What MI Research Has Revealed and Related Developments

Transcription

1 What MI Research Has Revealed and Related Developments

2 Now > 1100 controlled clinical trials in many different fields! Development: The applicability of MI is much broader than initially conceived (addictions). (Second edition, 2002)

3 In clinical trials, MI is often 1-2 sessions MI has been used effectively within health care visits! Development: MI can be a free-standing intervention ~1990

4 Fidelity of MI practice can improve with training, particularly with some individual feedback and coaching Training studies Ability to learn MI unrelated to years of professional education! Development: Learning MI is not simple; workshop and self-study do not improve MI competence much, although trainees may believe it does

5 Effectiveness of MI varies widely across studies, therapists, and sites About 2/3 or clinical trials are positive, 1/3 negative! Development: Process research is needed to understand when and why MI is effective ~ 2000

6 Therapist fidelity in delivering MI predicts whether clients change Large differences between therapists in fidelity and outcome Also large differences within therapists! Development: Clearer focus on technical as well as relational components in MI training it s not just being nice

7 Sustain talk is a better predictor than is change talk Ratio of client change talk to sustain talk is the best predictor Therapists substantially influence both change talk and sustain talk! Development: An important component of MI (and training) is to decrease counter-therapeutic responses that evoke resistance

8 When MI is compared head-to-head with other kinds of psychotherapy, there is usually little or no difference in outcome, even when MI is briefer! Development: MI is used as an ethical minimal intervention in psychotherapy and pharmaceutical trials

9 When MI is added to other evidence-based treatment (EBT), both become more effective and benefit lasts longer! Development: MI is increasingly used in combination with other evidence-based treatment methods

10 For example, skill in accurate empathy predicts outcome in clientcentered counseling, behavior therapy, group therapy, health care, acupuncture! Development: Perhaps what we have been studying is not a separate treatment, but what makes helpers more effective

11 MI appears to be differentially effective with less motivated and more resistive clients Clients who are already ready for change don t need the evoking elements of MI! Development: Not everyone needs motivational interviewing

12 MI is now being taught and practiced in 54 languages Clinical trials have been published from Africa, Asia, North and South America, Europe, Oceania, and Arabic nations The effect size of MI was larger in U.S. studies treating minority clients - seems to be a good cross-cultural counseling method! Development: Is MI rooted in something about our common evolutionary past? de Almeida Neto, A. C. (2017). Understanding motivational interviewing: An evolutionary perspective. Evolutionary Psychological Science, 3(4),

13 ! Evidence-based! Relatively brief! Specifiable (but be careful with manuals)! Verifiable (good fidelity measures)! With specific mechanisms of action! Broadly generalizable across problem areas! Culturally adaptable! Complementary to other treatment methods! Learnable by a broad range of providers

14 and still we re just getting started

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