emergency Patients

Suicide is the second leading cause of death for those ages 13–25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult psychiatric emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.     

Motivational interviewing for employment: An exploration of practitioner skill and client change talk

Motivational interviewing (MI) is an evidenced-based approach for building and strengthening motivation for change. The effect of MI training on practitioner conversations with unemployed clients within a government work and income service was evaluated using a mixed-method approach, comprising a multiple-baseline across practitioner (n = 5) design and a pre/post quasi-experimental design. After workshop MI training, practitioners demonstrated greater MI skills in conversations with clients, and MI skills were maintained during the period of post-workshop feedback and coaching. There was also more change talk spoken by clients in conversations that occurred post-MI workshop training compared to pre-training, suggesting increased motivation for change.     

Therapists' Use of DBT: A Survey Study of Clinical Practice

The purpose of this study was to examine how therapists conduct Dialectical Behavior Therapy (DBT) individual psychotherapy with clients, focusing on clinical factors that could account for decisions regarding modifications of DBT (e.g., client diagnosis, therapist theoretical orientation, and intensity of DBT training). Additionally, the study investigated how therapists integrate DBT into their primary approach to therapy. Greater adherence to the DBT protocol was reported by therapists who described using DBT with a client with a diagnosis of borderline personality disorder. More frequent use of DBT components (i.e., group skills training, consultation teams, and telephone consultation) was reported by therapists who viewed their therapy as being guided by an applied behavior analysis/radical behavioral theoretical orientation and by therapists who had received intensive DBT training. Most therapists reported using DBT skills in their non-DBT work, with non-cognitive-behavioral therapists more likely to introduce mindfulness skills.     

A solution-focused approach to working with clients who are suicidal

Self-harm and suicide are amongst the most challenging and frightening problems that therapists and counsellors can encounter in the course of their work. The risk of clients harming themselves in the course of treatment can debilitate the therapists from acting creatively and collaboratively, and make their actions defensive, focused solely on risk assessment rather than therapeutic change.Yet it is precisely a creative and collaborative response, such as that engendered by solution-focused therapy and other models, that is the most likely to facilitate change and re-empower clients to take back charge of their lives. This article describes a solution-focused approach to working with suicidal clients that can be used in conjunction with traditional approaches and which focus on establishing safety as well as assessing risk.Working from this model the clinician shifts to identifying client strengths and coping skills, to collaborating with the client to establish meaningful goals and to helping the client envision a positive future. Arguably, such an approach can increase collaboration between therapist and client and lead to a more client-centred safety plan.     

Evaluation of a Safe Sleep Training for Home Visitors and Their Clients

Sleep-related deaths are a common preventable cause of death, and such deaths occur disproportionately in families of color. Home visitors provide families with education about infant safe sleep guidelines; however, families face many barriers to engaging in safe sleep practices. This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. We examined the effects of the intervention on home visitors’ (n?=?23) knowledge, MI skill use, and cultural sensitivity using a single group pre-post design. We also examined home visiting clients’ (n?=?78) knowledge, attitudes, and behaviors using a quasi-experimental design. Home visitors were primarily female (97%), had a college degree (86%), and were primarily white (50%) or African American (43%). The home visiting clients were all female and were primarily African American (43%) and Caucasian (36%). Most clients (59%) earned less than 30,000 dollars per year. Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior. MI may be an effective technique for home visitors to help increase families’ safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families’ safe sleep behavior.

     

Implicit coping and enhancement motives predict unique variance in drinking in Asian Americans

Automatic cognitive processes have been shown to be unique predictors of drinking behavior and can be assessed using implicit measures. Drinking motives (e.g., enhancement and coping motives), which are also predictive of alcohol use, have not been studied using implicit measures. Moreover, in the US, implicit measures have been studied in samples largely consisting of Caucasian or White Americans. This study adapted the Implicit Association Test (IAT) to examine automatic analogues of enhancement and coping drinking motives and approach/avoid tendencies in 56 Asian American undergraduates. Enhancement and coping IATs were correlated with self-reported drinking motives and predicted unique variance in drinking frequency and heavy drinking when controlling for self-reported motives. Approach IAT scores were neither associated with self-reported approach/avoid tendencies nor predictive of drinking behaviors. These findings provide initial support for the unique predictive utility of drinking motives in Asian Americans, an understudied population.     

Applying motivational interviewing principles in a modified interpersonal group for comorbid addiction

The application of motivational interviewing (MI) principles in modified interpersonal group therapy (MIGT) addresses two gaps in the literature. First, it explicitly extends MIGT to non-abstinent, addicted patients who are in the precontemplative and contemplative stages of change in contrast to most MIGT models where abstinence is usually required. Second, it provides a novel, process-oriented group intervention for MI, in contrast to current applications of group-based MI which are more structured in their format. The main modification in technique was to prioritize the horizontal exploration of substance use disclosures with a focus on the here-and-now experience of disclosure and the interpersonal impact on the group, in order to: (1) encourage members to openly discuss their ambivalence and shifting motivational states, (2) harness the evocative impact of substance use disclosures between members to elicit change talk (self-motivational statements), and (3) selectively reinforce change talk when it emerges from these exchanges. The authors illustrate these concepts with a case report of an open-ended MIGT group with comorbid mental illness and addiction.     

Community violence victimization and aggressive behavior: the moderating effects of coping and social support

Exposure to community violence (CV) as a victim is an established risk factor for exhibiting later aggressive behavior. It is unclear, however, what factors may mitigate this relationship. This study tested the relationship of CV victimization to aggressive behavior, and the roles of coping style and perceived social support in moderating that relationship. Five hundred and fifteen 18–22‐year‐old men and women completed self‐report inventories on CV exposure, aggressive behavior, perceived support from family and friends, and coping strategies. From a prior study, factor analysis of the coping scales yielded three factors of (1) disengagement (i.e., using primarily avoidant strategies), (2) interpersonal (i.e., using primarily emotion‐focused strategies) and (3) problem‐focused (i.e., using primarily active/approach strategies) coping styles. Results indicated that high CV victimization, high disengagement (i.e., avoidant) and interpersonal (i.e., emotion‐focused) coping styles, and low perceived support from friends significantly predicted increased aggression scores. Significant moderating effects indicated that, as CV victimization increased in frequency, aggression scores were highest for those with low perceived friend support and high use of disengagement coping. Findings suggest that avoidant and emotion‐focused coping styles are risk factors, and perceived support from friends is a protective factor, for a putative “cycle of violence.” Aggr. Behav. 32:502–515. 2006. © 2006 Wiley‐Liss, Inc.     

Questions and reflections: the use of motivational interviewing microskills in a peer-led brief alcohol intervention for college students

The purpose of this study was to examine the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. First year students (N=67) took part in a Brief Alcohol Screening and Intervention for College Students (BASICS) led by peer facilitators trained in MI and BASICS. Participants were assessed pre- and 2 weeks post-intervention on contemplation to change, as well as, pre- and 3 months post- intervention on drinking quantity. Independent coders used the Motivational Interviewing Treatment Integrity scale (MITI, Moyers, Martin, Manuel, & Miller, 2003) to evaluate therapist MI adherence. Peer facilitators met beginning proficiency in MI on scores of empathy, the ratio of MI adherent behaviors to non-adherent behaviors and the ratio of open questions to total questions as defined by the MITI. Results indicated that a higher number of closed questions was related to less contemplation and a higher number of open questions was related to more contemplation post intervention. A higher number of simple reflections was associated with increased drinking at the 3 month assessment, however, complex reflections were found to attenuate the effect of simple reflections on changes in drinking. These findings highlight the importance of competent reflective listening skills and the need for continual training and supervision for peer facilitators.     

An analysis of coping profiles and adjustment in persons with rheumatoid arthritis

This study examined dispositional and situative antecedents of vigilant and avoidant coping behavior. Seventy-two subjects were classified in coping style on the basis of their responses to the vigilance and cognitive avoidance scales of the Mainz Coping Inventory (MCI, Krohne, 1989), and alternatively, on their trait anxiety and defensiveness scores (cf. Weinberger, Schwartz, & Davidson, 1979). In a subsequent laboratory task, subjects were exposed to various conditions of predictability of an aversive event. In anticipation of an aversive loud tone, coping behavior was operationally defined as choosing to listen either to a warning channel (i.e., vigilance) or instead to music (i.e., avoidance). Probability of occurrence of a warning signal while listening to the warning channel varied across trials, being either 0%, 33%, 66%, or 100%. Subjects were exposed to each level and were informed about the respective probability in advance. In general, listening to the warning channel increased with an increase in the probability of the warning signal. However, four groups of subjects who differed in their pattern of coping behavior across trials were observed: rigid-avoidant copers (always listening to music), rigid-vigilant copers (always monitoring the warning channel), flexible copers (switching from music to warning channel with increasing probability of warning), and inconsistent copers (vacillating between music and warning channel regardless of probability of warning). Coping style classifications did not show substantial associations with coping behavior. However, subjects demonstrating the inconsistent coping pattern scored high on trait anxiety.     

Changes in Hypothesized Mechanisms of Change Before and After Initiating Abstinence in Cognitive-Behavioral Therapy for Women With Alcohol Use Disorder

Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.     

Unobtrusive measures in behavioral assessment

A major distinguishing characteristic of behavioral assessment is the direct assessment of overt behavior. Direct assessment is assumed to provide a sample of behavior that reflects client performance in the situation in which behavior is assessed, even if the assessment procedures were not implemented. Yet, in the majority of investigations, behavioral assessment procedures are obtrusive, i.e., subjects are aware that their behavior is being assessed. The potential problem with obtrusive assessment is that it may be reactive, i.e., affect how subjects perform. Recent research has demonstrated that obtrusive observations often are reactive and that behaviors assessed under obtrusive and unobtrusive conditions bear little relation. From methodological and applied perspectives, additional attention needs to be given to unobtrusive measures of behavior change. The present paper illustrates unobtrusive measures in behavior modification including direct observations, archival records, and physical traces of performance. In addition, validation and assessment problems, questions about the obtrusiveness of the measures, and ethical issues are discussed.     

Increasing mentally retarded adolescents' verbalizations about current events

The effects of antecedent and consequent events on the verbal behavior of three institutionalized mentally retarded adolescents were examined. Verbal statements, related to current national and international events, were recorded after exposures to television news programs. The study examined the accuracy of verbalizations as a function of: (1) exposures to television news presentations in massed (i.e., viewing the entire news program before an opportunity to describe it) versus distributed from (i.e., viewing each news item separately with each followed by an opportunity to describe it), and (2) contingent tokens and social praise for correct verbal responses (i.e., statements corresponding to news items presented). Both the temporal distribution of news presentations and the reinforcement procedures improved the accuracy of verbal statements emitted by the subjects.