Editor’s note: It’s graduation season, which means a slew of new dissertations! In today’s post, we feature two recent projects on the use of motivational interviewing techniques in recovery settings. These entries are part of an ongoing drug-related dissertation bibliography continuously compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.
Motivational Interviewing Treatment Integrity and Client Change: Using ROC Analysis to Explore the Relationship Between MI Fidelity Level and Drinking Outcome
Author: Fischer, Daniel J.
Abstract: Those engaged in the research and practice of MI have shown interest in treatment adherence as an indicator of effective MI and have expressed curiosity in the threshold at which MI practice could be viewed as “good enough”. The most widely used and often cited of MI integrity measures are the Motivational Interviewing Skills Code (MISC) and the Motivational Interviewing Treatment Integrity code (MITI). These adherence tools share similar descriptive coding systems for therapist in-session behavior. MI fidelity standards are often used as reference points for therapist performance, yet practitioners rarely meet full criteria. Further, substandard ratings have been associated with positive client change. These findings have elicited questions about the necessary levels of therapist treatment adherence to promote client change and suggested the need for empirically-derived fidelity standards. This study analyzed existing data from a sample of Motivational Enhancement Therapy (MET) sessions from Project MATCH (Matching Alcohol Treatments to Client Heterogeneity) that were audio recorded and previously coded with the MISC. MI adherence variables were analyzed along with client drinking outcomes to test the relationship between therapist fidelity and client change. Therapist adherence was determined using behavioral codes common to the MITI and MISC. Client change thresholds were determined using clinically significant change standards developed by Jacobson and Truax. The relationships between therapist adherence level and client change thresholds were examined using Receiver Operating Characteristic (ROC) analysis. Findings showed mixed support for the relationship between therapist adherence level and client drinking outcomes, but yielded levels of therapist MI adherence associated with client changes in drinking outcomes.