Motivational interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay male couples.

Abstract

Epidemiological data indicate the need to address substance use and sexual HIV transmission risk among gay and bisexual men in relationships. While brief Motivational Interviewing (MI) delivered to the individual has shown efficacy in reducing sexual HIV risk with casual partners and substance use, the application of MI with couples has received less attention. Most studies of MI with couples have conceptualized the “spouse” or partner as an adjunct participant in the treatment of an identified client. We propose a theoretical framework for conducting MI with a couple, which approaches the couple as the identified client, and may be adopted when either one or both partners engage in the target behavior. We then discuss similarities between MI-processes conceptualized with our proposed framework and those that are salient in existing couples therapies. We utilize case examples from brief MI sessions targeting substance use and sexual HIV risk in gay male couples to illustrate three phenomena unique to the implementation of MI with couples: 1) interpersonal ambivalence; 2) the role of dyadic functioning in tolerating and resolving interpersonal ambivalence; and 3) joint goal formation as a prerequisite to the planning phase of MI. Connecting these phenomena with the transformation of motivation and accommodation processes outlined in Couples Interdependence Theory, this paper suggests that brief MI may be a promising modality for substance use and HIV risk reduction interventions with couples generally and gay couples specifically.

Pilot Randomized Controlled Trial of Motivational Interviewing with Sexual Minority Male Couples to Reduce Drug Use and Sexual Risk: The Couples Health Project

“…Earlier research indicated that 35-68% of new HIV infections among SMM were transmitted between main partners [4][5][6]. Estimated rates were as high as 79% among younger SMM (aged [18][19][20][21][22][23][24][25][26][27][28][29] [6]. More recent research has indicated that the likelihood of having condomless anal sex (CAS) with casual partners is comparable for single SMM and partnered SMM in non-monogamous sexual agreements [7,8].…”

“…To address this challenge, Starks et al [28,29] drew on Interdependence Theory [30,31] to derive processes and techniques unique to implementing MI with couples. This work adopted the novel premise that the couple was "the client" rather than identifying one partner in the couple as "the client" and the other as an "adjunct participant."…”

“…This work adopted the novel premise that the couple was "the client" rather than identifying one partner in the couple as "the client" and the other as an "adjunct participant." This framework [28,29] therefore provides a context for engaging couples where one or both partners in the relationship may use drugs to varying degrees.…”

“…Building on these principles, Starks et al [28] proposed that facilitating dyadic functioning is an essential process unique to MI with couples. MI traditionally conceives of four processes: engaging, focusing, evoking, and planning [16].…”

“…MI traditionally conceives of four processes: engaging, focusing, evoking, and planning [16]. Starks et al [28] suggested that facilitating dyadic functioning-a process characterized by eliciting the couple's strengths, activating pro-social exchanges between partners, and problem-solving around sources of conflictwas an additional essential component. Through subsequent qualitative analysis of session data, we derived techniques providers can use to mitigate conflict and support constructive accommodation in session [29].…”