Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles.

Abstract

To investigate the impact of counselor style, a 2-session motivational checkup was offered to 42 problem drinkers (18 women and 24 men) who were randomly assigned to 3 groups: (a) immediate checkup with directive-confrontational counseling, (b) immediate checkup with client-centered counseling, or (c) delayed checkup (waiting-list control). Overall, the intervention resulted in a 57% reduction in drinking within 6 weeks, which was maintained at 1 year. Clients receiving immediate checkup showed significant reduction in drinking relative to controls. The 2 counseling styles were discriminable on therapist behaviors coded from audiotapes. The directive-confrontational style yielded significantly more resistance from clients, which in turn predicted poorer outcomes at 1 year. Therapist styles did not differ in overall impact on drinking, but a single therapist behavior was predictive (r = .65) of 1-year outcome such that the more the therapist confronted, the more the client drank.

Dynamics of Resistance to Change: A Sequential Analysis of Change Agents in Action

“…Whereas earlier MI coding manuals could only predict the lack of behaviour change based on resistance language (i.e. sustain talk ;Miller, Benefield, & Tonigan, 1993), the adapted language categorization by Amrhein et al (2003) allows predictions of behaviour change in substance abuse. In summary, the coding of language in dyadic interactions into change and sustain talks has only been applied in therapeutic settings.…”

Alcohol Problems

“…Valle (1981) reported similar findings from a study of client-centred counselling for alcohol problems. A further remarkable finding was reported by Miller, Benefield & Tonigan (1993) who showed that half the variance in treatment outcome could be predicted by the degree to which the therapist had confronted the client, in many ways the opposite of empathy, during treatment sessions.…”

¿Mejora la entrevista motivacional la eficacia del tratamiento psicológico para dejar de fumar?

“…En el caso concreto del tabaquismo la mayoría de los fumadores no quieren dejar de fumar. La entrevista motivacional (EM) se ha propuesto como un procedimiento útil para incrementar la motivación intrínseca del individuo para el cambio (Bien, Miller y Boroughs, 1993;Bien, Miller y Tonigan, 1993;Miller, 1983;Miller y Rollnick, 1991.…”

“…En el caso concreto del tabaquismo la mayoría de los fumadores no quieren dejar de fumar. La entrevista motivacional (EM) se ha propuesto como un procedimiento útil para incrementar la motivación intrínseca del individuo para el cambio (Bien, Miller y Boroughs, 1993;Bien, Miller y Tonigan, 1993;Miller, 1983;Miller y Rollnick, 1991.La EM se define como un estilo de comunicación, centrado en el cliente, dirigido a un objetivo, que pretende provocar un cambio en el comportamiento, ayudando a resolver las propias motivaciones para cambiar de los clientes (Miller y Rollnick, 2002 La mayoría de los fumadores que acuden a tratamiento se encuentran en el estadio de precontemplación y contemplación (Prochaska, Velicer, Prochaska y Johnson, 2004), es decir, todavía no han considerado la posibilidad de abandonar el consumo de tabaco a corto plazo. En este sentido, la literatura señala que la EM está particularmente indicada para trabajar con aquellos clientes que se muestran ambivalentes y que están menos motivados para cambiar (Heather, Rollnick, Bell y Richmond, 1996;Hettema, Steele y Miller, 2005).…”