Client language as a mediator of motivational interviewing efficacy: Where is the evidence?
Client language as a mediator of motivational interviewing efficacy: Where is the evidence?
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DOI：
10.1111/j.1530-0277.2007.00492.x
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发表时间：
2007-10-01
影响因子：
3.2
通讯作者：
Amrhein, Paul C.
中科院分区：
文献类型：
--
作者：
Moyers, Theresa B.;Martin, Tim;Amrhein, Paul C.
背景：确定患者结果的会议指标对于确定心理治疗的机制很重要，包括动机访谈(MI)。目前的研究试图确定临床医生的行为是否会影响客户的言语，以及客户的言语在多大程度上预测了接受药物滥用治疗的客户的治疗结果。方法：研究1在Project Match中对5个地点的38次会议进行了研究。使用进程交换顺序代码(Scope)行为编码系统对会话进行编码。计算了转移概率和评分者间的信度。研究2在Project Match中检查了来自新墨西哥州站点的45个会话。使用MISC 1.0行为编码系统对会话进行编码。计算戒酒天数(PDA)和每天饮酒量(DDD)的远期结局指标。结果：在研究1中，评分者之间的信度估计表明，编码者能够可靠地区分范围内的类别。与MI(MICO)一致的行为很可能发生在客户改变谈话(CT)之后，而与MI不一致的行为(MIIN)很可能发生在对策谈话(CCT)之后。MICO和CCT之间也存在显著的负转移概率。在研究2中，CT被发现解释了结果变异性的重要部分，而不是归因于问题严重性的基线测量。结论：在早期治疗过程中，患者的言语似乎是物质滥用结果的有力预测因素。在这些数据中发现的治疗师行为模式和随后的客户语言支持我们为动机访谈描述的因果链中的干预测试。这些研究初步支持了激励性访谈中治疗师的行为、随后的客户言语和饮酒结果之间的因果关系。这两项研究的结果进一步支持了客户的言语影响行为改变的可能性，以及这种言语的发生受到治疗师的影响这一命题。
Background: Identifying in-session indicators of client outcomes is important in determining the mechanisms of psychotherapeutic treatments, including Motivational Interviewing (MI). The current studies sought to determine if clinician behavior influences client speech, and the extent to which client speech predicted treatment outcome in clients receiving treatment for substance abuse.Methods: Study 1 examined 38 sessions from 5 sites in Project MATCH. Sessions were coded using the Sequential Code for Process Exchanges (SCOPE) behavioral coding system. Transition probabilities and inter-rater reliability were calculated. Study 2 examined 45 sessions from the New Mexico site in Project MATCH. Sessions were coded using the MISC 1.0 behavioral coding system. Distal outcome measures were calculated for proportion of days abstinent (PDA) and drinks per drinking day (DDD). Hierarchical multiple regression and hierarchical logistic regression were used to characterize the relationship between client speech and outcome.Results: In Study 1, inter-rater reliability estimates indicate that coders reliably distinguished between the categories within the SCOPE. Behaviors consistent with MI (MICO) were significantly likely to be followed by client Change Talk (CT) and behaviors inconsistent with MI (MIIN) were significantly likely to be followed by Counterchange Talk (CCT). There was also a significant negative transition probability between MICO and CCT. In Study 2, CT was found to account for significant portions of outcome variability beyond that attributable to baseline measures of problem severity.Conclusion: Client speech during early therapy sessions appears to be a powerful predictor of substance abuse outcome. The pattern of therapist behaviors and subsequent client language found in this data supports the intervention test in the causal chain we have described for motivational interviewing. These studies provide preliminary support for a causal chain between therapist behaviors, subsequent client speech, and drinking outcomes within motivational interviewing sessions. The results of both studies provide further support to the proposition that client speech impacts the likelihood of behavioral change, and that the occurrence of such speech is influenced by the therapist.