Motivational Interviewing: Training, Research, Implementation, Practice

Buddy-motivational interviewing (buddy-MI) to Increase Physical Activity in Community Settings: Results of a Pragmatic Randomised Controlled Trial

David Brinson — 2015-01-13

This article describes the implementation and evaluation of a novel buddy-Motivational Interviewing intervention intended to help apparently healthy but relatively sedentary adults to adopt and maintain regular physical activity for health and fitness. This intervention is an adaptation of Motivational Interviewing which adds client-selected motivational-buddies who can provide in-session input as well as ongoing out-of-session support focused on strengthening client’s motivation for and movement toward their physical activity goals. A pragmatic parallel-group randomised controlled trial with 12-month follow-up was implemented to test the intervention. The trial demonstrated that buddy-MI was feasible and could be delivered with equivalent fidelity to standard MI and both groups demonstrated statistically significant changes across a range of behavioural and health-status outcomes. Moreover, the experimental group participants generally ‘outperformed’ the control group participants as shown by the consistent trends observed over three repeated measures out to 12-months (although these between-group differences were statistically non-significant). Qualitative data indicated participant acceptance of the programme as well as providing initial evidence of positive collateral health effects (‘ripple effects’ whereby buddies changed their behaviours also). Consideration for further development, evaluation and applications are also discussed.

Should We Trust our Judgments about the Proficiency of Motivational Interviewing Counselors?A Glimpse at the Impact of Low Inter-rater Reliability

Chris Dunn — 2015-01-13

Standardized rating systems are often used to evaluate the proficiency of Motivational Interviewing (MI) counselors. The published inter-rater reliability (degree of coder agreement) in many studies using these instruments has varied a great deal; some studies report MI proficiency scores that have only fair inter-rater reliability, and others report scores with excellent reliability. How much can we to trust the scores with fair versus excellent reliability? Using a Monte Carlo statistical simulation, we compared the impact of fair (0.50) versus excellent (0.90) reliability on the error rates of falsely judging a given counselor as MI proficient or not proficient. We found that improving the inter-rater reliability of any given score from 0.5 to 0.9 would cause a marked reduction in proficiency judgment errors, a reduction that in some MI evaluation situations would be critical. We discuss some practical tradeoffs inherent in various MI evaluation situations, and offer suggestions for applying findings from formal MI research to problems faced by real-world MI evaluators, to help them minimize the MI proficiency judgment errors bearing the greatest cost.

Are Aspects of a Motivational Interview Related to Subsequent Changes in Physical Activity and Regulatory Style? Examining Relationships among Patients with Rheumatoid Arthritis

Keegan Knittle — 2015-01-13

Objectives: To determine whether the integrity of motivational interviewing (MI) delivery relates to short-term changes in physical activity (PA) and regulatory style within a sample of patients with rheumatoid arthritis, and to examine whether therapist proficiency in MI improves over time. Methods: During a randomized controlled trial to promote PA, 27 patients received a MI from one of three trained physical therapists, which was coded with the Motivational Interviewing Treatment Integrity scales (MITI). Pearson correlations examined associations between MITI scores and changes in PA and regulatory style. Linear regression examined therapist proficiency over time. Results: MIs with greater reflection-to-question ratios and higher MI proficiency scores were related to increases in PA. MIs higher in global spirit and with a greater percentage of MI-adherent behaviors were associated with decreases in introjected regulation. Therapist proficiency in MI delivery tended to improve over time. Conclusions: Characteristics of motivational interviews are related to favorable shifts in regulatory style and PA behavior. Although MI proficiency increases over time and with feedback, a 15-hour training course seems insufficient for physical therapists to obtain basic MI proficiency. Practice Implications: Providing feedback to therapists new to delivering MI seems to improve MI proficiency and should help therapists to avoid using MI-non-adherent techniques.

Training Dietitians in Motivational Interviewing: A Pilot Study of the Effects on Dietitian and Patient Behaviour

Eileen Britt — 2015-01-13

Objective: To evaluate the transfer of Motivational Interviewing (MI) skills to dietietic practice in a clinical setting, and the effect of this on patient behaviour. This involved a replication of Britt and Balmpied (2010), except with dietitians providing the MI rather than nurses educators as in the earlier study. The current study, therefore, is a both a test of replication and generalisation. Method: Two dietitians were trained in MI and effects of this training were evaluated on both practitioner and patient behaviour when MI was delivered in a clinical settting with patients experiencing diabetes self-management difficulties. Comparisons were made between the dietitians’ and participants’ behaviour during baseline (standard Patient Education, n=6 participants) and after the dieitians were trained in MI (n=5 participants). Data were collated from transcripts of all sessions independently coded using the therapist and client behaviour counts from the Motivational Interviewing Skills Code to derive therapist and client behaviour counts. Results: MI training was effective relative to baseline performance. Conclusions: When trained in MI, the practitioners behaved in ways consistent with MI, and this appears to have evoked in-session behaviour from the participants consistent with emergent MI theory.

Developing Undergraduate Use of OARS: Skill Building for Senior Year Kinesiology Students

John Coumbe-Lilley — 2015-01-13

This article discusses course development, teaching, instructional methods and skills acquisition in motivational interviewing (MI) for kinesiology students completing a health coaching course in their senior year of undergraduate studies. The paper outlines how students 1) conducted a brief MI session, 2) applied open questions, affirmations, reflections and summaries (OARS) during a brief MI session and 3) identified the use and quality of OARS through the use of a range of learner centered practices (Weimer, 2002) including multi source feedback opportunities and approaches based on Kolb’s (1984) experiential learning cycle. The authors provide ten recommendations for educators and trainers to help them develop their practice in the teaching, learning and assessment of MI in undergraduate students or new-to-MI learners.

Training MI Interventionists across Disciplines: A Descriptive Project

Michael B. Madson — 2015-01-13

Motivational Interviewing (MI) is a counseling approach that is versatile and can be applied in many professional settings. Therefore, teaching MI skills to multidisciplinary groups simultaneously has the potential to be quite beneficial for strengthening the MI skills of different groups. This paper describes a project in which professionals and students from psychology and nutrition/ dietetics were trained in MI in an attempt to bolster both groups’ ability to implement MI as part of a larger health intervention project. Specifically, we outline the common themes that emerged among the trainees’ experiences. Implementing a multidisciplinary training program in which trainees use their expertise and contribute to the training process appeared to have created a rich learning environment.

Training Teen Mothers as Motivational Interviewers: A Feasibility Study

Carolina Yahne — 2015-01-13

When teen mothers do not graduate from high school, they and their children risk a lifetime of negative outcomes. They face major economic and health difficulties, often repeated across generations. To address this growing national concern that particularly impacts Hispanic teen mothers, we began by training young nonprofessional peer mentors in motivational interviewing (MI) to provide one-to-one support for teen mothers. To our knowledge, young non-clinicians have never before been formally evaluated for MI competency. Our preliminary investigation tested whether teen mothers who had succeeded in graduating could use MI effectively in conversations with their peers who had not yet completed high school. The six peer mentors were able to attain basic competency in MI. Some of their demonstrated skills went beyond competency to MI proficiency as measured by the MITI coding system. They also expressed their enthusiasm for the experience. They fully participated in the study protocols and also maintained the spirit of MI throughout the study. These findings are being used to design a training strategy for the peer mentors that can be used in schools and clinics throughout New Mexico. The question we asked was: “Can these young mothers, who have succeeded in graduating from high school, competently use MI to support other teen moms to continue their education?” The answer in this feasibility study was “yes”.

Generational Literalism

William R. Miller — 2015-01-13

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Celebrating Carl Rogers: Motivational Interviewing and the Person-Centered Approach

William R. Miller — 2015-01-13

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MITRIP Changes

Allan Zuckoff — 2015-01-13

Entrevista Motivacional y Justicia Social

William R. Miller — 2015-01-13

Este escrito explora la relación entre la entrevista motivacional (EM) y seis amplios valores humanos: la compasión, el respeto, la justicia, el potencial humano, la estimación de las diferencias, y la colaboración. Estos valores están implícitos en el espíritu y la práctica de la EM, y tienen implicaciones más allá de la práctica profesional.

Entrevista Motivacional e Justiça Social

William R. Miller — 2015-01-13

O presente artigo explora a relação entre a Entrevista Motivacional (EM) e seis amplos valores humanos: compaixão, respeito, equidade, potencial humano, valorização das diferenças e colaboração. Estes valores estão implícitos no espírito e prática da EM e tem implicações muito além da prática profissional.