“How does a therapist respond to resistance and what impact does this have on the client? An analysis of speech in Motivational Interviewing based treatment sessions for alcohol misuse.”

Background: There is an emerging evidence base of in-session process research in Motivational Interviewing (MI). Investigations have mostly taken place in the USA, have progressed from frequency to sequential analysis, and focused on change talk and change outcomes. Research focusing on how a therapist behaves in the presence of counter-change talk is rare but pertinent, since managing resistance is a central feature of the MI model. This investigation aims to discover if and how MI-specific therapist strategies affect immediate client counter-change talk. Method: Secondary analysis of 50 recorded MI sessions from a British randomised controlled trial were rated using a sequential behavioural coding manual for speech. Baseline counter-change talk was identified and subsequent therapist and client behaviours were coded and categorised for transitional analysis, to establish the probability of specific client behaviours following specific therapist behaviours. Results: Following baseline counter-change talk, therapist MI-consistent (MICO) behaviours were the most commonly observed. Strong to moderate predictive relationships were found between: MICO therapist behaviours and client change talk; MI-inconsistent (MIIN) behaviours and counter-change talk; and therapist-other behaviours and client-other behaviours. A moderate, positive predictive relationship was found between MI-consistent behaviours and client ambivalence, and a weak, negative predictive relationship was found between MIIN behaviours and client ambivalence. Ambivalence results indicate, but cannot evidence, an increase in change talk. Discussion: The results provide support for MI authors’ claims that therapists’ use of MI-specific linguistic techniques, not simply the MI spirit, affects clients’ subsequent talk about their drinking behaviour. These results were found when examining transitions between aggregated behaviours. This novel finding differs from contemporary research that has evidenced transitions between single utterances. The support for MI-specific techniques has therefore been extended to evidence patterns of multiple interactions. Further research with a larger sample, examining clients’ impact on therapist behaviour would be beneficial.