Clinician-client interactions in MET: the effect of clinicians' utterances on client commitment talk

Motivational Interviewing is an effective treatment for a range of problematic behaviours. However, previous studies have revealed substantial variability in the effectiveness of clinicians. Curiously, the specific clinician behaviours which contribute to positive outcomes have rarely been studied. Previous studies have often focused on the impact of broad categories of clinician behaviour on outcomes; such outcomes have often been overt client behaviours. The current study represented a substantial shift from the dominant methodologies in the MI literature. It aimed to study the effect specific clinician behaviours had upon client’s preparatory talk and strong commitment talk, in the second-to-second interactions between clinicians and clients.
A secondary analysis of Motivational Enhancement Therapy sessions was conducted, using recordings obtained during the United Kingdom Alcohol Treatment Trial (UKATT). Recordings were sampled from those clients who achieved and maintained positive changes in readiness to change following the UKATT study. Recordings were parsed and coded, with data being subjected to sequential and regression analyses.
The findings revealed that clinicians’ complex reflections were associated with, and predictive of, significantly more strong commitments from clients. Open questions and complex reflections were both associated with significantly more preparatory talk. However, only complex reflections acted as a significant predictor of preparatory talk.
It is concluded that complex reflections and open questions are necessary for the proficient practice of MI, and that clinicians should tailor their approach to match their client’s current motivational state. Moreover, the effectiveness of MI is likely attributable to a combination of the ‘spirit’ of MI and the proficient use of such skills, and possibly other specific skills. It is proposed that future research into MI and other psychological therapies should investigate the role of complex reflections, open questions and other specific clinician behaviours on client outcomes of interest.