Chasing change talk: the clinician's role in evoking client language about change.
ABSTRACT Client "change talk," or language in favor of changing a target behavior, is a hypothesized active ingredient of motivational interviewing that can predict actual behavioral change. This study isolated and manipulated change talk in a context resembling a psychotherapeutic encounter, comparing its prevalence in two conditions: change talk evocation (CT) and functional analysis (FA). Using a single-baseline (ABAB) design, clinicians alternated between CT and FA, consequating change talk only in the CT condition. Clinicians were 9 clinical psychology graduate students, and clients were 47 undergraduates with concerns about drinking. The hypothesis that greater Percentage Change Talk would be observed in CT than in FA was supported, t(46) = 6.561, p < .001, d = 1.19. A rationale for the development of a behavioral rating system to evaluate clinicians' proficiency in recognizing, responding to, and evoking client change talk is presented.
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ABSTRACT: AimsIncreased expectations for the use of evidence-based methods in addiction treatment have fueled a debate regarding the relative importance of “specific” versus “common” factors in treatment outcome.This review explores the influence of these factors on addiction treatment outcome.Methods The authors review and link findings from four decades of research on specific and general factors in addiction treatment outcome research.FindingsThough few would argue that what one does in addiction treatment is immaterial, outcome studies do tend to find small to no difference when specific treatment methods are compared with each other or with treatment as usual.In contrast, there are usually substantial differences among therapists in client outcomes, and relational factors such as therapist empathy and therapeutic alliance can be significant determinants of addiction treatment outcome.Conclusions In addiction treatment, relational factors such as empathy, which are often described as common, non-specific factors, should not be dismissed as “common” because they vary substantially across providers and it is unclear how common they actually are.Similarly they should not be relegated to “non-specific” status, because such important relational influences can be specified and incorporated in clinical research and training.Addiction 07/2014; · 4.60 Impact Factor
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ABSTRACT: No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors’ use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors’ use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists’ techniques as predictors of outcome during the course of treatment.Behaviour Research and Therapy 10/2014; · 3.85 Impact Factor
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ABSTRACT: Clients who verbalize statements arguing for change (change talk [CT]) in psychotherapy are more likely to decrease alcohol and other drug use (AOD) compared with clients who voice statements in opposition of change (sustain talk [ST]). Little is known about how CT and ST are expressed in groups in which adolescents may vary in their AOD use severity and readiness to change. First, we examined how session content was associated with CT/ST, and then we looked at whether different subtypes of CT/ST were associated with subsequent AOD outcomes 3 months later. Audio recordings (N = 129 sessions) of a 6-session group motivational interviewing (MI) intervention, Free Talk, were coded. Session content was not associated with CT; however, some session content was associated with higher percentages of ST (e.g., normative feedback). Subtypes of CT (Commitment and Reason) were associated with improved AOD outcomes, whereas Ability subtype remarks were related to increased marijuana use, intentions, and consequences. Findings offer helpful guidance for clinical training and narrow in on the type of CT to try to elicit in Group MI sessions. Regardless of session content, adolescents can benefit from hearing CT during the group. (PsycINFO Database Record (c) 2015 APA, all rights reserved).Journal of Counseling Psychology 01/2015; 62(1):79-86. · 3.23 Impact Factor