Motivational Interviewing in Primary Care

Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.     

Barriers to Learning Motivational Interviewing: A Survey of Motivational Interviewing Trainers' Perceptions

Trainers reported that motivational interviewing (MI)–inconsistent behaviors were frequently perceived during training and believed to create barriers to learning. More barriers were perceived in corrections than in mental health training audiences. Strategies to facilitate unlearning MI‐inconsistent behaviors may accelerate acquisition of MI.     

A Test of the Validity of the Motivational Interviewing Treatment Integrity Code

To evaluate the Swedish version of the Motivational Interviewing Treatment Code (MITI), MITI coding was applied to tape‐recorded counseling sessions. Construct validity was assessed using factor analysis on 120 MITI‐coded sessions. Discriminant validity was assessed by comparing MITI coding of motivational interviewing (MI) sessions with information‐ and advice‐giving sessions as well as by comparing MI‐trained practitioners with untrained practitioners. A principal‐axis factoring analysis yielded some evidence for MITI construct validity. MITI differentiated between practitioners with different levels of MI training as well as between MI practitioners and advice‐giving counselors, thus supporting discriminant validity. MITI may be used as a training tool together with supervision to confirm and enhance MI practice in clinical settings. MITI can also serve as a tool for evaluating MI integrity in clinical research.     

Motivational Components of Client Reactance

In this study the authors attempted to determine the motivational personality characteristics associated with psychological reactance. A total of 251 undergraduate psychology students took the Therapeutic Reactance Scale (TRS), the Questionnaire for Measuring Psychological Reactance (QMPR), and the Personality Research Form (PRF). Results show a personality pattern of the psychologically reactant person as defensive, aggressive, dominant, autonomous, and nonaffiliative. Implications of this pattern for resistance in counseling are discussed.     

Understanding Motivational Interviewing Effectiveness: Contributions From Rogers' Client-Centered Approach

The object of this article is to gain a better understanding of motivational interviewing (MI) effectiveness using the framework of Rogers' approach. Examining MI's common points and differences with Rogers' client-centered therapy can make it possible to identify some of MI's active ingredients and its underlying process of effectiveness, especially related to MI relational component. In return, MI, a strongly evidence-based approach, could provide empirical basis and support of effectiveness for Rogers' client-centred therapy. The review of literature on Rogers' therapy and MI shows strong links between the two approaches. MI applies most of Rogers' therapy attitudes and techniques such as empathy, acceptance, autonomy support, collaborative style, and confidence in the client's ability to change. The article further presents a review of research data related to the therapeutic effects of each of these attitudes. Finally, implications for clinical practice and further research are discussed. MI and Rogers' client-centered approach have much to offer each other. The strong process and outcome research tradition in MI could bring about evidence on Rogers' therapy effectiveness. Rogers' work provides a testable theoretical basis for the mechanisms of MI effectiveness. Further MI research should operationalize more than just empathy in the relational component.     

Entering the Sacred: Using Motivational Interviewing to Address Spirituality in Counseling

Despite the salience of spirituality in the lives of many clients, counselors are often hesitant to explore spiritual issues in counseling, largely out of a valid concern of imposing values on the client. Motivational interviewing provides a framework within which a counselor can both assess spirituality and facilitate client exploration of spiritual issues without fear of imposing values.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address intimate partner violence in alcohol-treatment-seeking men. Analyses of feedback provided during manual development suggest participants (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention might be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address IPV in alcohol treatment-seeking men. Analyses of feedback provided during manual development suggest participants: (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention may be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Motivational Interviewing Versus Cognitive Behavioral Group Therapy in the Treatment of Problem and Pathological Gambling: A Randomized Controlled Trial

Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance.     

从自我决定论看动机访谈法疗效机理

动机访谈法是以病人为中心、促使病人自己改变问题行为的咨询技术和方法。该文从自我决定论角度,解释了动机访谈法取得疗效的机理:动机访谈法起到满足病人基本心理需要(胜任感、归属感、自主性),推动病人产生自主动机的作用,促使病人提高适应性行为的质量和稳定性,提高心理健康水平,从而取得心理治疗效果。     

Rogers Redux: Relevance and Outcomes of Motivational Interviewing Across Behavioral Problems

Very little work regarding C. Rogers's (1961) client‐centered counseling has been published in the counseling discipline's journals over the last 20 years. However, during this time there has been an impressive output of empirical research using motivational interviewing (MI) in which C. Rogers's theory and approach are foundational. A review of MI's basic theoretical premises and applications for a multitude of behavioral problems are presented. Justification for integrating MI into counseling practice, training, and research is offered.     

Solution‐Focused Counseling and Motivational Interviewing: A Consideration of Confluence

Solution‐focused counseling (SFC) and motivational interviewing (MI) have gained recognition over the past 2 decades. A review of the features of these counseling approaches is provided, as well as an examination of the similarities and differences on several dimensions of counseling. Attention is given to empirical research, and it is proposed that SFC and MI be considered concurrently, which appears consistent with calls in the literature for theoretical integration. A case study is included.     

Coding counsellor behaviour in motivational interviewing sessions: inter-rater reliability for the Swedish Motivational Interviewing Treatment Integrity Code (MITI)

The aim of this study was to evaluate inter-rater reliability when using the Swedish version of the Motivational Interviewing Treatment Code (MITI) as an adjunct to MI training, clinical practice and research. Coders were trained to use the MITI for scoring taped sessions. The 4-month basic training had a duration of 39 hours. Following training, 60 audio-taped live interviews were randomly assigned for MITI coding. Mean intra-class correlation (ICC) coefficients were calculated for 7 coders across all pairs of coders. Cronbach's alpha was calculated to estimate the covariance between each pair across their common interviews. Six months later, a second inter-rater reliability test was performed, when 5 coders coded the same 15 randomly selected tapes. At the second reliability testing the mean ICC was 0.81 and the mean Cronbach's alpha was 0.96. However, the ICC varied for different sub-variables of the MITI, ranging from 0.42 empathy to 0.79 for number of Closed questions. In conclusion, MITI shows promising potential to be a reliable tool to confirm and enhance MI training as well as practice in clinical settings and in evaluating MI integrity in clinical MI research. However, coder assessment of empathy and MI-spirit, "global" variables, requires further refinement.     

Reliability and Validity of a Treatment Fidelity Assessment for Motivational Interviewing Targeting Sexual Risk Behaviors in People Living with HIV/AIDS

This study psychometrically evaluates the Motivational Interviewing Treatment Integrity Code (MITI) to assess fidelity to motivational interviewing to reduce sexual risk behaviors in people living with HIV/AIDS. 74 sessions from a pilot randomized controlled trial of motivational interviewing to reduce sexual risk behaviors in people living with HIV were coded with the MITI. Participants reported sexual behavior at baseline, 3-month, and 6-months. Regarding reliability, excellent inter-rater reliability was achieved for measures of behavior frequency across the 12 sessions coded by both coders; global scales demonstrated poor intraclass correlations, but adequate percent agreement. Regarding validity, principle components analyses indicated that a two-factor model accounted for an adequate amount of variance in the data. These factors were associated with decreases in sexual risk behaviors after treatment. The MITI is a reliable and valid measurement of treatment fidelity for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS.     

动机性访谈：一种以咨客为中心的行为改变咨询技术

动机性访谈是目前在西方国家比较流行的一种以咨客为中心的行为改变咨询技术,但在我国关于这一技术的研究和应用都还比较少。本文概述了动机性访谈技术的理论基础、应用原则(表达神入;发展差异;接受阻抗;维持自我效能)和基本技能,并介绍了这一咨询技术的应用现状与研究方向。     

The Straight Path to Healing: Using Motivational Interviewing to Address Spiritual Bypass

Spiritual bypass is the avoidance of underlying emotional issues by focusing solely on spiritual beliefs, practices, and experiences. Motivational interviewing (MI) is a client‐centered, compassionate approach to effectively addressing resistance among those who present with spiritual bypass. In this article, the authors provide background information on spiritual bypass and a rationale for adopting an MI approach to working with these clients. A case presentation illustrates 1 example of using MI with spiritual bypass.