Project ELICIT

Motivational Interviewing (MI) is an evidence-based treatment for substance abuse that is widely used by practitioners in diverse health-care settings. In addition to a large base of clinical trials demonstrating efficacy, progress has also been made in understanding how MI works. Studies point toward two particular "active ingredients," growing from two different theoretical bases: (1) a relational component, particularly emphasizing accurate empathy, and (2) a technical component, focused on eliciting client arguments for and commitment to change. The relational component is almost universally emphasized in MI training, whereas attention to the technical component of MI has been highly variable in training.

Initial research findings from our laboratory lend support to the psycholinguistic component as a potential mechanism of action in MI. Based on cognitive dissonance and self-perception theory, the originators of MI hypothesized that clients who are led to express language in favor of change during MI sessions will convince themselves to change as they hear themselves speak, resulting in more favorable therapeutic outcomes. Such "self-motivational statements" include language indicating desire, ability, reasons, need or commitment to change. Our data indicate that such client in-session language is an important predictor of substance use outcome in at least two different randomized controlled trials involving MI, and that the extent of such self-motivational statements accounts for at least as much variance in client outcomes as more common process variables such as self-efficacy. Another study from our group indicates that this type of client language does not occur randomly in therapy sessions, but is subject to experimental influence and is powerfully predicted by particular counselor behaviors and interpersonal skills.

If counselors' ability to recognize and reinforce self-motivational statements is a key component of effective MI, then it should be a focal point of training in this method. Furthermore, effective training in this technical component of MI should result in significant observable increases in client change talk and commitment language (two different forms of self-motivational statements). Such change in client speech is important because it reliably predicts drug abuse treatment outcome, and is therefore a benchmark of effective MI practice.

This Stage 3 behavior therapy development project addresses this particular theory-based aspect of MI, assessing our ability to train counselors to increase the strength of client change talk and commitment language during MI sessions, facilitating subsequent experimental testing of this hypothesized causal chain that thus far has been supported primarily by correlational evidence. In an additive randomized design, 140 clinicians inexperienced in this treatment method will receive customary MI training (MIT) focused on the relational component of client-centered spirit and empathic listening skills, with or without enhanced training in the technical component to recognize, elicit, and differentially reinforce client change talk and commitment language (MIT+). The effects of MIT versus MIT+ will be assessed by coding actual counseling sessions with clients at several periods after training.