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Deconstructing Proficiency in Motivational Interviewing: Mechanics of Skilful Practitioner Delivery During Brief Simulated Encounters

Published online by Cambridge University Press:  09 July 2010

Bryan Hartzler ,
Blair Beadnell ,
David B. Rosengren ,
Chris Dunn  and
John S. Baer
Bryan Hartzler*
Affiliation:
University of Washington, USA
Blair Beadnell
Affiliation:
University of Washington, USA
David B. Rosengren
Affiliation:
University of Washington, USA
Chris Dunn
Affiliation:
University of Washington, USA
John S. Baer
Affiliation:
University of Washington, USA
*
Reprint requests to Bryan Hartzler, Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA. E-mail: hartzb@u.washington.edu
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Abstract

Background: Proficient delivery of motivational interviewing (MI) is often determined by global rating of relational elements or cumulative tallies of technical elements. Yet limited empirical evidence exists to clarify how relational and technical elements are associated, or if rates of skill indices and their constituent technical elements vary within a clinical encounter. Aims: This study sought to document temporal variance in rates of MI skill indices and their constituent technical elements during brief clinical encounters with a standardized patient wherein delivery was “MI-proficient”, and to distinguish those temporal patterns from those observed in encounters with “MI-inconsistent” delivery. Method: Data were accessed from a large MI training trial wherein relational and technical elements of MI delivery were scored for 503 recordings of a simulated 20-minute clinical encounter. Notably, independent raters tallied technical elements in 5-minute segments, allowing evaluation of potential variance among the encounter's quartile intervals. Global ratings of MI spirit identified subsets of recordings with MI-proficient (n = 49) and MI-inconsistent (n = 43) delivery for stratified analyses. Results: Analyses contrast temporal trajectories of technical aspects of MI-proficient and MI-inconsistent delivery, with the former characterized by: 1) elicitation and reflective listening as primary opening strategies; 2) increased depth of reflective listening as a predominant strategy in subsequent, focused therapeutic discussion; and 3) increased use of elicitation and information provision in change planning as the encounter approached conclusion. Conclusions: Findings are generally consistent with seminal descriptions of MI (Miller and Rollnick, 1991, 2002), and document temporal aspects of skilful MI delivery in brief encounters.

Keywords

Motivational interviewingpsychotherapy processaddiction
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 38 , Issue 5 , October 2010 , pp. 611 - 628
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

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