English summaries (01/2012)
Implementing Motivational interviewing in initial sessions with substance abusers
This study investigated the substance abuse (SU) counselors' adherence to motivational interviewing (MI), a well-known SU method in the Finnish outpatient setting. The data included the first encounters of 16 counselors and their 36 clients with an alcohol or SU problem. The interaction tapes were transcribed and coded with MITI (Motivational Interviewing Treatment Integrity), a method developed for evaluating MI treatment adherence. The reliability of the Finnish version of MITI was shown to be of good quality although MI-Non-Adherent and complex reflection -codes need further improvement. The MI results showed that the counselors' style of interaction adhered to the spirit of MI relatively well. However, the more specific MI methods were implemented more randomly, thus weakening MI treatment integrity in most of the sessions. The results highlight the need for instruments like MITI to ensure objective feedback and close monitoring in training and supervising MI for obtaining good MI treatment fidelity.
Keywords: motivational interviewing, initial setting, substance abuse, outpatient, reliability, MITI
Reflective listening in motivational interviewing: a technique or a skill?
Motivational interviewing (MI) is usually studied by coding counselor behavior with a specific coding instrument designed to evaluate and count the counselor's MI-consistent and inconsistent behavior. This study supplemented MITI (Motivational interviewing treatment integrity) coding with Conversation analysis (CA) to explicate why reflections, the fundamental skill in MI, are sometimes difficult to code resulting in low reliability results. The data included the first audiotaped and transcribed encounters of clients with a substance abuse problem at an outpatient clinic. CA results showed that problematic reflections halted the clients' perspective and contributed to the interaction more as a roadblock than as an MI-consistent listening skill. Explicit conclusions for MITI coding improvements are made. The results pave the way for further studies on reflections to identify the most effective reflective listening skills for improving clients' treatment attendance and the need to focus on efficient means to teach and learn this challenging yet influential method.
Keywords: conversation analysis, motivational interviewing, MITI, reflective listening, substance abuse treatment
Therapists' impact on the effectiveness of substance abuse treatment: a systematic review
The aim of this study was to review studies of the therapist impact on the effectiveness of substance abuse treatment. A systematic review of studies measuring the therapist effect on substance abuse treatment retention and outcome was conducted. Peer-reviewed articles matching review criteria from the past decade were analyzed for relevant information, such as the therapist (n), the client (n), most typically used substance and key results. Twenty-two studies matched the criteria. The findings included five categories concerning therapist impact on substance abuse treatment effectiveness: 1) Therapists' professional background, 2) Therapist-targeted interventions, 3) Matching therapists to clients, 4) Therapeutic alliance and 5) Therapist style. The key results supported findings from earlier studies. In conclusion, the therapist effect is a crucial factor in effective substance abuse treatment and future research of this area is recommended.
Keywords: substance abuse, therapist, treatment, effectiveness, retention, systematic review