Running Head: EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 1

Transcription

1 Running Head: EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 1 Effectiveness of Motivational Interviewing in Overcoming Resistance of Offenders Name of Student Eastern New Mexico University

2 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 2 Abstract The increases in court-ordered and probation required counseling is a concern for counselors wanting to implement effective therapy that can overcome resistance to change which can reduce recidivism, motivate change and improve lifestyle for the offender population. Motivational Interviewing compared to other therapy techniques will be examined in an eightweek study of offender clients. Offenders that are entering counseling for the first time will be assigned by systematic randomization to one of four groups in a Solomon 4-group pretest/posttest design to ascertain which therapy is most effective in reducing resistance. Research has shown that Motivational Interviewing is effective in treatment of the offender population and this study will add to the existing knowledge to determine effective treatments that can be implemented by counselors to overcome resistance and reduce recidivism.

3 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 3 Effectiveness of Motivational Interviewing in Overcoming Resistance of Offenders The increase in court-ordered therapy requirements for the offender population both incarcerated and in community corrections is requiring the counseling profession to find effective treatment techniques to reduce recidivism. Different theoretical counseling techniques have been used with resistant and offender populations both adult and juvenile; however, results vary and leave many questions as to what is needed to assist different offender populations. One of the biggest obstacles to success in this area is the strong resistance or ambivalence in the offender population s desire or need to change. According to the Bureau of Justice (2012) 13% of parolees were reincarcerated in 2010 showing a need to overcome resistance in counseling to help prevent recidivism. This is an ongoing concern of society as it affects the safety of the population and creates a drain on resources. Motivational Interviewing (MI) has shown promise as an effective way to overcome resistance but it is relatively new in the counseling world. It was first developed by Miller and Rollnick (1991) to help resistant or ambivalent clients overcome alcoholism and drug abuse. It has been expanded to include other types of resistance and more information is needed to confirm that it is effective in overcoming the resistance of offender populations (Miller & Rollnick, 2002). Understanding how effective MI is in overcoming offender resistance is important in working toward the goal of reducing offender recidivism. Significance of Problem The significance of this study will be to determine if MI is effective in reducing resistance in the offender client base to help them make a positive change, thus reducing recidivism. Helping offenders want to change destructive patterns, as well as learn how, is necessary both for improvement in their lifestyle and for society at large. Research has

4 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 4 consistently shown that rehabilitative programs are much more effective at preventing and reducing recidivism than programs that are only sanction based (Lancaster, Balkin, Garcia, & Valarezo, 2010). With this in mind, ascertaining if this counseling technique is effective in reducing resistance and promoting change is of utmost importance. As counselors move toward a more integrated theoretical approach, how different techniques can be used during different stages of the counseling process needs to be examined (Arkowitz, 2002). This will help advance better understanding and use of theoretical techniques in counseling. MI can be a first step in overcoming resistance and helping clients to make necessary lifestyle changes to prevent reoffending and improve their quality of life. Definition of Terms Because MI has been shown to be effective in treatment resistance, it is a technique that counselors of offender populations may want to incorporate in their treatment. MI is a clientcentered treatment program that helps the client to find motivation from within (Rollnick & Miller, 1995). It varies from client-centered treatment because it has a little more directive and goal oriented style without being confrontational or oppositional. It encourages exploration into the client s reasons for change through a quiet and eliciting style of interpersonal interaction (Rollnick, & Miller, 1995). The person that does not want to change is common in the offender population so knowing how to help them find a reason to change is the challenge, and MI is being investigated as a promising way to accomplish this goal (Arkowitz, 2002). Other techniques have been used with offender populations but have the disadvantage of being too directive. Arkowitz (2002) found that the shoulds prevalent in directive styles only serve to increase the resistance of the client.

5 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 5 Many offenders are considered resistant clients because they are forced to participate in treatment programs. They do not want to face self-examination and will use many tactics to avoid this process such as combative behaviors to redirect the counseling process into a confrontation between the counselor and themselves (Elliot, 2002). This resistance is manifested as a power struggle between the counselor and the client, and research has found that confrontation only serves to increase resistance and raise defenses of the client (Elliott, 2002). Arkowitz (2002) found that there are two types of resistance which a counselor may have to overcome; either the person does not know how or does not want to change. Offenders usually fall into the category of those that do not want to change which makes them strongly resistant to treatment. Research identifying techniques that overcome client resistance needs to be conducted to help prevent recidivism in the offender population. Offenders that are examined in this study are adults entering community corrections such as parole and probation who are required to participate in treatment directed at their particular offenses such as drug or alcohol abuse, sexual offending, or domestic violence. Summary Understanding how effective MI is in reducing the level of resistance in this population will be very important for counselors in integrating the technique into their practice. Having an effective technique to overcome resistance at their disposal will help them work with this client base and move towards more effective interventions. Counselors working with offender populations will be identified from various agencies and given training in Motivational Interviewing. This will enable them to use and monitor the method s effectiveness with their client base and offer more effective interventions to prevent recidivism. Counselors will use the Correctional Treatment Resistance Scale (CTRS) to measure each client s level of resistance

6 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 6 (Shearer, & Ogan, 2002). This research will be able to answer the question: Will there be an increase in the motivation to change after implementing MI with resistant offender clients thus opening the door for other types of interventions? Literature Review Offender populations are one of the most resistant client bases because most are courtordered to participate in therapy and many do not see a need or have the desire to make the necessary changes required to reduce the likelihood of recidivism. This study will examine the effectiveness of MI in reducing client resistance to change and how this can enhance the success of other change therapies. Effectiveness of many techniques have been examined in offender therapy and rehabilitation, so the review of literature will look at current research of techniques in counseling for reducing resistance to change and recidivism in the offender population. Motivational Interviewing Technique A study by Austin, Williams, & Kilgour (2011) examined the effectiveness of MI in increasing motivation to change in a sample of 38 male prison inmates in two New Zealand prisons with high risk of recidivism. The authors noted that many correctional programs tend to be very directive and highly structured which are unlikely to benefit offenders low in motivation to change (Austin et al., 2011). This was an exploratory study to examine how effective the Short Motivational Programme (SMP) was in increasing motivation to change, which is essential for other rehabilitation programs to be effective and to attain the goal of offenders participating in social and community resources upon their release (Austin et al., 2011). The relationship of motivation to change and recidivism risk was also examined and was expected to show a negative relationship (Austin et al., 2011). The SMP is a manual-based version of MI, and high risk offenders received treatment over a five week period with one hour sessions each week

7 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 7 administered by registered clinical psychologists trained in MI (Austin et al., 2011). Offender motivation was assessed prior to and immediately following SMP treatment with the SMP URICA, an adaptation of the University of Rhode Island Change Assessment Questionnaire (URICA) by Anstiss (2003; as cited in Austin et al., 2011). The risk of recidivism was also measured with the Risk of Reconviction scale (RoC*Rol) as well as socially desirable responding with the Balanced Inventory of Desirable Responding (BIDR) and a risk score of.07 was required for inclusion in the study (Austin et al., 2011). Paired sample t-tests and one way repeated measures ANOVA were used to analyze the data. The hypothesis that MI is effective in motivation to change was tentatively supported and the follow-up sub-group also showed that motivation to change was maintained for three to twelve months (Austin et al., 2011). The authors suggested that more research into the effectiveness of MI is justified and needed (Austin et al., 2011). This is consistent with the goal of the present study in examining MI s effectiveness in reducing resistance to change. A case study by Patel, Lambie, and Glover (2008) examines the effectiveness of Motivational Counseling (MC) with a juvenile sex offender (JSO) referred to as Paul. Motivational Counseling is an integration of MI (Miller & Rollnick, 2002) and Motivational Enhancement Therapy (Miller, Zweben, DiClemente, & Rychtarik, 1995, as cited in Patel et al., 2008) that addresses the client s perception of the problem behavior and their motivation to change (Patel et al., 2008). While cognitive behavioral and multisystemic approaches offer helpful interventions and techniques, they do not address the issue of resistance to change in treating the JSO population (Patel et al., 2008). Since JSOs are commonly abuse survivors and exhibit poor social skills, academic limitations, low self-esteem and lack insight regarding their behavior, they are especially low in motivation to change and accept responsibility (Patel et al.,

8 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING ). This case study examines how to move the client through the first three stages of the Transtheoretical Model of Change (TMC) precontemplation, contemplation, and preparation using MC techniques of expressing empathy and respect, reflective listening, developing discrepancy, rolling with resistance, normalizing and exploring ambivalence, and supporting the clients sense of self-efficacy explained in the article (Patel et al., 2008). As expected in the precontemplation stage Paul is completely unmotivated to change even denying any wrong doing or need to change. As therapy progresses using the MC techniques he comes to realize the need to accept responsibility for his actions and make the changes that will help prevent a relapse of the undesirable behavior (Patel et al., 2008). The authors conclude that MC has the advantage over other therapies that employ external inducement to change because it increases a client s intrinsic motivation which is shown to have long-lasting effects and reduce recidivism (Patel et al., 2008). This supports this study s premise that MI can reduce resistance to change and thus reduce recidivism of the offender population. Scott, King, McGinn, and Hosseini (2011) examined use of Motivational Enhancement Treatment (MET) on a highly resistant group, domestic batterers. This study examined whether the use of specialized interventions would increase program completion and reach goals of engagement and accountability (Scott et al., 2011). A sample of 486 men from a large batterer intervention program who were attending treatment as part of probation or sentencing as well as a small number of voluntary clients participated in the study (Scott et al., 2011). A resistance screening was done and participants were classified as either resistant or non-resistant and one third of the sample was identified as resistant to any intervention (Scott et al., 2011). Facilitator behaviors were coded and rated with the Helping Skills System in both standard and MET conditions (Scott et al., 2011). Treatment completion rates and counselor-rated success measures

9 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 9 were also taken to determine the effectiveness of treatment conditions and assignment to a group was done as subjects entered treatment and could attend at scheduled times (Scott et al., 2011). Therapist behaviors were found to be significantly different between standard and MET therapies (Scott et al., 2011). Scott et al. also found that resistant clients that participated in the MET treatment program were significantly more likely to complete the program but that counselorreported accountability was significantly varied with the highest rating for the non-resistant clients closely followed by resistant clients in MET program and standard treatment showing the lowest rating. Overall positive effects of MET were found over standard treatment interventions in engagement but may not be sufficient in bringing about the change needed to prevent reoffending which prompted the researchers to suggest that further study is warranted as the first condition of engagement and completion was met (Scott et al., 2011). A meta-analysis of the effectiveness of motivational interviewing on offender populations was conducted to examine outcomes, clarify empirical support of the benefits, and to identify gaps in knowledge needing to be addressed (McMurran, 2009). A search of relevant databases as well as internet sources were used to identify studies that focused on MI and MET and excluded other interventions using a motivational style (McMurran, 2009). Thirteen published studies and six dissertation abstracts were included with substance abuse treatments being the most common, and treatment engagement, readiness to change, decrease in offending, and reduced substance abuse included in the various measures (McMurran, 2009). McMurran found that a meta-analysis was not possible with the information available though the search conducted and also noted the limitations of this review specifically that many studies are conducted in a motivational style and these were not included and others may not have been identified. Developing a sound theoretical base for MI is suggested to improve the possibility of developing a testable hypothesis

10 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 10 (McMurran, 2009). McMurran notes that MI could have the power to help offenders move from external motivation to intrinsic which is essential in lasting effects of treatment and reduction of recidivism. Skill of the therapists delivering MI is also emphasized as important in the effectiveness of MI to effect change in the offender population and session rating protocols are suggested in future studies (McMurran, 2009). McMurran concludes that MI is an intervention that is worth further investigation to develop an evidence base for treatment of offenders. Cognitive Behavioral Therapies Polaschek, Bell, Calvert, and Takarangi (2010) explored both explicit and implicit measures of treatment change in a cognitive behavioral program. The researchers gathered a sample of 30 male prisoners in a violence prevention unit (VPU) that were just beginning an intensive treatment and rehabilitation program toward the end of their sentences (Polaschek et al., 2010). Data was collected before and after treatment from four cohorts that entered the program over 18 months including two self-report explicit questionnaires The Criminal Attitudes to Violence Scale (CAVS) and the Aggression Questionnaire (AQ), implicit association tests (IAT), and Violence Risk Scale (VRS) scores that were gathered during treatment by the therapists (Polaschek et al., 2010). The IATs showed that the participants found weapons significantly less likable after treatment, but violent word evaluations showed no change (Polaschek et al., 2010). The CAVS and AQ showed that disagreement with violent attitudes increased and aggression decreased among participants and Visual Analogue Scales (VAS) showed a more negative attitude toward weapons and increased rating of violence as bad (Polaschek et al., 2010). Comparisons of the measures showed a medium-large to large correlation on the VRS and the IAT weapons-entertainment pre and post scores and AQ scores were strongly related to the post-treatment VRS scores (Polaschek et al., 2010). The implicit

11 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 11 preference for weapons post program is an important indication of risk that may not be detected by explicit measures showing the value of implicit evaluation of risk (Polaschek et al., 2010). This further supports the importance of motivation to change being implicit and intrinsic. Landenberger and Lipsey (2005) conducted a meta-analysis which examined the effects of cognitive behavioral therapy (CBT) on recidivism of offenders using selected moderator variables. The intervention in included studies had to be a CBT treatment or if multimodal CBT had to be a major component in the treatment program (Landenberger & Lipsey, 2005). Also for studies to be included participants had to be offenders and were not restricted to any specific type of offense, criminal offending post treatment must be an outcome variable and results presented in quantitative form so that effect size could be calculated, and a randomized or quasiexperimental design with both a control and treatment group (Landenberger & Lipsey, 2005). Recidivism outcomes were coded for the purpose of the meta-analysis and conventional metaanalysis techniques were used. The study found that CBT has positive effects on recidivism and the odds of not reoffending were 1.53 times as great as the control group (Landenberger & Lipsey, 2005). Effect sizes were analyzed for moderator variable and only three factors explained the variation in recidivism effects the risk level of the offenders that participated, skillful implementation of the treatment, and the inclusion of a few important treatment elements (Landenberger & Lipsey, 2005). The treatment components that resulted in larger effects were anger control and interpersonal problem solving; however, victim impact and behavior modification yielded smaller effect sizes (Landenberger & Lipsey, 2005). This analysis showed the need to include anger management and interpersonal skills components in CBT treatment of offender populations, but most important to reducing recidivism in the analysis of the research is that the program be well implemented (Landenberger & Lipsey, 2005).

12 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 12 Integrated Techniques While this CBT has shown effectiveness, it is a more directive and confrontational approach and may have negative effects on resistance, so the current study will look at reducing resistance with MI so that other treatments such as CBT can then be implemented with greater results. Westra (2004) examines using MI for clients in an integrated way with CBT in three case studies. In each case the client demonstrated ambivalence or outright resistance to the directive CBT therapy program (Westra, 2004). Making the change to MI helped each client to explore and examine their own attitudes and reasons for resisting change as well as the advantages of remaining the same or making changes with a decisional balance exercise (Westra, 2004). While Westra acknowledged more research with controlled methods is indicated, MI was effective in helping these clients to move to the action stage of change. This opened the way for more directive and specific change therapies, matching the therapy to the client s particular stage (Westra, 2004). Rather than replacing CBT or other effective therapies, MI showed potential to supplement and help move clients to a working alliance with the therapist for change (Westra, 2004). Rather than continuing with techniques that will not yield results or cause a discontinuation of treatment, Westra asserted that integration of MI with other change-oriented treatments will help move forward the change process. This study supports the premise of the proposed study that reducing resistance to active change can take place with offenders opening the way to other intervention therapies and reduce the incidence of reoffending. Recent research by Monakes, Garza, Wiesner, and Watts (2011) examined implementing Adlerian Sand Tray therapy in conjunction with cognitive behavioral rehabilitative treatment with adult male substance offenders. Projective techniques have proven to help remove filters that are used in verbal dialogue to avoid or disguise cognitions and emotions that would

13 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 13 otherwise be avoided (Monakes et al., 2011). Participants were selected from a court-mandated adult male offender treatment facility and four residents were selected that met the inclusion criteria (Monakes et al., 2011). Each participant received individual sessions completing one tray per session in the following sequential order identifying information, presenting problem, current function of life tasks, goals of treatment, and treatment expectations (Monakes et al., 2011). A therapist observed the construction of the tray and used reflection skills to facilitate and used the client s metaphor to reflect asking facilitating questions to help the client process feeling and emotions (Monakes et al., 2011). The therapist coded the story that came from the interview with the client and also completed a session summary form their own concept of the tray (Monakes et al., 2011). Data was gathered in the form or unstructured interviews that were examined by the researchers using Colaizzi s (1978, as cited in Monakes et al., 2011) seven-step method of phenomenological analysis. Participant s overall experience was positive even though the initial phase elicited feelings of uncertainty (Monakes et al., 2011). The client s also recognized the sand tray as self-expression that allowed deeper examination than talking would allow (Monakes et al., 2011). The implications of this study indicate that alternatives to verbalization may help facilitate the client s deeper examination of issues and opened the way for them to identify areas needing change (Monakes et al., 2011). Therapist Characteristics and Skill Forsberg, Ernst, and Farbring (2011) examined the skill of prison services staff in implementing a motivational interviewing (MI) skills in BSF (Behavior, Counseling, Change) sessions, usual prison planning interviews (UPI), and conducted by counselors with three different training levels: (1) no additional training (UPI); (2) workshop-only training (BSF); or (3) workshop plus feedback from recorded counseling sessions delivered in peer groups (BSF+)

14 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 14 (Forsberg et al., 2011). Random assignment of consenting inmates to one of the three interventions in 14 prisons was used to establish the 3 study groups. The MITI 3.0 was used to measure the counselor s skills in implementing MI in the program (Forsberg et al., 2011). An ANOVA was used to analyze the data and significance was found between the three interventions and significant differences were found in MI adherence between the groups (Forsberg et al., 2011). Forsberg et al. found that BSF+ counselor competence was significantly different from the other two conditions calling into question the lack of training in MI and the resulting positive results to the clients. However the researchers also found that the BSF+ groups did not achieve the level of proficiency that would elicit change in client behavior and stated that it could be due to a lack of sufficient time the training was implemented (Forsberg et al., 2011). This study emphasizes the need for extensive counselor training in MI to be proficient enough to elicit change in client behavior. Communication is a very important to the success of any therapeutic relationship. With this in mind, Bisese (1990) examined counselor communication styles in relation to client response choices of resistant or resonant through a simulated psychotherapy sessions. Certain specific usage of restricted language by the therapist was addressed and styles most likely to either promote or stop resistance of clients (Bisese, 1990). Participants were 30 first year medical students and each was exposed to all four styles of therapist communications being studied (Bisese, 1990). The disengaged communication style showed increased resistance in conjunction to current and past relationships but not with transference relationships (Bisese, 1990). Collaborative expressions did reach significance in decreasing resistance for past and current relationships than both disengaged and unidirectional communication styles (Bisese, 1990). Low resistant choices were most frequent in transference relationship communication

15 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 15 styles especially when the intervention focused on the patient s attitude behavior or orientation with the therapist. This could be viewed as client s intense modeling or imitation of the therapist and resistance as less modeling. This finding emphasized the importance of the therapists attending, retaining, comprehending, and acceptance of the communication. The emphasis is on the relationship and how it is affected by the communication style of the therapist (Bisese, 1990). Communication that promotes alliance enhancement and corroboration between the therapist and client are shown to decrease resistance so these skills should be part of counselor training and continuing education to help counselors to be more effective(bisese, 1990). This study supports the assertion that counselor skill and training is important in reducing resistance in clients. Conclusion Increasing positive offender outcomes are important to society and individual safety. Effective rehabilitative treatments for offender populations are important in reducing recidivism and improving life quality for them and their families. Therapies to overcome resistance to change are increasingly important to help offenders to accept responsibility and work toward positive lifestyle changes and reduce the risk of reoffending. The present study will investigate the effectiveness of motivational interviewing in overcoming resistance to change. Methods The purpose of this study is to gather data and evaluate the technique of MI in overcoming offender resistance to change in a counseling setting. Understanding the effectiveness of MI in reducing resistance advances the knowledge of the counseling profession and an understanding of what is best practice with the offender population. This section will be divided as follows: participant selection criteria and randomization used, the instruments used to

16 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 16 gather data will be identified and explained, the procedures used to assign participants to groups and how the information will be gathered and evaluated. Participants Eighty individuals will be chosen using systematic randomization to participate from offenders who are court-ordered to enter counseling or entering counseling as a condition of probation or parole. These individuals will be chosen from counseling agencies and offices serving offender clients which will be identified in the eastern New Mexico area. Selection of participants will be based on two criteria. First they must be receiving services as a result of a court order or as a condition of probation or parole. The second is two-fold, either they have not received services for the offense before, or the previous counseling received did not include use of MI. The eastern New Mexico region will be divided into four sections and two agencies that offer counseling services to offenders will be randomly selected from each section. Counselors working at the chosen agencies will be asked to participate until one counselor from each of the two different agencies in each section is recruited to assist in the study. If the agency selected does not yield any participating counselors, another agency in the area will be chosen until two counselors are participating from each area resulting in a total of eight counselors. These counselors will then ask every third new court-ordered offender meeting the specified participant criteria to participate in the study and will gain the client s permission by having them sign a consent form. This will continue until each counselor has 10 clients that have agreed to participate in the study. The counselors will alternate assigning the new clients to groups in a Solomon four-group design.

17 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 17 Instruments Each participant in the pretest condition will be given a survey that is designed to measure their level of resistance before their first counseling session and again at the end of the treatment period. The groups in the posttest only condition will be given the survey upon completion of the treatment period. This survey will be adapted from the Correctional Treatment Resistance Scale (CTRS) used in a study by Shearer and Ogan (2002) for use with incarcerated offenders. The scale will be adapted by eliminating or rewording items that pertain to incarcerated individuals and shortened to contribute to ease of administration. The scale will then be evaluated by counselors experienced in treating resistant clients. The scale will consist of five choices and be scored by a number value given to each choice. Values will be assigned as follows: 5 - Strongly agree, 4 Agree, 3 Neutral, 2 Disagree, and 1- Strongly disagree. The items will address issues such as counselor distrust, compliance, cynicism, denial, and low selfdisclosure which the participants will answer with the choices ranging from strongly agree to strongly disagree. Many of the items will be reversed scored to increase the reliability of the result. An example of a question would be: I don t trust counselors to maintain confidentiality with what I might say to them. The participant will then select the choice that best fits their attitude. The counselors will also keep a journal of their perceptions of how the client is responding to the counseling techniques used and if they see any improvement or inclination to change. Procedures The study will be conducted with offender clients that have been chosen by the eight counselors that have agreed to participate in the study. As the counselors gain the consent to participate from each individual, they will be assigned to one of four groups in Solomon four-

18 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 18 group design. Two groups will receive counseling using the MI technique and the other two will receive counseling using the technique preferred by their counselor. The group assignment will determine the type of counseling received and the pretest posttest and posttest only condition. Each group will be assigned as follows: Group 1- pretest/posttest condition whose treatment will be MI, Group 2 - pretest/posttest condition whose treatment will not include MI, Group 3 assigned to posttest only condition whose treatment will be MI, Group 4 assigned to a posttest only condition whose treatment will not include MI. Four of the counselors that have been chosen to help in this study will be trained in use of the MI techniques in 2 two-day workshops by a certified instructor in MI. Following this training, as these counselors obtain permission to participate from the new clients, they will alternate assigning them to groups 1 and 3 until each counselor will have five clients in each group. They will administer the pretest survey to group 1 before the first counseling session begins and again at the end of eight weeks of treatment. Group 3 will be given the survey at the end of the eight-week treatment period. The other four counselors will use whatever techniques they prefer other than MI. They will alternately assign the clients that have agreed to participate to groups 2 and 4, the control groups, until each counselor has five clients in each group. They will then administer the survey to group 2 before any treatment begins and again at the end of the eight-week treatment period. Group 4 will take the survey after eight weeks of treatment have been completed. The surveys will be coded to identify the participants so the pretest and posttest and treatment and control groups can be identified for data analysis and to maintain anonymity and confidentiality. The survey will be scored on a Likert scale from one to five points possible with higher scores indicating high resistance to change. The scores will be analyzed using planned comparisons to indicate the effectiveness of MI in reducing resistance.

19 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 19 The counselors will keep a journal of each session that tracks their perceptions and evidence of progress during the treatment period. These observations will be coded by other counselors trained in the techniques used in treatment of the participants, but who will remain blind as to the purpose of the study and the observations to control for bias. This data will also be used in the planned comparisons.

20 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 20 References Arkowitz, H. (2002). Toward an integrative perspective on resistance to change. Journal of Clinical Psychology, 58(2), Austin, K. P., Williams, M.W. M., & Kilgour, G. (2011). The effectiveness of motivational interviewing with offenders: An outcome evaluation. New Zealand Journal of Psychology, 40(1), Bisese, V. S. (1990). Therapist specific communication styles and patient resistance: An analogue study. Counselling Psychology Quarterly, 3(2), Bureau of Justice Statistics. (2012). Community Corrections Retrieved from Elliott, W. N. (2002). Managing offender resistance to counseling--the '3R's'. Federal Probation, 66(3), Forsberg, L., Ernst, D., & Farbring, C. A. (2011). Learning motivational interviewing in a reallife setting: A randomised controlled trial in the Swedish Prison Service. Criminal Behaviour & Mental Health, 21(3), DOI: /cbm.792. Lancaster, C., Balkin, R. S., Garcia, R., & Valarezo, A. (2011). An evidence-based approach to reducing recidivism in court-referred youth. Journal of Counseling & Development, 89(4), Landenberger, N. A., & Lipsey, M. W. (2005). The positive effects of cognitive-behavioral programs for offenders: A meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1(4), Retrieved from McMurran, M. (2009). Motivational interviewing with offenders: A systematic review. Legal and Criminological Psychology, 14(1),

21 EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING 21 Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York, NY, US: Guilford Press. Miller, W. R., & Rollnick S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York, NY, US: Guilford Press. Monakes, S. G., Wiesner, Y., & Van III Watts, R. E. (2011). Implementing Adlerian sand tray therapy with adult male substance abuse offenders: A phenomenological inquiry. Journal of Addictions & Offender Counseling, 31(2), Patel, S. H., Lambie, G. W., & Glover, M. M. (2008). Motivational counseling: Implications for counseling male juvenile sex offenders. Journal of Addictions & Offender Counseling, 28(2), Polaschek, D. L. L., Bell, R. K., Calvert, S. W., & Takarangi, M. K. T. (2010). Cognitivebehavioural rehabilitation of high-risk violent offenders: Investigating treatment change with explicit and implicit measures of cognition. Applied Cognitive Psychology, Special issue: Current directions at the juncture of clinical and cognitive science 24(3), Rollnick, S., & Miller, W.R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, Retrieved from Roseman, C. P., Ritchie, M., & Laux, J. M. (2009). A restorative justice approach to empathy development in sex offenders: An exploratory study. Journal of Addictions & Offender Counseling, 29(2), Scott, K., King, C., McGinn, H., & Hosseini, N. (2011). Effects of motivational enhancement on immediate outcomes of batterer intervention. Journal of Family Violence, 26(2), Shearer, R. A., & Ogan, G. D. (2002). Measuring treatment resistance in offender counselling. Journal of Addictions and Offender Counselling, 22(2),