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the Behavior Therapist
ISSN 0278-8403
VOLUME 34, NO. 4 • APRIL 2011
April 2011 57
Contents
Research Forum
Marvin R. Goldfried
Generating Research Questions From Clinical
Experience: Therapists’ Experiences in Using CBT
for Panic Disorder 57
Clinical Forum
Julie A. Schumacher, Michael B. Madson,
and Grayson S. Norquist
Using Telehealth Technology to Enhance
Motivational Interviewing Training for Rural
Substance Abuse Treatment Providers: A Services
Improvement Project 64
Professional Development
Mitch Prinstein
Why Volunteer for Psychology Association
Governance Groups and Committees? 71
At ABCT
Kristene A. Doyle and Kamila White
A Closer Look at the Benefits of ABCT
Membership 72
Welcome, New Members! 73
Call for Web Editor 75
ASSOCIATION FOR BEHAVIORAL
AND COGNITIVE THERAPIES
Research Forum
Generating Research
Questions From
Clinical Experience:
Therapists’
Experiences in Using
CBT for Panic
Disorder
Marvin R. Goldfried, Stony Brook
University
The overall goal of this new initiative by
the Society of Clinical Psychology is to
provide a mechanism whereby practicing
therapists could participate in the research
process. Much has been said about the dissemi-
nation of research findings to the practicing clin-
ician, and it is now important to provide
practicing therapists with a way of disseminat-
ing their clinical experiences in using empirically
supported treatments (ESTs) to the research
community—as well as to other practitioners.
This mechanism has been in place for practicing
physicians, who have the opportunity to give
the U.S. Food and Drug Administration (FDA)
feedback on the problems encountered in using
research-based, empirically supported medica-
tions in clinical practice. In developing this ini-
tiative for ESTs, the Society provides a two-way
bridge between research and practice, not only
to ensure a firm clinical basis for our research ef-
forts, but also to hopefully encourage practition-
ers to use research findings in guiding their
clinical work. Although there is certainly a long
history of a gap between research and practice,
there now exists growing pressure for account-
ability by governmental agencies and insurance
companies, which I would maintain needs to be
informed by both research findings and clinical
practice.
[continued on p. 59]
Vote in April,
on-line,
for the next
leaders
of our field
(see p. 70)
58
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March 2011 59
The first of what will be several surveys
of practicing clinicians on the use of ESTs
has focused on the treatment of panic disor-
der, a clinical problem one is likely to en-
counter in clinical practice, and one for
which there exists a fair amount of research
evidence. At present, the only EST for panic
consists of CBT. The goal of the clinical sur-
vey was not only to determine the extent to
which CBT works in actual clinical practice,
but also to uncover those mediators and
moderators that may create obstacles for ef-
fective clinical intervention. Indeed, the
question of how to further improve our in-
tervention for panic disorder has been
something raised by others (e.g., McGabe &
Antony, 2005; Otto & Gould, 1996;
Sanderson & Bruce, 2007). Moreover, the
identification of variables that interfere with
clinical effectiveness have long been
thought of as potential research questions,
derived from clinical practice, and in need of
further investigation (Foa & Emmelkamp,
1983).
The items included in this survey in-
volved treatment, therapist, patient, and
contextual variables, which were generated
by a group of clinicians who were experi-
enced in using CBT clinically. The following
therapists graciously participated in exten-
sive open-ended interviews that were used
to develop the questionnaire items: Dianne
Chambless, Steven Fishman, Joann Galst,
Alan Goldstein, Steven Gordon, Steven
Holland, Philip Levendusky, Barry
Lubetkin, Charles Mansuto, Cory
Newman, Bethany Teachman, Dina Vivian,
and Barry Wolfe. In addition, a special com-
mittee within the Society of Clinical
Psychology was formed to develop the sur-
vey, and consisted of individuals having a
long-standing commitment to closing the
gap between research and practice: Louis
Castonguay, Marvin Goldfried, Jeffrey
Magnavita, Michelle Newman, Linda
Sobell, and Abraham Wolf.
The survey itself, which took approxi-
mately 10 minutes to complete, was adver-
tised internationally to practicing clinicians
experienced in using CBT for panic. The
following categories were included in the
survey, where clinicians responded to a
number of variables in each category that
they found to limit the successful use of
CBT in reducing symptoms of panic:
patient’s symptoms related to panic
other patient problems or characteristics
patient expectations
patient beliefs about panic
patient motivation
social system (home, work, other)
problems/limitations associated with
the CBT intervention method
therapy relationship issues
Overview of Panic Survey Findings
A total of 326 therapists responded to
the questionnaire, most of whom had their
degrees in clinical psychology. The median
age was 45 years, with a range of 25 to 81
years of age. Consistent with this broad age
range, a little more than one third had 20 or
more years of clinical experience, and a
comparable amount less than 10 years.
Close to half of the respondents indicated
that the duration of therapy with panic pa-
tients typically lasted between 3 and 6
months, although there was a substantial
number that saw patients 6 months to a
year. Interestingly enough, practicing thera-
pists indicated that their success rate in
using CBT to reduce panic symptoms was
approximately 80%, which is consistent
with the findings from randomized clinical
trials.
When asked about those patient symp-
toms related to panic that undermined ef-
fectiveness, 62% indicated that chronicity
played a major role. Other symptom char-
acteristics that make symptom reduction
less possible included the presence of post-
traumatic stress disorder (PTSD), the ten-
dency to dissociate, functional impairment,
and severity. With regard to other patient
characteristics that created difficulties, the
two most typical patient problems con-
sisted of their inability to work between ses-
sions and their unwillingness to give up
safety behaviors. Several of the other patient
problems that made symptom reduction
more difficult were reflective of the com-
plexity of the case—an observation made
by Chambless and Goldstein several years
ago (Chambless & Goldstein, 1982).
With regard to patient expectations that
limited clinical effectiveness, the most typi-
cal reported were patient expectations that
they would be free of all anxiety, that the
therapist would do all the work and make
things better, and that medication was
needed to reduce panic. One of the most
problematic beliefs about panic, reported to
limit the clinical effectiveness of CBT, was
the thought that their fears were realistic
(e.g., they would have a heart attack, they
would faint). Interestingly enough, rela-
tively few therapists reported clinical limi-
tations resulting from patients’ belief that
symptom reduction would have a negative
impact on their relationships. Not surpris-
ingly, the role of patient motivation was
highlighted, with approximately 67% of
therapists noting that not only was this a
problem at the outset of therapy, but also
that it contributed to premature termina-
tion.
A large percentage of therapists pointed
to the patient’s social system as an impor-
tant factor that could potentially under-
mine clinical effectiveness, such as the
environment at home and at work. This un-
derscores the importance of research that is
needed to assess and modify relevant envi-
ronmental antecedents and consequences of
panic, and the role of significant others in
their support or sabotage of the therapy.
When asked about the problems and
limitations associated with the CBT inter-
vention itself, close to 61% indicated that it
did not provide sufficient guidelines for
dealing with patients’ reluctance to elimi-
nate safety behaviors. Interesting enough,
however, more experienced therapists did
not find this as much of a problem as did
therapists who were less experienced. Other
limitations of the treatment protocol in-
volved the logistical problems associated
with in vivo exposure, its inability to deal
with comorbid problems, and the difficulty
in simulating panic symptoms in the ses-
sion.
Therapy relationship issues were high-
lighted as contributing to clinical difficul-
ties. No less than 61% of the respondents
indicated that the therapy alliance was not
strong enough to bring about change, and
another 60% noted that patients did not
feel that their distress was sufficiently un-
derstood or validated by the therapist. Of
particular significance was that close to one
third of the therapists admitted that their
frustration with progress and their negative
feelings for the patient created difficulties.
There was another interesting finding
regarding experience level, which raises the
question about the extent to which thera-
pists adhered to the CBT protocol.
Experienced clinicians are more likely to
make use of breathing retraining, to work
on resolution of stressful conflicts that may
lead to panic (e.g., relationship issues), and
to help the patient understand the develop-
mental roots of panic. In addition, they
more often use assertiveness and communi-
cation training. The issue here is why more
experienced therapists go beyond the CBT
protocol: Because of their greater clinical
experience? Because they may have learned
to use CBT later in their career? Because
younger therapists may have learned to
conduct CBT from manuals? With regard
to experience level, it might be noted that,
[continued from p. 57]
60 the Behavior Therapist
in a controlled clinical trial, it was found
that more experienced CBT therapists
treating panic patients were more likely to
be clinically effective than less experienced
clinicians, even though both were rated as
being comparably effective in implement-
ing the protocol (Huppert et al., 2001).
Regardless of experience level, however,
73% of the therapists in our survey indi-
cated that more than symptom reduction
was needed in working with panic disorder
patients.
As noted above, the detailed findings of
the survey appear in The Clinical Psychologist,
the newsletter of the Society of Clinical
Psychology (American Psychological
Association [APA] Division 12 Committee
on Building a Two-Way Bridge Between
Research and Practice, 2010).
The survey findings are intriguing and,
in many ways, raise as many questions as
they answer. However, this is precisely the
purpose of the survey—to provide the re-
searcher with clinically derived directions
for future research. It is also a step in the di-
rection of closing the gap between research
and practice. The objective is to give clini-
cians a voice in the research agenda; hope-
fully make them more willing to reap the
benefits of research findings; and point to
research questions that come from clinical
experience.
Closing the Clinical-Research Gap
An important step in closing the gap be-
tween research and practice involves the
question of how to best disseminate re-
search findings to the practicing clinician.
One recent finding that addresses this ques-
tion revealed that practicing therapists are
more likely to be interested in ESTs when
the dissemination of information includes
case illustrations (Stewart & Chambless,
2010). In considering other ways for re-
searchers to more effectively get their mes-
sage across, it is important to appreciate the
various issues that might prevent practicing
therapists from making use of research find-
ings—such as the difficulty in fully compre-
hending the methodological and statistical
complexity of the research literature, having
the available time to learn new interven-
tions, and needing to learn a new theoretical
approach. However, I suspect there is more
to it than that.
My concern is that in our eagerness to
disseminate research findings, we as therapy
researchers may have inadvertently alien-
ated our clinical colleagues. I know this to
be the case with two CBT colleagues who,
as practicing clinicians, could not be faulted
for failing to make use of research findings;
they were avid readers of the research litera-
ture (Fensterheim & Raw, 1996). Despite
their commitment to using empirically sup-
ported interventions, they confessed that
they felt betrayed by researchers who rec-
ommended interventions without consult-
ing their clinical colleagues. In their
comments about the pressure they felt to
conduct therapy only in ways that were pro-
posed by research findings, Fensterheim
and Raw confessed that they were con-
cerned about
who should make the decision about how
much flexibility is allowable, of how large
should be the Procrustean bed. We doubt that
it will be the practicing therapist who does so.
So, once again, the standards and methods of
clinical therapy will be set by those who do
the least amount of clinical practice. (pp. 169-
170)
In their review of therapy research find-
ings and the impact that a list of ESTs might
have for clinical practice in the United
Kingdom, Roth and Fonagy (1996) pointed
to some of its unintended adverse conse-
quences—especially as it pertains to the
third party certification of which therapies
are approved:
Where payers yield to this temptation in the
design of managed care programs and direc-
tives regarding first-line treatments, the reac-
tion of many clinicians is to become suspicious
of moves toward (or demands for) evidence-
based practice. This adversarial process
threatens to set those paying for care against
those providing it, and indeed, providers
against researchers. In this context, there are
clear perils along the path of applying re-
search findings to clinical practice. On the one
side, the risk that practitioners reject psy-
chotherapy research out of hand; on the other,
the possibility that purchasers embrace it un-
critically, leading to a cookbook approach to
planning. (p. 40)
One of the goals of closing the gap be-
tween research and practice is to prevent
this from happening.
Using their newfound clinical apprecia-
tion for the need to establish a collaborative
relationship with their patients, two gradu-
ate students—the future of clinical psychol-
ogy—have argued that the question is not
how researchers can disseminate informa-
tion about data-based interventions to prac-
titioners. Instead, they pose the question in a
more collaborative way:
“How do researchers and clinicians work to-
gether to develop efficacious treatments?” . . .
we the researchers should not be disseminat-
ing onto the clinicians but rather engaging in
dialogues with the professional community as
we create new interventions. We believe that
if we continue to frame this issue as an “us”
versus “them” predicament, we will perpetu-
ally be stuck where we are, and, even worse,
may continue to grow further polarized rather
than closer together. (Hershenberg & Malik,
2008, pp. 3-4)
The idea of having clinical researchers
and practicing therapists work together in
developing clinically meaningful and em-
pirically sound interventions is not new. It is
a theme that runs through Chambless and
Goldstein’s (1982) Agoraphobia: Multiple
Perspectives on Theory and Treatment. It is also
inherent in Foa and Emmelkamp’s (1983)
Failures in Behavior Therapy, in which they
indicate that “Contact with clients has
taught us that clinical practice is not as sim-
ple as that portrayed in textbooks. . . . It
seems that once a technique was endorsed
as effective, it became almost taboo to
admit that sometimes the expected positive
results were not obtained” (p. 3). The chal-
lenges of using ESTs in clinical practice are
especially evident in dealing with complex
clinical cases, which particularly calls for an
“increased dialogue between scientists and
practitioners at a field-wide level” (Ruscio &
Holohan, 2006, p. 158). Although the two-
way bridge initiative described above is one
way this can be done, there are numerous
other approaches as well (e.g., Barkham,
Hardy, & Mellor-Clark, 2010; Castonguay
et al., 2010; Eubanks-Carter, Burckell, &
Goldfried, 2010; Sobell, 1996).
What’s Next?
As noted above, the use of the two-way
bridge project was developed by the Society
of Clinical Psychology, Division 12 of the
APA. The initiative has been expanded so
that it is now a collaborative effort of both
Division 12 and Division 29—the psy-
chotherapy division. This joint effort reflects
the growing awareness on the part of re-
searchers and practitioners that, more than
ever before, collaboration is needed.
Also indicated earlier was that the sur-
vey on the treatment of panic disorder was
the first of a series of surveys to be con-
ducted. The next two involve the use of
ESTs—also in these cases, CBT—for the
treatment of social anxiety and of general-
ized anxiety disorder. I invite the reader to
take 10 minutes to complete each of the two
March 2011 61
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62 the Behavior Therapist
surveys, the results of which we hope to pre-
sent at conferences, publish in journals and
newsletters, and disseminate on the
Internet. Many of the items included in
these surveys are the same as those used for
the survey on panic, making it possible to
obtain information on clinically based issues
that may cut across different clinical prob-
lems. The survey on social anxiety can be
found at http://www.surveymonkey.com
/s/6L9CLHN, and the survey on general-
ized anxiety disorder is at: http://www.sur-
veymonkey.com/s/Z8QPRH7.
References
American Psychological Association (APA)
Division 12 Committee on Building a Two-
Way Bridge Between Research and Practice.
(2010). Clinicians’ experiences in using an em-
pirically supported treatment (EST) for panic
disorder: Results of a survey. The Clinical
Psychologist, 63, 10-20. Retrieved March 7,
2011, from http://www.div12.org
/tcp_journals/TCP_Fall2010.pdf#page=10
Barkham, M., Hardy, G. E., & Mellor-Clark, J.
(Eds.). (2010). Developing and delivering practice-
based evidence: A guide for the psychological thera-
pies. Chichester, UK: Wiley-Blackwell.
Castonguay, L. G., Boswell, J. F., Zack, S. E.,
Baker, S., Boutselis, M. A., Chiswick, N. R.,
. . . Holtforth, M. G. (2010). Helpful and hin-
dering events in psychotherapy: A practice re-
search network study. Psychotherapy: Theory,
Research, Practice and Training, 47, 327-345.
Chambless, D. L., & Goldstein, A. J. (Eds.).
(1982). Agoraphobia: Multiple perspectives on the-
ory and treatment. New York: Wiley-
Interscience
Eubanks-Carter, C., Burckell, L. A., & Goldfried,
M. R. (2010). Clinical consensus strategies for
interpersonal problems between young adults
and their parents. Journal of Consulting and
Clinical Psychology, 78, 212-224.
Fensterheim, H., & Raw, S. D. (1996).
Psychotherapy research is not psychotherapy
practice. Clinical Psychology: Science and Practice,
3, 168-171.
Foa, E. B., & Emmelhamp, P. M. G. (Eds.).
(1983). Failures in behavior therapy. New York:
Wiley-Interscience.
Goldfried, M. R. (2010). How can we close the
gap between clinical practice and research? the
Behavior Therapist, 33, 78-80.
Hershenberg, R., & Malik, J. (2008). Graduate
student’s view of evidence-based treatment.
The Clinical Psychologist, 61, 3-6.
Huppert, J. D., Bufka, L. F., Barlow, D. H.,
Gorman, J. M., Shear, M. K., & Woods, S. W.
(2001). Therapists, therapist variables, and
cognitive-behavioral therapy outcome on a
multicenter trial for panic disorder. Journal of
Consulting and Clinical Psychology, 69, 747-755.
McGabe, R. E., & Antony, M. M. (2005). Panic
disorder and agoraphobia. In D. R. Ledley, &
R. Heimberg (Eds.), Improving outcomes and pre-
venting relapse in cognitive behavioral therapy (pp.
1-37). New York: Guilford.
Otto, M. W., & Gould, R. A. (1996). Maximizing
treatment outcome for panic disorder:
Cognitive-behavioral strategies. In M. H.
Pollack, M. W. Otto, & J. F. Rosenbaum
(Eds.), Challenges in clinical practice:
Pharmacological and psychosocial strategies (pp.
113-140). New York: Guilford.
Roth, A., & Fonagy, P. (1996). What works for
whom? A critical review of psychotherapy research.
New York: Guilford.
Ruscio, A. M., & Holohan, D. R. (2006).
Applying empirically supported treatments to
complex cases: Ethical, empirical, and practi-
cal guidelines. Clinical Psychology: Science and
Practice, 13, 146-162.
Sanderson, W. C., & Bruce, T. J. (2007). Causes
and management of treatment-resistant panic
disorder and agoraphobia: A survey of expert
therapists. Cognitive and Behavioral Practice, 14,
26-33.
Sobell, L. C. (1996). Bridging the gap between
scientists and practitioners: The challenge be-
fore us. Behavior Therapy, 27, 297-320.
Stewart, R. E., & Chambless, D. L. (2010). What
do clinicians want? An investigation of EST
training desires. The Clinical Psychologist, 63, 5-
10.
Task Force on Promotion and Dissemination of
Psychological Procedures. (1995). Training in
and dissemination of empirically-validated
psychological treatment: Report and recom-
mendations. The Clinical Psychologist, 48, 3-23.
...
Correspondence to Marvin Goldfried,
Ph.D., Department of Psychology, SUNY-
Stony Brook, Stony Brook, NY 11794;
e-mail: Marvin.goldfried@sunysb.edu
As part of an ongoing collaborative initiative to establish a two-way
bridge between research and practice, the Society of Clinical
Psychology (Division 12 of the American Psychological Association)
and Division 29 of the American Psychological Association, have cre-
ated a mechanism whereby practicing therapists can report on their
clinical experiences using empirically supported treatments (ESTs).
Much in the way that the Food and Drug Administration provides
physicians with a method for giving feedback on their experiences
in using empirically supported drugs in clinical practice, we have
established a procedure for practicing therapists to disseminate
their clinical experiences. This is not only an opportunity for clinicians
to share their experiences with other therapists, but also can offer
clinically based information that researchers may use to investigate
ways of improving treatment.
We started with the treatment of panic disorder, and some of you
may have taken that survey, for which we are grateful. The findings
of the panic survey appear in APA (2010; see full reference above).
You can obtain a copy of this on page 10 of the newsletter by either
clicking, using control+click, or copy and pasting the following:
http://www.div12.org/tcp_journals/TCP_Fall2010.pdf#page=10
We would now ask you to complete a very brief survey of your clin-
ical experiences in using an EST—specifically CBT—in treating
social anxiety. By identifying the obstacles to successful treatment,
we can then take steps to overcome these shortcomings.
Your responses to this brief survey,
which will be anonymous, will be tallied with
those of other therapists and posted on the Division
12 and 29 websites at a later time. The results of
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Also of Interest
64 the Behavior Therapist
The annual prevalence of alcohol,
drug, or combined alcohol-drug use
disorders is approximately 9%.
However, each year only about 10% of
those who meet criteria for a substance use
disorder receive treatment of any kind
(SAMHSA, 2009). Even when individuals
with substance abuse treatment needs ac-
cess care, those who do so outside the con-
text of research protocols are unlikely to
receive evidence-based practices and are at
risk for early treatment attrition, because of
low motivation, conflicts with treatment
staff, and other factors (Ball, Carroll,
Canning-Ball, & Rounsaville, 2006; Miller,
Sorensen, Selzer, & Brigham, 2006). This
information bespeaks an urgent need in the
U.S. for successful implementation of evi-
dence-based practices designed to enhance
treatment engagement.
Motivational interviewing (MI), a rela-
tively brief and flexible intervention that is
designed to enhance patient readiness to
change health behaviors, is well-suited to
help satisfy that need (Miller & Rollnick,
2002). Although initially developed as an
intervention for alcohol use disorders
(Miller, 1983), MI has been shown in sev-
eral controlled trials to produce significant
changes in a variety of substance-related
health behaviors, including alcohol-related
problems, marijuana-related problems, and
drug-related problems (Lundahl, Kunz,
Brownell, Tollefson, & Burke, 2010). MI is
also uniquely suited to address the problem
of nonengagement. Utilizing a combina-
tion of relational components, based on tra-
ditional client-centered counseling, and
technical components, MI helps individuals
explore and resolve ambivalence and en-
hance readiness for behavior change (Miller
& Rose, 2009). MI was shown in a large ef-
fectiveness trial to increase engagement and
retention in substance abuse treatment
(Carroll et al., 2006), which has been associ-
ated with better substance abuse treatment
outcomes (Stark, 1992).
MI may also be uniquely suited to ad-
dress substance abuse treatment needs in
rural and underserved areas. Roberts,
Battaglia, and Epstein (1999) reported that
at least 24% of residents of rural areas in the
U.S. suffer from substance or mental health
disorders. A key problem with access to
health care of all types in rural areas of the
U.S. is the limited number of providers in
these regions. For example, as summarized
by McDonald, Harris, and LeMesurier
(2005), although approximately 25% of the
U.S. population lives in rural areas, only
10% of physicians practice in rural areas.
Not surprising, given the overall lack of
providers in rural areas, specialty care, in-
cluding mental health and substance abuse
treatment services, may be particularly diffi-
cult for rural populations to access. In a sur-
vey of rural mental health providers in
Idaho, lack of psychiatrists or other appro-
priately trained mental health staff was the
second most cited barrier to adequate men-
tal health care (McDonald et al., 2005).
Thus, MI’s adaptability to varied treatment
sites and provider types is ideal for rural and
underserved areas where patients may not
have access to substance abuse facilities
(e.g., Bernstein et al., 2005; Senft, Polen,
Freeborn, & Hollis, 1997).
Promises and Problems in MI
Dissemination and Implementation
Given its promise to address important
public health issues, including alcohol and
other drug use disorders, MI has attracted a
large following of clinicians and scientists
from various disciplines who share a com-
mitment to research, practice, and dissemi-
nation of MI (Adams & Madson, 2006).
This dedication was emphasized by the de-
velopment of the Motivational Interview-
ing Network of Trainers (MINT) in 1995.
The main emphasis of this group is not only
to prepare individuals to become trainers
focused on the dissemination of MI but to
advance how others are trained in MI. For
instance, members of this community have
engaged in designing training activities
(Rosengren, 2009), studied the efficacy of
MI across diverse behaviors (Lundahl et al.,
2010), and developed various measures
with utility in training and evaluation of MI
skill (for a review see Madson & Campbell,
2006). Beyond these activities the MI com-
munity has emphasized the importance of
empirically investigating the outcome of
MI training approaches.
Several authors have highlighted the im-
portance of documenting training processes
and practitioner skill development (Dunn,
Deroo, & Rivara, 2001), where clinical out-
comes following MI interventions were diffi-
cult to interpret due to a lack of information
regarding how practitioners were trained in
MI (Madson, Campbell, Barrett, Brondino,
& Melchert, 2005). Two recent reviews have
attempted to outline the empirical evidence
relating to MI training with similar find-
ings. Through a systematic review of 27
published MI training outcome studies,
Madson, Loignon, and Lane (2009) found
generally favorable results in relation to (a)
confidence using MI, (b) knowledge, (c) in-
creased skill, (d) interest in learning more
about MI, (e) intention to use MI, and (f) in-
tegration into practice. These findings were
supported by Söderlund, Madson, Rubak,
and Nilsen (in press) in their review of MI
training with general health-care practi-
tioners. One concern raised by these reviews
was the questionable results due to lack of
validated outcome measures. The majority
of trainings were provided in the format of
workshop or classroom trainings and the
length of time ranged from 9 to 16 hours.
This discovery is somewhat concerning in
light of the finding that workshop training
may foster improvements in knowledge and
intention to use MI but is less likely to gen-
eralize better MI practice as initial skill ac-
complishments fade (Walters, Matson,
Baer, & Ziedonis, 2005) and highlighted
the need for training evaluation that ex-
tended beyond the workshop format.
Few documented efforts have been made
to extend the MI training research beyond
the traditional workshop format. To date,
the most comprehensive attempt to identify
the best MI training model was a random-
ized trial conducted by Miller, Yahne,
Moyers, Martinez, and Pirritano (2004),
which compared five different training con-
Clinical Forum
Using Telehealth Technology to Enhance
Motivational Interviewing Training for Rural
Substance Abuse Treatment Providers:
A Services Improvement Project
Julie A. Schumacher, University of Mississippi Medical Center
Michael B. Madson, University of Southern Mississippi
Grayson S. Norquist, University of Mississippi Medical Center
March 2011 65
ditions (wait-list, workshop, workshop plus
practice feedback, workshop plus individual
coaching sessions, and workshop, feedback
and coaching) in a group of self-selected,
highly skilled clinicians. Although all active
training conditions outperformed the wait-
list control, only the workshop-plus condi-
tions resulted in enduring training gains.
Additional advantage was shown for the
workshop plus feedback and coaching con-
dition when client utterances were exam-
ined; this condition resulted in significantly
more MI-consistent client language during
sessions.
Overall, the findings of Miller and col-
leagues (2004) were very promising and
have provided an important springboard for
research in MI training. First, Miller and
colleagues underscored not only the impor-
tance of training that extends beyond an
initial workshop, but also the value of feed-
back and coaching based on objective evalu-
ation/coding of sessions versus clinician
self-report. Clinician self-report of MI ad-
herence and skill was not reliably associated
with objective measures of adherence and
skill in this study. Second, in this study,
workshop alone outperformed this condi-
tion in a prior study of less highly skilled
clinicians who attended training through
their employer (Miller & Mount, 2001),
suggesting that baseline skill and trainee
motivation are important factors to con-
sider in MI training. Third, the rapid attri-
tion of participants and the reduction in
work samples for review across the study
period, falling from 76% at 4 months to
45% at 12 months, calls for caution in in-
terpreting these favorable results and high-
lights the need for methods to improve the
submission of work samples. Finally, even in
this skilled, motivated group, some clini-
cians were unable to achieve beginning pro-
ficiency in MI, suggesting enhancements or
modifications to the training protocol may
be warranted.
Since the original project by Miller et al.
(2004), there have been attempts to repli-
cate and extend the findings with different
populations. Moyers et al. (2007) at-
tempted to replicate and extend these find-
ings in 129 practitioners from 54 Air Force
bases. Participants in this study had, on av-
erage, less education, fewer years of experi-
ence in counseling, less experience with
substance abuse clients, and expressed less
interest in learning MI at the outset of train-
ing than those in the Miller et al. study. All
participants received an MI book and video
training series. Participants were random-
ized to receive workshop only, an enhanced
training condition that included workshop
training plus personalized feedback based
on one interaction with a simulated patient,
or a self-directed training condition that in-
cluded the book, video series, and a delayed
workshop. Although initial increases in
clinical skills were found after the workshop
,they were not as large as those found in the
2004 study by Miller and colleagues.
Surprisingly, providers in the group receiv-
ing feedback and coaching did not differ in
their improvements from other groups.
Further, at posttraining a larger percentage
of participants in the self-directed group
(who received no workshop) met all criteria
for MI proficiency.
Low compliance with work-sample pro-
vision was also a problem in the Moyers et
al. (2007) study. Audible work samples
were submitted by 68%, 58%, and 38% of
participants at 4, 8, and 12-month follow-
up, respectively. Interestingly, participants
in the self-directed training group were also
most likely to comply with work-sample
submission. The authors speculate that this
was influenced by the fact that workshop
66 the Behavior Therapist
training was only available to this group
after all work samples had been submitted,
and thus these participants may have per-
ceived greater incentives for submitting the
samples. In the enhanced condition, in
which participants had up to 6 consultation
calls available to them, only 20% com-
pleted all six calls, and 36% did not com-
plete any of the calls. All participants in this
condition received personalized feedback
based on an interaction with a simulated
patient conducted at workshop completion.
More recently, Walters, Vader, Nguyen,
Harris, and Eells (2010) emphasized the ne-
cessity of ongoing coaching and feedback as
part of successful MI training. In taking
their training “out of the lab,” Walters and
colleagues compared an enhanced MI train-
ing program for probation officers with two
groups of untrained officers (those who
wanted MI training and those who did not
want MI training). All participants (N=
30) completed work samples at three times
during 6 months (baseline, 2 months, and 6
months). Probation officers who received a
training package that included a 2-day
workshop, a half-day booster session in the
first month and one or two coaching ses-
sions monthly during 6 months maintained
improvements in MI skills over 6 months.
These skill improvements were greater than
officers who received no MI training. While
this finding replicates previous research,
many participants in the enhanced MI
training group still did not meet MI begin-
ning proficiency levels. Seven officers total
from all three groups (three from the MI
training group) did not complete the pro-
ject; however, only one officer chose to dis-
continue and all others discontinued
because of transfers. Thus, the retention
rate was good. Because training was not the
sole focus of this project, less information
was provided about the specific aspects of
the training package such as the nature and
focus of coaching or organization support
for officer involvement in the program.
Taken together, these results highlight
that MI is not easy to train or learn, an as-
sertion emphasized by Miller and Rollnick
(2009). Additionally, while the workshop
format may continue to be the preferred
method for MI training, it appears to be in-
sufficient for helping providers competently
integrate MI into their clinical repertoires.
Researchers suggest that more comprehen-
sive training models that include feedback
and coaching revolving around work sam-
ples may be more appropriate to build be-
ginning proficiency. Moreover, there is clear
evidence that additional modifications or
enhancements to training will be required
to enable most clinicians to achieve expert
competence in motivational interviewing.
As a final note, the existing literature on MI
training reveals that in addition to cost, a
major barrier to ongoing feedback and su-
pervision is the provision of work samples;
even groups of providers who are “highly
motivated” for MI training exhibit limited
compliance with this with this aspect of
training.
Continuing Education
and Telehealth Technology
Barriers to sufficient, efficacious MI
training may be compounded in rural and
underserved areas, where clinicians have
difficulty accessing continuing education
opportunities. Fortunately, there is growing
evidence that rural health professionals are
open to receiving continuing education
through telemedicine technologies and per-
ceive such training as beneficial. For exam-
ple, evaluation of continuing medical
education programs in Vermont and up-
state New York offered via telemedicine
technologies, such as videoconferencing, re-
vealed that 70% of providers who remotely
attended these programs would not have
attended if it had not been available over
telemedicine. Moreover, 73% of those who
remotely attended the programs reported
that it was as effective as having a presenter
in the room (Callas, Ricci, & Caputo, 2000).
Participants in a video-conferencing educa-
tion program for mental health profession-
als in six rural Canadian communities
similarly reported high levels of satisfaction
with the training received, particularly the
opportunity to interact with other profes-
sionals. Participating professionals also re-
ported significant pre-post gains in
confidence with interventions and issues on
which they had received training (Church et
al., 2010). However, as noted previously,
despite clinician confidence, it is doubtful
that typical continuing education offerings,
even when offered in traditional face-to-face
contexts, are adequate to help providers
achieve proficiency in MI (Walters et al.,
2005).
Schafer, Rhode, and Chong (2004) ex-
amined the impact of MI workshop training
offered via telehealth technology to staff at
substance abuse treatment agencies
throughout the state of Arizona. Training
was delivered as five, 3-hour live video
workshops broadcast one per month for 5
months. Findings of the study provide
promise for use of telehealth technology to
broadly disseminate MI, while at the same
time further underscoring the need for en-
hanced training. Although participants
were moderately satisfied with all aspects of
the training and reported significant in-
creases in self-perceived MI knowledge and
skills, objective measures revealed statisti-
cally significant, but clinically insignificant
improvements in MI knowledge. Addition-
ally, although there was evidence of signifi-
cant increases in reflective listening on a vi-
gnette-based measure, MI proficiency as a
result of the workshops was difficult to as-
sess. Only 9 participants (out of 351 who
observed at least one workshop) submitted
work samples across the study, and these in-
dividuals demonstrated minimal, non-
significant improvements in MI skill.
The low rate of work sample submission
and training completion in the Schafer et al.
(2004) study are also important to note.
Although the original intent of the trainers
was to have 30 participants submit audio-
tapes of sessions with clients before, imme-
diately after, and 4 months after the five
telecasts, only 23 agreed to do so, and only 9
actually submitted all five recordings.
Additionally, although 351 providers at-
tended the first workshop broadcast, only
145 attended all 5 telecasts. While gener-
ally consistent with prior research about
training attrition over time (e.g., Miller et
al., 2004), this finding is still somewhat sur-
prising. Broadcasts were made to 19 sites,
13 of which were in rural areas. Thus, for
many of the participating providers, train-
ing was likely far more convenient than typ-
ical continuing education opportunities.
The research on use of telehealth tech-
nology to promote dissemination of MI and
other evidence-based practices to rural sub-
stance abuse and mental health settings
suggests that practitioners are open to this
method of delivery of continuing education
programs. However, the research also sug-
gests that without modifications, such pro-
grams will result in dissemination of
information, but will not result in true tech-
nology transfer. In real-world settings, with
real-world practitioners, even intensive MI
training programs with significant in-per-
son components have failed to produce the
skill acquisition necessary for posttraining
implementation of MI by participating
practitioners (Moyers et al., 2007; Walters
et al., 2010).
In a services improvement project, we
implemented a continuing education pack-
age adapted from the training protocol de-
scribed by Miller and colleagues (2004)
utilizing a combination of intensive face-to-
face training with telehealth technologies as
well as the use of telehealth technologies
alone to implement an enhanced training
March 2011 67
protocol for MI in rural community sub-
stance abuse treatment settings. In devel-
oping the training protocol, we sought to
emulate successes observed and address
barriers identified in research on MI train-
ing.
Method
Participants
Participants in the services improvement
project were 16 providers at two commu-
nity substance abuse treatment facilities in
rural Mississippi. Twelve participants were
alcohol and drug counselors and 4 were su-
pervisory staff at these facilities. Six partici-
pants reported college or graduate-level
training and the mean number of years of
experience was 5.7 (SD = 5.7).
Measures
Attendance at postworkshop group and
individual coaching sessions and compli-
ance with submission of requested work
samples served as measures of training en-
gagement. This information was supple-
mented with qualitative comments from
participants about the reasons for nonatten-
dance and noncompliance and trainer ob-
servations.
Procedures
The training was designed to include a
2-day MI introductory workshop followed
by 10 weeks of individual and group coach-
ing. Individual coaching involved five 15-
minute individual sessions during which
adherence and competence feedback was
provided based on audiotaped work sam-
ples. These sessions also included problem
solving, demonstration of skills, and role-
play related to how to individualize MI to
specific client issues. Because MI is more
than what clinicians are already doing
(Miller & Rollnick, 2009), individual ses-
sions often focused on the use of questions,
reflections, summaries, and affirmations in
an MI-consistent way. Group coaching in-
volved five 1-hour sessions during which
progress and problems were discussed, skills
and concepts were reviewed, and practice
exercises were conducted. All coaching ses-
sions were provided in a style consistent
with MI with the goal of modeling MI skills
(Madson et al., 2008; Martino et al., 2006).
For example, coaching sessions included (a) a
summary or review of previous sessions, (b)
agenda setting, (c) eliciting trainee evalua-
tion of the sample, (d) feedback about the
sample, and (e) eliciting trainee response to
the feedback. Coaches were mindful to also
use MI-consistent reflections, questions, af-
firmations and summaries as well as to ask
permission to provide feedback or give in-
formation. The individual and group coach-
ing were provided on alternating weeks.
Due to delays in the installation of equip-
ment at the first site (n= 12), all workshop
training and group coaching was provided
in person by the first author at this site. At
the second training site (n= 4), workshop
training and group coaching were provided
via video-conference by the first author. All
individual coaching was provided by tele-
phone by the first and second authors, both
of whom are academic, licensed clinical psy-
chologists and members of MINT with 6.5
and 4.5 years of MI training experience, re-
spectively. To supplement this training,
each participating facility received two
copies of the book Motivational
Interviewing: Preparing People for Change
(2nd ed.) and one copy of an MI DVD train-
ing series (Miller et al., 1998; Miller &
Rollnick, 2002).
Several modifications were made to the
Miller et al. (2004) training protocol. First,
all training was offered on-site at commu-
nity substance abuse treatment facilities.
This modification was made primarily to re-
duce trainees’ travel time, thereby increas-
ing the ability of facilities to allow all of
their clinical staff to participate in training.
The management teams at the facilities ex-
pressed a strong desire for the training to re-
sult in implementation of MI at the
facilities. It was also hoped that this modifi-
cation would enhance technology transfer
by increasing facility-level participation,
support, and motivation for the training—
allowing providers to share their successes
and enthusiasm for the approach and collec-
tively problem solve barriers to implemen-
tation. It was hoped that use of group
coaching, a second modification made pri-
marily to reduce the amount of trainer time
required for coaching provision, would sim-
ilarly foster technology transfer. A third
modification to the Miller et al. protocol
was provision of a greater amount of per-
sonalized feedback in the weeks immedi-
ately following training through individual
coaching. Additional and related modifica-
tions, intended to increase compliance with
this aspect of training were the provision of
digital audio-recorders and a secure web-
based portal for submission of work samples
and a request for work samples to be sub-
mitted every 2 weeks following the train-
ing, rather than every 4 months.
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Results
The modifications to the training proto-
col appeared successful in the goal of in-
creasing participation. All group coaching
sessions at both sites were attended by 75%
to 83% of participating clinicians, with
87% of trainees across the two sites attend-
ing at least 4 out of 5 coaching sessions. In
addition, facility-level support and motiva-
tion for the training was evident in the
group coaching sessions. At most of these
coaching sessions, several minutes at the
outset were spent with several clinicians de-
scribing their successes in using MI and the
positive differences they noticed in client re-
actions. Modifications to the training proto-
col were also generally successful in the goal
of enhancing compliance with work-sample
submission. All trainees across the two facil-
ities completed at least two individual
coaching sessions, with 94% completing 3
or more and 50% submitting all requested
samples and completing all 5 individual
coaching sessions.
Despite the overall high level of engage-
ment with the training, participants ex-
pressed several difficulties with providing
work samples. Only one trainee provided all
samples as scheduled. Thus, the coaching
initially scheduled to take place over 10
weeks continued for over 18 weeks at the
first facility due to missed and rescheduled
sessions. Trainees provided various reasons
for missed and rescheduled sessions, such as
lack of appropriate cases, client refusal, and
competing work demands. Although few
trainees openly expressed anxiety about
having their performance reviewed, the
trainers suspected that evaluation anxiety
likely contributed substantially to problems
with work sample submission. Additionally,
very few of the work samples provided were
optimal for MI training purposes. Many
were very brief (≤15 minutes), with clients
who had been in treatment for several
weeks, and involved reviewing 12-step
homework. At the second site, following
initial problems with sample submission
(25% of samples submitted), trainees were
instructed to audio-record role-plays in lieu
of work samples when necessary. Following
this modification, we were able to achieve
95% compliance with submission of re-
quested samples. However, trainees contin-
ued to experience difficulty finding time to
record samples (coaching period extended
from 10 weeks to over 30 weeks) and we
continued to receive samples that were brief
and focused on suboptimal content for MI
training.
Discussion
The goal of this services improvement
project was to facilitate the dissemination of
MI by implementing an evidence-sup-
ported training program in rural communi-
ties using telehealth technology. Given that
previous studies identified trainee attrition
and decreasing work sample submissions as
major concerns in the training methods
outlined by Miller and colleagues (2004),
these methods were adapted for this project
not only to address the unique needs of
trainees in rural areas, but also to target
these concerns. Relative to published infor-
mation about trainee attrition and compli-
ance (e.g., Miller et al., 2004; Moyers et al.,
2007), these modifications appeared suc-
cessful in keeping trainees involved in the
training and work sample submission
process. In particular, it appears that on-site
training and group supervision might have
reduced barriers such as travel and increased
work absence that can often interfere with
intensive training programs. Further, the
steps to leverage current technology (use of
digital recorders, on-line submission portal)
for work sample submissions might have
eased the process for trainees in such a way
that increased their willingness, from a pro-
cedural standpoint, to submit samples.
Thus, based on these very preliminary re-
sults it appears that attempts to reduce as
many barriers to trainees’ engagement as
possible might improve their involvement
and motivation to follow through with
training procedures.
Limitations
Although this work provides important
insights and ideas for future work in tech-
nology transfer, the fact that this was a
small services improvement project (with
an objective of improving services and client
outcomes in real-world settings), rather
than a large, rigorously controlled research
project (with an objective of contributing to
our body of knowledge), limits conclusions
that can be drawn. For example, the small
sample and nonrandom selection of partici-
pating sites limits the generalizability of
findings. It may be that the sites that partic-
ipated in this project are more committed to
adoption of evidence-based practices than
typical substance abuse treatment facilities.
Additionally, although one site received all
training via telehealth technology (video-
conference and telephone) and one group
received all training except individual in-
person coaching, the fact that this occurred
because of delays in installation of tele-
health equipment rather than random as-
signment (as would be the case in a typical
research project) precludes us from drawing
conclusions about the relative efficacy of
these two approaches. This is an important
question that must be addressed in future
work. It is also difficult to understand ex-
actly how to contextualize the outcomes of
our project in the research literature. Given
that this project was explicitly identified by
our IRB as not meeting the federal defini-
tion of “research,” the work was subject to
HIPPA and other regulations and policies
governing standard operating procedures at
the sites, but was not subject to research
regulations. It is possible that clinicians are
more willing to participate fully in training
opportunities offered outside a research
context (without extensive informed con-
sent documents and assessment batteries)
and that this, rather than modifications to
the training protocol, is responsible for our
relatively high rates of training compliance.
Future Directions
When examining the results of this pro-
ject with those from Miller et al. (2004) and
Moyers et al. (2007), it appears that work
sample submissions is a major training bar-
rier. Although our submission rates were
good, the length and type of samples made
observation and feedback difficult. To cor-
rect this problem in the future, projects
might include specific guidance about se-
lecting and securing appropriate cases for
work samples and suitable length and focus
of sessions. Further, if using role-plays or
real-plays (i.e., practice MI sessions in which
the partner playing the client discusses a be-
havior change he or she is really consider-
ing, such as increasing exercise or reducing
television watching), specific guidelines for
organizing the client role may help. These
instructions might include how to choose a
target behavior as the client (i.e., not too
personal or too trivial—something you feel
two ways about), provide examples of po-
tential behaviors, and any specific guiding
rules (e.g., avoid being too resistant or too
accommodating). Finally, projects may con-
sider using simulated standardized patients
(Lane et al., 2007; McNaughton et al.,
2008). Using simulated standardized pa-
tients may allow trainers to structure work
samples in a fashion that allows for consis-
tency and better evaluation of MI skill.
With regard to the use of distance tech-
nologies in training, future work might ex-
plore how newer technologies, such as
mobile phone applications, might be ap-
plied to this task. As clinicians, continuing
education providers, and researchers move
March 2011 69
forward in this area, it is important to work
with information technology experts familiar
with HIPPA and other relevant regulations
to ensure that communications comply
with rigorous ethical and confidentiality
standards. In the current project, all partici-
pating clinicians obtained written informed
consent from clients to records sessions and
submit the sessions to the first and second
author via a secure web-server verified by
the IT department at our academic medical
center as HIPPA-compliant.
Overall, these results highlight the po-
tential value in embracing and integrating
technological advances in training pro-
grams, especially for rural trainees.
Therefore, trainers might consider the vari-
ous modifications in planning trainings.
This project also highlighted barriers to
technology transfer and opportunities for
future investigation.
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www.eabct2011.org
EABCT 2011
CONGRESS
AUGUST 31–SEPTEMBER 3, 2011
Prevention
An Invitation to Reykjavík, Iceland, for the
THEME
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...
This work was supported by a grant from a
program funded by the Health Services and
Resources Administration (U1 FRH07411-
03-03, Program PI: Fox; Project PI:
Norquist). The findings and conclusions in this
report are those of the authors and do not nec-
essarily represent the official position of the
Health Services and Resources Administration.
Correspondence to Julie A. Schumacher
Ph.D., University of Mississippi Medical
Center, 2500 N. State Street, Jackson, MS
39216; e-mail: jschumacher@umc.edu
V
OTING
electronic
Remember to cast your electronic vote. If we
do not have your email in our system, then we
mailed you a paper ballot. If you did not
receive voting materials, please contact us!
April is
election
month
www.abct.org
March 2011 71
It is not easy to maintain a career in clin-
ical psychology these days. Whether
employed primarily as a scientist, in-
structor, or clinician, and no matter what
your career stage (i.e., student, early career
professional, senior psychologist), one’s to-
do list is perpetually overflowing.
So, the prospect of volunteer work seems
especially infeasible for most.
But volunteering as a member of a com-
mittee or running for an elected position
within professional societies in psychology
may offer more to the field, and for your ca-
reer, than you may realize. This article offers
a brief list of factors that may help you re-
consider why volunteering can be worth
your valuable time.
1. The Field Needs You!
As a discipline, clinical psychology has
made enormous strides in a relatively brief
period of time. In just over 60 years or so,
tremendous advances have been offered in
the areas of psychopathology classification
and treatment, clinical psychology training,
and clinical science. The field truly has
transformed within the time of one genera-
tion. But there is much work to do be done.
Active debates continue in many areas, in-
cluding many current hot topics, such as ev-
idence-based practice, transportability of
efficacious treatments, internship supply/
demand, clinical psychology training mod-
els, accreditation practices, the DSM, public
education, and the globalization of clinical
psychology. What most do not realize, how-
ever, is that the most impactful decisions re-
garding these extremely important issues
usually occur within small groups of 10 to
15 clinical psychologists who meet within a
governance group or committee. In short,
you can be one of these 10 to 15 people!
Such committees and governance groups
often struggle to find volunteers to fill its
vacancies, and often a range of expertise and
professional backgrounds are preferred. If
you thought that only the most well-known
and experienced psychologists have an op-
portunity to make such an impact, then
think again!
2. Immediate Gratification Is Possible!
Let’s face it. There is little we do as clini-
cal psychologists that helps us to feel imme-
diately efficacious. It can take years to see
the fruits of one’s research take hold. And
even when we do make a difference in the
life of a client, we are trained to emphasize
their contributions, not our own, in their
progress. In short, it’s often hard for a clini-
cal psychologist to feel like they have made a
quick and lasting professional impact. This
is why volunteer work within professional
societies can be so gratifying. Here is an op-
portunity to contribute to a policy, a re-
source, or a professional opportunity that
can change the field in a quick and dramatic
way. There is so much to work on within the
field, and governance groups most often are
comprised of very bright, motivated, and
innovative people who are ready to make a
difference. This can be an invigorating con-
text in which ideas turn into action and
problems find quick solutions. This type of
atmosphere can provide the perfect comple-
ment to what many clinical psychologists
do during their “day job,” and can offer
quick and effective respite from the routine
of one’s full-time responsibilities.
3. The Dividends of Networking
Many psychologists and psychology
trainees truly want to make a difference in
the field and crave the opportunity to feel
quickly gratified by their work. But there
are only a certain number of hours in the
day, and their well-meaning intentions give
way to an understandable diffusion of re-
sponsibility. If this sounds familiar, then
perhaps this last selling point will be useful
for you: Volunteer work, and its concomi-
tant opportunities for professional network-
ing, likely will have a direct benefit for your
career. Students and early career profession-
als: Guess who will be sitting across the
table from you as you volunteer? . . . The
same people who likely will read your appli-
cations for internship, write your promotion
letters, and offer you jobs. Mid-career and
senior psychologists: You already know that
your colleagues within a committee will
also be your peer reviewers on manuscripts
and grants. A context to chat informally
with these fellow volunteers can offer enor-
mous opportunities for professional devel-
opment. A single trip to a governance
meeting can give you tremendous insight
into factors that will improve your work
and your professional trajectory.
Still don’t think you have the time to get
involved? If you read this blurb, then you
must have 5 minutes to spare! Let this be an
initial investment into a new aspect of your
career that will help you feel empowered,
gratified, and perhaps most importantly,
will help the field that you have dedicated
your professional life to.
ABCT has many opportunities to get in-
volved. Visit www.abct.org/Members for
more information (and see below).
...
Correspondence to Mitch Prinstein, Ph.D.,
University of North Carolina-Chapel Hill,
Psychology-Davie Hall CB 3270, Chapel Hill,
NC 27599; mitch.prinstein@unc.edu
Professional Development
Why Volunteer for Psychology Association
Governance Groups and Committees?
Mitch Prinstein, University of North Carolina, Chapel Hill
Ever have aspirations of running for office or getting more involved in ABCT gover-
nance? A terrific first step is to become a member of an ABCT committee. For exam-
ple, if you are a regular user of Facebook, Twitter, or other forms of social media,
we could use your help on the Social Networking Media Committee. Like to know
what members are thinking or just like to help? We could use more members on the List Serve Committee. This is, after all, a mem-
bership organization. So we are always looking for members to serve on the Membership Committee, Student Membership
Committee, Ambassador Program, and members in academic settings for our Graduate Mentor Directory. Involvement does take
time but not a lot of it. There are email exchanges, teleconferences, and a face-to-face meeting of the committee during the Annual
Convention. If you’re ready, drop a line to Mary Jane Eimer, Executive Director, mjeimer@abct.org She will be happy to hear your inter-
ests and suggest the appropriate committee(s) for your skill sets.
Getting Involved
72 the Behavior Therapist
If someone asked you why you belong to
this professional organization as op-
posed to another, how would you re-
spond? Perhaps your answer would be
because of our fantastic annual convention,
or maybe it is because ABCT was your first
“professional home.” ABCT is an organiza-
tion where you can build relationships, re-
main current in scholarly research, network,
earn continuing education credits, and
grow your leadership skills through many
volunteer opportunities within the organi-
zation. In addition, it may surprise you that
many of the benefits of ABCT are available
to you 365 days a year. What are some of
these benefits of ABCT membership?
List-Serve
Many members of ABCT work hard
every day to help their clients function better
in their environment, and the ABCT list-
serve is a great resource for recommenda-
tions on treatment manuals, assessment
challenges, self-help manuals, referrals, and
discussions about issues affecting our field.
In one recent interesting list-serve thread
—“The greatest advice I ever received”—
members shared the most influential rec-
ommendations they had received during
their careers. The effect was that one piece
of advice was spread to all of our members
who participate on the list-serve, generat-
ing more posts with more valuable advice,
and so on . . .
Online Access to Scholarly Journals
All members receive free online access to
Behavior Therapy and Cognitive and
Behavioral Practice. Both journals help schol-
ars and practitioners stay at the forefront of
the field as they relate to clinical problems.
Special Interest Groups (SIGs)
Members can become involved in any of
over 40 SIGs within the organization. SIGs
serve as a smaller community within the
larger ABCT community. SIG membership
can be a great opportunity to facilitate col-
laborations on shared interests and develop
leadership skills through many volunteer
opportunities within the organization. In
addition, the Association hosts the popular
Friday-night SIG expo during our annual
convention, where members can meet one
another with similar interests as well as in-
teract with many of the influential leaders
and past presidents of ABCT .
Mentorship
Another benefit of membership is men-
torship. The opportunity to mentor a
younger professional or be mentored by a
seasoned professional permeates the stages
of one’s career development. If you are a
student member or a new professional
member, there is the opportunity to link
with and be guided by one of ABCTs many
experienced members – some of whom have
had a seminal impact on the field. Believe it
or not, these influential members are ap-
proachable and genuinely interested in our
younger members’ career development. On
the other hand, for our veteran members of
ABCT, there is the opportunity to foster the
development of our next generation of lead-
ers in the field and in our organization. If
you have already done so, you may want to
join our Graduate Mentorship Directory if
you are in academia or check it out if you are
a student.
Website
As a service to its members, the ABCT
website (www.abct.org) maintains a large
and growing library of videos and podcasts
to help demonstrate clinical techniques to
illustrate behavioral and cognitive thera-
pies. Members can download free fact
sheets of various psychiatric disorders
(which are very helpful to clients), and re-
ceive sizable discounts on the purchase of
Clinical Grand Rounds, Professional
Development series, and the Clinical
Assessment series. Finally, perhaps the most
popular hit on our website is the Find-a-
Therapist service. If you have not signed up
for this clinical benefit, please be sure to do
so. For only $50 more, we can list your prac-
tice particulars and philosophy. We also
highlight a new clinician each month with
our “ABCT Clinician of the Month.” The
website also includes teaching resources
(i.e., CBT course syllabi) and includes regu-
lar updates on obtaining your continuing
education credits.
The benefits of membership in ABCT are
exciting and wide-ranging. Our member-
ship is strong and continues to grow
stronger each year. There is a culture of
community within ABCT. Our members
come back year after year because of the
breadth of the offerings in the program, the
opportunity to reconnect with old col-
leagues and graduate school friends, as well
as network and develop new professional re-
lationships. There are numerous ways to get
involved to contribute to influencing the di-
rection of the field, from joining a SIG, vol-
unteering on a committee, or generating
interesting and insightful conversations on
the list-serve. At the forefront of its goals,
ABCT wants to ensure that members con-
tinue to take advantage of the many bene-
fits offered. ABCT wants to continue to be
your professional home.
...
Correspondence to Kristene A. Doyle,
Ph.D., Albert Ellis Institute, 45 E. 65th St.,
New York, NY 10065;
krisdoyle@albertellis.org.
At ABCT
A Closer Look at the Benefits of ABCT
Membership
Kristene A. Doyle, Albert Ellis Institute
Kamila White, University of Missouri–Saint Louis
n w
IN-PRESS
“. . . therapist avoidance
and therapist fear are
likely critical to most
instances of treatment
failure in DBT, as well
as other treatments.”
—Rizvi, “Treatment Failure in
Dialectical Behavior Therapy”
doi:10.1016/j.cbpra.2010.05.003
Cognitive and Behavioral
Practice’s landmark special
issue on Treatment Failure
is now online:
sciencedirect.com/abct
March 2011 73
FULL MEMBERS
Adrian Aguilera
Charlene Bang
Peter Barnes
Bekh Bradley
Debra M. Burnett
Daniel J. Buysse
Erin L. Cassidy-Eagle
Brian Peter Chiko
Larry Cohen
Kellie Condon
Eileen I. Correa
Eugene Joseph D'Angelo
Daniel Scott DeBrule
Jacqueline Dillon DeMarco
Grace Eleanor Dent
Shannon Dorsey
Colleen J. Doyle
Michael E. Dunn
Elizabeth EllisOhr
Emmanuel E. Enekwechi
Pablo Gagliesi
Eda Gorbis
Robert Michael Gresham
Tracy D. Guiou
Susan Haverty
Efren F. Hilera
Kimberly Renee Hill
J. Bruce Hillenberg
Barron Hung
Matthew L. Israel
Peter S. Jensen
Ertugrul Koroglu
Margaret (Peggy) Kriss
Julie Ann London
Jennifer Lynn Martin
Joshua Masse
Georganne M. Neufeld
Noosha Niv
Kevin N. Ochsner
Samantha D. Outcalt
Meghan Carrie Prosser
Margaret Rea
Mary Catharine Rimsans
Prathima Setty
Carla Sharp
K. Bryant Smalley
Michelle Sun Smith
Kevin Douglas Stark
Jill A. Stoddard
Dustin K. Teruya
Chrystal D. Tunstall
Robert Joseph Vanecek
Zachary Warren
Paula Wilbourne
Alison M. Yaeger
NEW PROFESSIONALS
Andrea R. Ashbaugh
Amanda Gale
Clare Smith Gaskins
Chloe Hoang
Amanda LintsMartindale
Emily Malcoun
Debra L. Mishler
Stephen Stuart O'Connor
Sydney Savion
Karen E. Seymour
POSTBACCALAUREATE
Lauren Asarnow
Lauryn Bauerband
Kalpa Bhattacharjee
Jacquelyn Bridgette Blocher
Jennifer Ann Czarlinski
Perry I. Factor
Elizabeth Henry
M. Alexandra Kredlow
Kimberly Ann Martin
Christina Metcalf
Stephanie Nicora
Kathryn Phillips
Amelia McMorris Rowley
Catherine Shaffer
Hannah Weisman
STUDENT
Tara Elizabeth Adams
Molly Adrian
Casey E. Allington
Rachel Dawn Amodio
Lindsay Anderson
Brooke J. Arterberry
Kelsey Elizabeth Banes
Michael John Baniewicz
Leland R. Bardsley
Erik Benau
Dana Elizabeth Bender
Lisa Betthauser
Vickie Bhatia
Sarah Ann Bilsky
Michael James Bordieri
Lauren Bradley
Beau Charles Brendley
Lara C. Buckley
Lisa Jane Burklund
Alisa Burpee
Tara M. Calafiore
Barbara Duff Calvert
Robert A. Caponetti
Larisa Cicila
Lauren Coby
Sadie Cole
Gina T. Cortesi
Stuart Patrick Cotter
Sarah Dahl
Alison Darcy
Lily Davis
Rachel Davis
Qianqian Fan
Ben Ben Felleman Felleman
David Fingerhut
Caitlin Lee Fissette
Philip Joseph Fizur
Mara Fleischer
Sarah E. Forsberg
Andrew Frane
Ann Nita Frankel
Zachary D Friedman
Jessica Lauren Fugitt
Ingrid Galfi
Kerri Marie Garruba
Darya Gaydukevych
Daniel L. Gering
Michael Joseph Gillen
Jenna Lynn Godfrey
Kate Golash
Joshua Caplan Gottlieb
Natasha Gouge
Bethany S Gourley
Jessica Lynn Graber
Laura Frances Graham
Maya Gupta
Kelly Haker
Julie P. Harrison
Alison Hartwig
Ashley Tate Hatton
Avi Helman
Rachel Hibberd
Roger Elliot Hicks
Bridget Mary Hirsch
Katherine Holshausen
Alexandra Melissa-Anne
Inzunza
Nadia Islam
Michelle L Jaques
Tami Rene Jeffcoat
Kathryn Jones
Matthew Ryan Judah
Lauren Kerwin
Katherine R. Keyser
Cara J. Kiff
Michael Brandon Klein
Sam Klugman
Lauren Knickerbocker
Rachel P. Kolko
Amanda Kuryluk
Abigail Lamstein
Brian Eugene Lattner
Robert Daniel Laxson
Daniele V. Levy
Michelle Lupkin
Laurin Jarrold Mack
Mallory Laine Malkin
Megan Mawson
Charles David Maxey
Andrew McAleavey
Wendy Lee McMahon
Peter Carl Meidlinger
Colleen L. Merrifield
Jennifer Maye Milliken
Daisy Minter
Kelly Nicole Moore
Jessica Diana Nasser
Dia Nath
Erica Joy Natwick
Elizabeth Ann Nicola
Kristen Elizabeth Ogilvie
Anthony Oliver
Jennifer Kathleen Olivetti
Daniel R. Pastel
Janice Rose Paton
E. Brodie Pope
Kaitlyn A Powers
Alexander Harrison Queen
Laura Quentin
Greer Raggio
Esty Rajwan
Jesse Renaud
Michael Bruce Roberts
Adrienne Lynn Romer
Elizabeth Love Ross
Mary Gilman Simmering
McDonald
Noelle Bassi Smith
Alexis Smith-Baumann
Carol Swann
Koki Takagaki
Jeannette D. Tappe
Sarah Ann Thomas
Andres G. Viana
Megan Viar-Paxton
Muthumbi wa Kimani
Jolie Weingeroff
Lauren K. White
Gail Williams
Hannah Camille Williamson
Nina S. Wommack
Bethany Wootton
Sanne Nyke Wortel
Victoria Wright
Katelin Janine Wyness
Angelina Yiu
Nicole Zaha
Annie Zhang
Abe Zubarev
Welcome, New Members! The individuals listed below
have recently joined ABCT.
74 the Behavior Therapist
ABCT Ambassadors are easily recognized at
the annual meeting by their special ribbons.
They also receive a certificate of recognition
and are featured on our website and in tBT.
ABCTAMBASSADORS
ABCT’s Ambassador program is
a brand-new initiative promoting
leadership, participation, and
membership in ABCT.
Articulate ABCT’s vision, purpose, and
identity to encourage membership
Mentor individuals through the process of
presenting at the annual convention or
transitioning into leadership positions
Act as the eyes and ears
of the association locally
are needed to:
messenger
guide
signify
For more information, contact Lisa Yarde
at ABCT’s central office (lyarde@abct.org)
March 2011 75
CALL for WEB EDITOR
ABCT is seeking a Web editor to assist in updating material in, and developing policies for, its Web site. The position
is funded with both an honorarium and editorial support. The role principally involves helping to develop content for
the Web site and determine the site and navigational structure best suited to our audiences. Technological knowledge
is less essential. The following mission statement and strategy statement detail information on the proposed aims,
activities, and audiences of this new Web site effort.
Web Page Mission Statement
The Web page serves a central function as the public face of ABCT.
As such, it has core functions linked to the mission and goals of the organization: facilitating the appropriate utiliza-
tion and growth of CBT as a professional activity and serving as a resource and information source for matters related
to CBT.
Informational and resource activities are directed toward three conceptual groups:
• Members—with emphasis on providing an interface for many of the administrative functions of the organization,
including conference information, dues, public listing of therapists, etc.
• Nonmember Professionals—to advertise the comparative efficacy, diversity of styles, and methods of cognitive-
behavior therapy, with additional information on training opportunities, available syllabi, and new findings in the
scientific literature.
• Consumers—to provide information and treatment resources on disorders and their treatment, with emphasis on the
style, “feel,” and efficacy of cognitive-behavior therapy, as well as information on additional issues that consumers
confront in treatment (e.g., combined treatments, relapse prevention, etc.).
Web Page Strategy Statement
One of the broader changes in the architecture of the Web page is that our content will now come up on searches.
Accordingly, we need to plan content that will bring professionals and consumers to our site.
The Web editor will need to liaise with associate editors, periodical editors, committees, and SIGs for content. Such
content includes:
• Diagnosis-specific information pages (e.g., information on depression and its treatment)
• Efficacy information (comparative, combination treatment issues)
• The “feel” of cognitive-behavioral treatment
• CBT, BT, DBT, RET . . . what is in a name?
• Recent research findings
• Position statements—regarding issues in the field (to clarify what our organization stands for)
• Speakers bureau
• Links to publications
• Helping media find the right person to discuss a topic
• CBT curricula
• Featured therapist of the month
• Research funding available
• Learning opportunities
ABCT’s web site is now a mature site, having undergone several structural revisions. Now, we are looking for a mem-
ber to help us maximize our own web’s outreach potential and grow it while maintaining structural integrity. In addi-
tion, candidates can apprentice with our current web master, learning the interface among web editor, web master, and
central office.
How to Apply
ABCT members interested in applying for this position should contact David Teisler, Director of Communications,
ABCT, at teisler@abct.org. The deadline for applications is April 15, 2011.
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dissertation done in a timely
fashion, then take the litera-
ture to one step beyond
where it is at right now—
you can set the world on fire
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Professionals, Educators, & Students
Best Advice I Ever Received
From ABCT’s “The Best Advice I Ever Received”
... Recent work has also provided psychometric and administrative information on tools that assess MI competency in the context of MI training (Gill, Oster, & Lawn, 2019). Adherence/competence tools are an important part of training to develop MI proficiency (Schumacher, Madson, & Norquist, 2011), facilitating deliberate practice (Rousmaniere et al., 2017), and evaluating the benefit of MI on client outcomes (Miller & Rose, 2009). However, the conceptualization of MI has evolved since these two prior reviews, requiring increased attention to the composition of therapist skills needed for quality MI delivery across research contexts. ...
... This is an important limitation as evidence that a tool predicts client success is an important determinant of whether (a) MI will be implemented into practice and (b) a clinic will expend the time and resources to train their providers in MI. In the context of community-based training, utilization of trainee-completed or client-rated tools may be preferred (Schumacher et al., 2011). Whereas psychometric properties are strong for certain tools (e.g., VASE-R; CEMI), additional work evaluating the convergent validity of these tools with the well-established observer-rated tools can better justify their use in community-based settings. ...
... In particular, commonly used observer-rated tools have large and generally robust bodies of psychometric evidence to support their use as measures of MI quality across research contexts. However, more work is needed on the predictive ability of these tools on client outcomes and the use of observer-rated tools both within and outside the research context is limited by factors such as lack of availability of work samples for coding (Schumacher et al., 2011), costs associated with training coders (Glynn, Hallgren, Houck, & Moyers, 2012), and barriers to accessing or utilizing treatment data to assess quality. Thus, future research must continue to focus on strategies that reduce costs associated with observed-coding based measures, such as Table 3 Recommended tools across research contexts a . ...
Article
The need for sustained skill development and quality assurance when executing behavioral interventions is best demonstrated in the empirical evolution of Motivational Interviewing (MI). As a brief behavioral intervention that identifies the therapeutic process as an active treatment ingredient, it is critical for researchers, trainers, and administrators to use psychometrically sound and theoretically congruent tools to evaluate provider skills and fidelity when executing MI. Yet, no prior work has evaluated the breadth of MI tools employed across research contexts. Therefore, this review identified MI fidelity and skill development tools across measurement, training and efficacy/effectiveness studies and evaluated their psychometric strength and fit with current MI theory. We identified 199 empirical studies that employed an MI fidelity/skill tool and we found 21 tools with varying degrees of empirical support and theoretical congruence. Specifically, we identified five observer-, two trainee- and one client-rated tool with strong empirical support, and nine observer- and two client-rated tools with preliminary empirical support. We detailed the empirical strength, including the extent to which tools were linked to trainee/client outcomes across research contexts and offer recommendations on which MI tools to use in training, efficacy, and effectiveness trials.
... 13 Also of import with regard to MI training for SU are the characteristics of trainees and training settings, as these are often highly variable and significantly influence the generalizability of findings. 9,14,15 With regard to training methods, evidence-based training protocols for MI or other interventions are often not readily available, with a few notable exceptions such as the MIA: STEP (Motivational. Interviewing Assessment: Supervisory Tools for Enhancing Proficiency) protocol. ...
... Pharmacists and criminal justice employees were included in 1 study each (4%). Nine studies (36%) included trainees from other backgrounds, such as case managers, 37 supervisory staff at community treatment facilities, 15 and other professionals in patient care roles (e.g., nonspecified clinicians, 23 physician's assistants 24 ). ...
Article
Background: Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods: The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results: Just over two-thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about: a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); b) setting characteristics (80%); c) training methods (format = 96%, length = 92%); d) coaching (76%); and e) evaluation of MI skills (92%). Conclusion: Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainee skill continue to limit knowledge of effective training methods.
... Research suggests that MI is a useful EBM that increases a person's motivation to change behavior by resolving ambivalence (Burke et al., 2003;Rubak et al., 2005;Lundahl et al., 2010). Originally developed by Rollnick and Miller (2013) for use with substance use/abuse disorders, the social work field has employed this approach to address a range of problems, including intimate partner violence (Schumacher et al., 2011), parent-child engagement (Sterrett et al., 2010), and retention in parenting programs (Chaffin et al., 2009). Additionally, MI is used to assess families (Snyder et al., 2012), as a treatment approach in the juvenile justice setting (Doran et al., 2013), and to assure child safety and well-being with alcohol-abusing parents (Forrester et al., 2008). ...
Article
Full-text available
During the past 20 years, social work education has built a bridge between the classroom and field using client simulation to learn clinical skills. This paper outlines an innovative model of simulation that incorporates LS used to teach motivational interviewing (MI). In addition, guidelines with specific steps for teaching MI with simulation and LS are discussed. Unfortunately, most present day simulation models leave out methods to instruct and supervise students in real time. When implementing clinical simulations there is little opportunity to correct a trainee’s behavior or to practice a new skill at the perfect teachable moment during an interview. This instruction must wait until the interview is finished and the debriefing has begun. With the addition of LS, the simulation experience is enhanced for students as the supervisor is now incorporated as an active participant in the interview. Using LS, the instructor can now direct and even model appropriate clinical responses and interventions. The use of simulation with LS is innovative and builds on social work’s evolving body of simulation-based education and further strengthens this approach. Results of this model suggest that students quickly learn to appreciate the value added of LS to simulation and that clinical skills learned resist decay overtime.
... This training included established MI training exercises most frequently identified by experienced MI trainers during a curriculum development survey as being appropriate for an introductory training in MI for substance use (Schumacher et al., 2012). Given documented problems with provider participation in postworkshop coaching (Moyers et al., 2008;Schumacher, Madson, & Norquist, 2011), feedback-based coaching was incorporated into the workshop as well as being offered after the workshop. Specifically, trainers would break participants into pairs or small groups and provide individualized coaching and performance-based feedback during role-plays and other practice exercises. ...
Article
Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The "practice and dissemination" curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012-2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.
... The course material in the addictions class introduced MI to counseling students in the program, who were drawn to its optimistic, strategic approach. They communicated to faculty about their interest in learning more about MI, which corresponds to a growing request from professionals in the addiction field for MI training (Schumacher, Madson, & Norquist, 2011). Ultimately, MI was chosen as the counseling model for the clinic because it has strong research support for being effective with alcohol-abusing college students and is associated with increased counseling self-efficacy among counseling students (Mastroleo, Turrisi, Carney, Ray, & Larimer, 2010). ...
Article
Full-text available
The purpose of the pilot study was to examine the effectiveness of a university-based addiction clinic where counseling students treat clients with Motivational Interviewing. Participants (N = 55) were college students referred for alcohol-related problems to an addiction counseling training clinic within a CACREP-accredited counseling program. In the clinic, counseling students screen for problematic drinking through the Alcohol Use Disorders Identification Test (AUDIT) and counsel clients with Motivational Interviewing. The authors examined AUDIT scores from the clinic archives and subjected the scores to paired sample t-tests and Wilcoxon Signed-Rank Tests based on the normality of the subscales. The paired sample t-tests and Wilcoxon Signed-Rank Tests both resulted in statistically significant decreases from pretreatment to post-treatment scores. The findings support the feasibility, preliminary design, and likelihood of positive results of future research that expands the parameters of our pilot study. Implications for research and counselors are discussed.
... Originally developed for use with substance use/abuse disorders, MI is now used to addresses a range of problem behaviors including child welfare. For example, interventions employing Motivational Interviewing reduce intimate partner violence (Schumacher et al., 2011), promote parent-child engagement (Sterrett, Jones, Zalot, & Shook, 2010) and improve retention in parenting programs (Chaffin et al., 2009). Additionally, MI is used to assess families (Snyder et al., 2012), as a treatment approach in the juvenile justice setting (Doran, Hohman, & Koutsenok, 2013), and to assure child safety and wellbeing with alcohol-abusing parents (Forrester et al., 2008). ...
... Research indicates that addiction counselors are open to adopting EBPs (Haug et al., 2008), and among EBPs, addiction counselors are most ready to adopt MI (McGovern, Fox, Xie, & Drake, 2004). Because MI has gained momentum as an EBP for substance abuse, demands for professional training in MI have increased (Schumacher, Madson, & Norquist, 2011). MI is a nonjudgmental, client-centered, yet directive treatment approach that is designed to elicit positive behavioral change through exploring and resolving client ambivalence (Miller & Rollnick, 2013). ...
Article
The authors evaluated the effectiveness of continuing education training in motivational interviewing (MI) for addiction counselors. Participants reported a significant increase in counseling self‐efficacy, and 87.5% reported increasing MI use in their practice. Only 3.8%, however, participated in posttraining consultation.
... Learning MI may have practical limitations outside of research environments that emphasize coding work samples. MI fidelity coding can result in attrition problems because of difficulties producing timely and audible work samples and clinician concerns with this level of oversight (Schumacher, Madson, & Norquist, 2011). Moreover, extended coaching and feedback may not be feasible in community settings from a cost/benefit perspective (Dunn & Darnell, 2014). ...
Article
This study evaluated the impact of Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) workshops on posttraining knowledge, skills, negative attitudes, and interest in implementing evidence-based practices (EBPs). Participants (N = 70) were primarily mental health counselor (41.4%), social workers (20.0%), substance abuse counselors (15.7%), school counselors (5.7%), and nursing professionals (4.3%) who selected the 1- or 2-day workshop for continuing education credit. Participants attended either a Basic MI training workshop (1 day) or a Basic MI training plus an advanced MI/SBIRT training workshop (2 days) to assess if exposure to two EBPs would improve training outcomes. Participants in both the 1-day and 2-day workshops reported posttraining increased perceived knowledge and skills, decreased negative attitudes toward EBPs, and increased interest in implementing EBPs from pretraining to posttraining. There were no differences between participants in the Basic MI or MI plus advanced MI/SBIRT training conditions. Implications for reducing the research-practice gap in EBPs are discussed.
Chapter
Full-text available
Learning motivational interviewing (MI) is not easy, and research shows that many factors are involved in developing competence in using MI. Drawing heavily on the authors’ experience and research as MI trainers, this chapter provides common sense tips for readers to facilitate their development of MI skills, such as setting realistic expectations, keeping an open mind, and getting objective feedback. Readers are also introduced to strategies they can use to address two potentially difficult challenges they may confront in trying to learn and implement MI: clients who frustrate them and clients who are similar to them. Case examples of each challenge and MI-consistent and MI-inconsistent examples of each strategy are provided to help readers better understand when and how to apply each strategy.
Article
Full-text available
Objective: The authors investigated the unique contribution motivational interviewing (MI) has on counseling outcomes and how MI compares with other interventions. Method: A total of 119 studies were subjected to a meta-analysis. Targeted outcomes included substance use (tobacco, alcohol, drugs, marijuana), health-related behaviors (diet, exercise, safe sex), gambling, and engagement in treatment variables. Results: Judged against weak comparison groups, MI produced statistically significant, durable results in the small effect range (average g = 0.28). Judged against specific treatments, MI produced nonsignificant results (average g = 0.09). MI was robust across many moderators, although feedback (Motivational Enhancement Therapy [MET]), delivery time, manualization, delivery mode (group vs. individual), and ethnicity moderated outcomes. Conclusions: MI contributes to counseling efforts, and results are influenced by participant and delivery factors.
Article
Full-text available
We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10-session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty-five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre- and post-programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter-agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co-ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.
Article
Full-text available
Motivational interviewing (MI), an evidence-based counseling approach, has received much recognition from a wide variety of health care professionals. Because of the rising interest in MI, there is increasing demand for training in this counseling approach. The MI training community has answered this call and as a result placed much emphasis on studying the MI training process. The purpose of this article is to provide a systematic review of the published research on MI training. Our goal is to provide a consolidated account of MI trainings outlining the populations receiving training, methods used, and training outcomes. We also identify which aspects of the (W. R. Miller & T. B. Moyers, 2006) eight stages of learning MI each study addressed. Recommendations for advancing the MI training research are highlighted.
Article
Full-text available
This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals. Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training. Ten studies were found. The median length of the training was 9h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants' daily practice, but the results must be interpreted with caution due to the inconsistent study quality. The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies. This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.
Article
Motivational interviewing (MI) has been recommended as a supervision style in probation. This project examined the effectiveness of an MI training curriculum on probation officer MI skill and subsequent probationer outcome. Twenty probation officers were randomized to receive MI training, or to a waiting list control, while an additional group of 10 officers served as a supervision-as-usual group; officer outcomes included questionnaires and standardized interactions at baseline, 2 months, and 6 months. A total of 380 probationers were assigned to officers during a 4-month period; offender outcomes included the probability of having a drug-positive urinalysis or an otherwise poor outcome after 6 months. The MI training program improved officer skill as measured by standardized interactions. However, after controlling for baseline characteristics, probationer outcome did not vary by training group, nor did officer MI competence predict outcome. Results are discussed in terms of the role of MI in the overall probation system.
Article
The development of motivational interviewing (MI) has contributed to a significant change in the zeitgeist of substance abuse treatment. Dr. William Miller has been instrumental in the direction MI has taken. Dr. Miller helped develop MI, guide research and training initiatives, and as a result set a solid foundation for the future of MI. In this article, an interview with Dr. Miller is provided, in which he reflects on his career as he prepares for retirement and provides his perspective on the future of substance abuse treatment and training. Dr. Miller's recommendations for training therapists in MI are also highlighted.
Article
Professional training in motivational interviewing, as on many other topics, is often delivered via a one-time clinical workshop. To what extent do practitioners actually acquire skillfulness through such training? Twenty-two counselors participated in training, of whom 15 completed a study of changes in practice behavior up to 4 months after a motivational interviewing workshop. In addition to self-report questionnaires, they provided taped practice samples before and after training, which were coded for counselor and client behavior. On paper-and-pencil measures, participants reported large increases in motivational interviewing skills. Observational measures reflected more modest changes in practice behavior that were often retained 4 months after training. Clients, however, did not show the response changes that have been found to be predictive of better outcomes with motivational interviewing. While practice behavior changed to a statistically significant extent, the effect of training was apparently not large enough to make a difference in client response. Possible implications for training and quality control of psychotherapies are considered.
Article
Motivational interviewing is an approach based upon principles of experimental social psychology, applying processes such as attribution, cognitive dissonance, and self-efficacy. Motivation is conceptualized not as a personality trait but as an interpersonal process. The model deemphasizes labeling and places heavy emphasis on individual responsibility and internal attribution of change. Cognitive dissonance is created by contrasting the ongoing problem behavior with salient awareness of the behavior's negative consequences. Empathic processes from the methods of Carl Rogers, social psychological principles of motivation, and objective assessment feedback are employed to channel this dissonance toward a behavior change solution, avoiding the “short circuits” of low self-esteem, low self-efficacy, and denial. This motivational process is understood within a larger developmental model of change in which contemplation and determination are important early steps which can be influenced by therapist interventions. A schematic diagram of the motivational process and a six-step sequence for implementing motivational interviewing are suggested.(Received December 1982)
Article
Evidence indicates that workshop training, personalized feedback, and individual consultation can increase competence in motivational interviewing (MI) among highly motivated and skilled substance abuse counselors. Little is known, however, about the translational value of these training strategies for counselors with fewer counseling skills and less stated motivation to learn MI. This study presents evidence from a randomized, controlled trial of 129 behavioral health providers assigned to receive workshop training and enrichments to learn MI. A diverse group of Air Force behavioral health providers working in substance abuse treatment programs were trained in MI and subsequently observed in clinical sessions at 4, 8 and 12 months after training. Results indicate that training was effective in increasing the skill level of these clinicians; however, these gains had decreased by the 4-month follow-up point. Training enrichments in the form of personalized feedback and consultation phone calls did not have an expected, additive effect on clinician skill level. The results of this study lend support to the hypothesis that a greater investment of resources and incentives may be necessary to achieve gains in MI skills for counselors with relatively lower baseline skills than those commonly participating in research studies.
Article
Early attrition from substance abuse treatment is very high, although rates do not differ dramatically from those found in medical and psychiatric treatments. The consequences of substance abuse treatment dropout are severe, however, with early dropouts having the same outcome as untreated clients. Evidence is considered regarding the impact of demographic and social variables on continuation in treatment. The effects of client motivation, substance use, criminality and legal pressure, prior treatment history, and psychopathology are also examined. An analysis of treatment factors and procedures used to enhance retention indicates that more conveniently located, smaller, decentralized clinics, with higher clinical staff ratios and more per capita expenditures, have lower attrition rates. Clients are also likely to continue in treatment longer when they receive rapid initial response and individual attention, and when they are seen in smaller groups in friendly, comfortable environments. Inexpensive techniques such as reminder phone calls and personal letters can be employed in the absence of resources needed to mount more extensive attrition prevention interventions.