A Sequential Analysis of Clinician Skills and Client Change Statements in a Brief Motivational Intervention for Young Adult Heavy Drinking |
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| Institution: | Brown University, Center for Alcohol and Addiction Studies;College of Community and Public Affairs, Binghamton University;Brown University, Center for Alcohol and Addiction Studies;Truman State University;University of Notre Dame;Perelman School of Medicine, University of Pennsylvania;The University of Texas Southwestern Medical Center;Fordham University;Griffith Health Institute, Griffith University, Gold Coast Campus;Griffith Health Institute, Griffith University, Mount Gravatt Campus;Griffith Health Institute, Griffith University, Gold Coast Campus;Oakland Cognitive Behavior Therapy Center and University of California, Berkeley;San Francisco Group for Evidence-Based Psychotherapy and University of California, San Francisco;Alpert Medical School of Brown University;Temple University;University of Pittsburgh and Western Psychiatric Institute and Clinic;Temple University;University of Illinois–Chicago;University of Illinois–Urbana Champaign;University of Wisconsin–Madison;Temple University;Temple University;University of Wisconsin-Madison;Temple University |
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| Abstract: | This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians’ use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians’ use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change. |
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