RESEARCH
Motivational interviewing is a counseling style that has been particularly effective in treating a wide variety of addictions. The focus is to encourage “change talk” defined as “any self-expressed language that is an argument for change”. The purpose of the intervention is to encourage change talk because research has shown that increased change talk predicts improved outcomes for the students. In contrast, “sustain talk”, the person’s arguments for not changing their behavior predicts poorer outcomes. This study explores how the behaviors of each therapist might affect whether their clients engage in change talk or sustain talk.
In this study, 92 college students and eight therapists were evaluated during a single session of an ongoing alcohol intervention. Overall, the therapists exhibited high amounts of motivational interviewing behaviors and clients verbalized more than twice as many “change talk” statements per session as sustain talk. In other words, when clients were discussing their desires, abilities, reasons, and needs to make changes, they were more likely to make changes than when they were making statements about not wanting to change. When the therapist behaviors were broken down further, nearly all of the therapist motivational interviewing behaviors (e.g., open questions, reflective listening) were significantly more like than chance to be followed by change talk and sustain talk. Interestingly, affirming was the only therapist behavior that was more likely to be following by change talk and less likely to be followed by sustain talk. Giving information and closed questions were less likely to be followed by change talk or sustain talk and more likely to be followed by neutral talk.
The authors suggest that the use of reflection and open questions may be the most efficient approach to encourage open discussion of target behaviors, including the pros (change talk) and cons (reluctance to change or sustain talk). The authors also note that the use of affirmation, by definition, is an acknowledgement of a client’s wish to change and is a useful tool in solidifying the change direction.
IMPLICATIONS FOR PROFESSIONALS
Sexual abuse is an egregious act and both professionals working with the individuals who cause the harm as well as stakeholders agree that accountability is key to any treatment intervention. . This study helps to highlight “what works” in implementing effective treatment approaches particularly in the campus setting. These finding show that therapists who affirm their clients’ strengths, motivations for change, and other positive attributes are more likely to help their clients find and work on meaningful treatment goals. In the campus environment, where stopping sexual assault is the main focus, motivational interviewing can help young people meet that focus and find success in making choices in which causing harm to others is unacceptable.
IMPLICATIONS FOR THE FIELD
Much has been written and discussed in the field about how to develop strengths-based approaches to help adolescents and young adults move beyond harmful sexual behaviors. Recognizing the diversity of those who cause harm, this approach will not work for everyone. However, this study reminds us of the power that motivational interviewing and similar approaches can have in changing the developmental trajectory of these teens and young adults. Specifically, this paper reminds us of the importance of getting back to the basics of how people change most effectively – often in a trusting relationship where they can explore not only what went wrong with their behavior, the harm caused by their behavior, but also bring in what can steer them towards behaviors that are positive and allow them to stay in their community.
CITATION:
Apodaca, T.R., Jackson, K.M., Borsari, B., Magill, M., Longabaugh, R., Mastroleo, N.R., & Barnett, N.P. (2016). Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in Motivational Interviewing? Journal of Substance Abuse Treatment, 61, 60-65. doi: 10.1016/j.jsat.2015.09.001.
ABSTRACT
Objective: To identify individual therapist behaviors which elicit client change talk or sustain talk in motivational interviewing sessions.
Method: Motivational interviewing sessions from a single-session alcohol intervention delivered to college students were audio-taped, transcribed, and coded using the Motivational Interviewing Skill Code (MISC), a therapy process coding system. Participants included 92 college students and eight therapists who provided their treatment. The MISC was used to code 17 therapist behaviors related to the use of motivational interviewing, and client language reflecting movement toward behavior change (change talk), away from behavior change (sustain talk), or unrelated to the target behavior (follow/neutral).
Results: Client change talk was significantly more likely to immediately follow individual therapist behaviors [affirm (p=.013), open question (p<.001), simple reflection (p<.001), and complex reflection (p<.001)], but significantly less likely to immediately follow others (giving information (p<.001) and closed question (p<.001)]. Sustain talk was significantly more likely to follow therapist use of open questions (p<.001), simple reflections (p<.001), and complex reflections (p<.001), and significantly less likely to occur following therapist use of therapist affirm (p=.012), giving information (p<.001), and closed questions (p<.001).
Conclusions: Certain individual therapist behaviors within motivational interviewing can either elicit both client change talk and sustain talk or suppress both types of client language. Affirm was the only therapist behavior that both increased change talk and also reduced sustain talk.
and treatment interventions. and mental health programs that are responsive to the needs of this community.
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