Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study

Full text

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Note: This article will be published in a forthcoming issue of
The Sport Psychologist. This article appears here in its
accepted, peer-reviewed form, as it was provided by the
submitting author. It has not been copy edited, proofed, or
formatted by the publisher.
Section: Professional Practice
Article Title: Enhancing Athlete Engagement in Sport Psychology Interventions Using
Motivational Interviewing: A Case Study
Authors: Rory J. Mack1, Jeff D. Breckon2, Paul D. O’Halloran3, and Joanne Butt1
Affiliations: 1Centre for Sport & Exercise Science, Faculty of Health & Wellbeing, Sheffield
Hallam University, UK. 2Advanced Wellbeing Research Centre, Sheffield Hallam University,
Sheffield, UK. 3La Trobe University, School of Psychology and Public Health, Bundoora,
VIC, Australia.
Running Head: Motivational interviewing and sport psychology
Journal: The Sport Psychologist
Acceptance Date: November 20, 2018
©2018 Human Kinetics, Inc.
DOI: https://doi.org/10.1123/tsp.2018-0053

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Enhancing Athlete Engagement in Sport Psychology Interventions using Motivational
Interviewing: A Case Study
Rory J. Mack. Centre for Sport & Exercise Science, Faculty of Health & Wellbeing, Sheffield
Hallam University, S10 2PB, UK.
*Jeff D. Breckon. Advanced Wellbeing Research Centre, Sheffield Hallam University,
Sheffield, S10 2BP, UK.
Paul D. O'Halloran. La Trobe University, School of Psychology and Public Health,
Bundoora, VIC, 3068, Australia.
Joanne Butt. Centre for Sport & Exercise Science, Faculty of Health & Wellbeing, Sheffield
Hallam University, S10 2PB, UK.
*Correspondence: j.breckon@shu.ac.uk
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Abstract
The clear reporting of the counseling approach (and theoretical underpinning) applied by sport
psychologists is often missing, with a tendency to focus on intervention content rather than
therapeutic processes and relationship building. Well defined psychotherapies such as Motivational
Interviewing (MI) can help fill this void and provide an underpinning counseling approach (in an
athlete-centred manner) as a framework for delivering interventions such as psychological skills
training (PST). This article describes the role of MI as a framework upon which PST sport psychology
interventions can be mapped and delivered. The paper presents an athlete case study to explain the
role of MI at each phase of the interaction. Robust, well-defined applications of MI in sport require
further research although evidence from other psychological domains suggests that it can be
successfully blended into sporting contexts.
Keywords: motivational interviewing, athlete engagement, integration, sport psychology, intervention
framework
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Sport psychologists typically operate within one of three frameworks and orientations:
psychophysiological; socio-psychological; or cognitive-behavioral (CB).The latter model has
traditionally been most widely employed with athletes to inform the delivery of psychological skills
training (PST; Lindsay, Breckon, Thomas, & Maynard, 2007; Murphy, 1995). Within this PST approach,
self-control strategies such as positive self-talk and mental rehearsal are taught to build athletes’
abilities to regulate internal processes, manage environmental conditions, and execute skills and
strategies under pressure, through both cognitive and somatic techniques (Behncke, 2004). This
application has tended to be in a problem-centred way, rather than an athlete-centred way (Holt &
Strean, 2001), and perhaps consequently, in recent years there has been increased interest in applying
other approaches from counseling and clinical psychologies with athletes. To date, these include
cognitive behavioral therapy (CBT; McArdle & Moore, 2012) and derivatives of this approach (e.g.,
rational emotive behavior therapy, REBT; Turner & Barker, 2014), solution-focused therapy (SFT;
Høigaard & Johansen, 2004), and third wave therapies such as acceptance and commitment therapy
(ACT; Shortway, Wolanin, Block-Lerner & McDonald, 2018) and mindfulness-acceptance-commitment
therapies (MAC; Gardner & Moore, 2004a).
This application of CB approaches is extremely dependent on the practitioner’s ability to
"engage the client in any sort of dialogue about their problem and therefore the potential for a CB
intervention” (Leahy, 2006, p. 137). And yet, published sport psychology interventions appear to place
more emphasis on content than on the processes of relationship-building and their delivery (Longstaff
& Gervis, 2016), and there is a need to better understand the mechanisms of action or mechanisms
of change (Gardner & Moore, 2012; Mack, Breckon, Butt & Maynard, 2017; Poczwardowski, Sherman
& Henschen, 1998). It is clear that sport psychologists have the knowledge and ability, but it is often
less clear how these are delivered in conversations with athletes. For example, the specific
communication strategies used (and not used), specific models and tools implemented, conscious
processes in cultivating a therapeutic alliance, recognition of athlete readiness for an intervention,
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
structures which guide practitioner decision-making during sessions, and processes for integrating two
or more complimentary therapeutic methods are rarely described in detail. This makes it difficult not
only to replicate reported interventions, but also difficult to identify the mechanisms which contribute
to a successful intervention.
Given the growing number of therapeutic approaches and interventions being applied in sport
psychology, there is an increasing need to precisely define intervention content and delivery,
specifically in regards to the individual and professional philosophies of the practitioner
(Poczwardowski, Sherman, & Ravizza, 2004) and the needs of the athlete (Gardner & Moore, 2004b).
While this broadening of the discipline is encouraging - given that there is a tendency for neophyte
practitioners to adopt the dominant approach in their field (Fishman, 1999) - to avoid uniformly
applying PST based on the cognitive behavioral model, there is a need for practitioners to investigate
other approaches, in case a situation arises where this is not appropriate (Corlett, 1996; Murphy,
1995).
The CB approach is arguably dominant in mental health, as the premier choice for treatment
of a large number of different forms of distress (Cromarty, 2016; Holmes, 2002; Moloney & Kelly,
2004). Nevertheless, it is not without its critics, and these limitations are relevant for sport psychology
as the CB approach and its derivatives continue to be applied with athletes. Examples include a focus
on fixing athlete 'problems' (e.g., Cunliffe & Hemmings, 2016), perhaps at the expense of identifying
and reinforcing athlete strengths; the risk of appearing critical or disrespectful in dissecting and
assessing irrational, distorted or faulty thinking patterns (Ryle, 2012); a recognition that cognitive
behavioral therapy (CBT) will be ineffective in one third of cases, and a readiness to attribute this to
the client's lack of motivation or insight (Moloney & Kelly, 2004). Further, in CBT, if an intervention is
evaluated and deemed unsuccessful in terms of the intervention goals, the initial formulation is
questioned (McArdle & Moore, 2012, p.307). An alternative may be to evaluate the strategies used to
deliver the intervention, including the therapeutic alliance (Baldwin, Wampold, & Imel, 2007). For
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
example, what if the formulation was accurate and the content of the intervention was pertinent, but
the intervention was not delivered in an athlete-centred, empathetic, collaborative, autonomy-
supportive manner? Or, what if the athlete simply didn't 'buy in' to the strategies being proposed by
the practitioner, or was not ready for them, and so disengaged from the applied work? Finally, Brown
(2011) indicates that athletes can struggle to initiate, practise and maintain CB restructuring or self-
regulation strategies, while Massey, Gnacinski and Meyer (2015) identified the largest portion (37%)
of sampled NCAA athletes as 'pre-contemplators' regarding engagement in a PST programme. Taken
together, these assertions indicate that prematurely focussing on intervention content (at the expense
of the therapeutic processes) could be detrimental to that intervention.
Research (e.g., Aviram & Westra, 2011; Driessen & Hollon, 2011; Naar & Safren, 2017; Westra
& Arkowtiz, 2011) has suggested that clinical interventions such as CBT can be enhanced by applying
an underpinning/adjunct approach such as Motivational Interviewing (MI; Miller & Rollnick, 2013) in
order to form an integrative MI-CBT (athlete-centred) therapy. While this integrative approach is
becoming well understood and commonly applied in health settings, there is little, if any, awareness
of its potential in sport psychology settings and this particular counseling approach has all the tenets
to enhance current practice in sport psychology. Therefore the aim of this article is to provide a
contemporary perspective of MI and describe its use in sport psychology as a blended framework upon
which CB and other interventions might be delivered and their effectiveness enhanced. A case study
approach is employed to provide a context and examples of the processes and technical and relational
components of MI, to underpin both the therapeutic alliance and PST interventions, before making
recommendations for its use in practice and research.
Motivational Interviewing
Motivational Interviewing is an evidence-based collaborative psychotherapy with roots in
Rogerian person-centred counseling (Rogers, 1959). MI seeks to engender an autonomy-supportive
relationship, and has been demonstrated to be effective in exploring and managing individual's
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
ambivalence about changing behavior (Miller & Rollnick, 2013). The approach includes: the relational
component (spirit of MI); technical or micro-skills (OARS); and four processes (Breckon, 2015).The
application of MI is now widespread across both behavior cessation (i.e., addictions) and behavior
adoption (i.e., physical activity and diet change) contexts, and as an adjunct to other therapeutic
interventions. Its popularity is evidenced by the volume of MI controlled trials having been published
(over 700 to date) and reviews of studies (e.g., Hettema & Hendricks, 2010; Knight, McGowan, Dickens
& Bundy, 2006; Lundahl et al., 2013), with reviews generally finding MI to have significant positive
effects, particularly when combined with treatment as usual. For example, Marker and Norton (2018)
examined 12 trials using an MI + CBT approach to treat anxiety disorders, and determined that MI as
an adjunct to CBT was more effective in in reducing symptoms of anxiety than was CBT alone. Similarly,
Soderlund (2017) reviewed nine studies to determine the effectiveness of using MI to self-manage
physical activity levels in patients with diabetes mellitus type 2. While it was concluded that using MI
did show promise for this when applied by proficient counselors, this review highlighted a key difficulty
in reviewing the effectiveness of MI: it is often difficult to make comparisons between studies
reporting the use of MI, because the competency of those administering the treatment is often not
measured, and the quantity and standard of training they have received in the approach is often not
reported. This makes it difficult to say with certainty that the MI approach is being applied
competently and faithfully.
The Spirit of MI
The spirit (or relational component) of MI is its guiding principle and has been described as a
way of being and thinking that is most common in MI practitioners (Westra, 2012). It is perhaps best
illustrated as four components: Partnership; Acceptance; Compassion; and Evocation (Miller &
Rollnick, 2013). These components contain within them many of the humanistic principles of Carl
Rogers, including collaboration between practitioner and client; practitioner attempts to demonstrate
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
accurate empathy; practitioner attempts to be non-judgemental in hearing the client's story; and
practitioner makes effort to be supportive of client autonomy and self-direction.
Technical (micro skills) components of MI: OARS
The technical skills, or OARS: Open questions that encourage elaboration and exploration;
Affirmations offered from the practitioner that reflect the athlete’s autonomy, attitudes and behaviors
toward change (as opposed to praise which is laden with practitioner judgements of performance);
Reflections that demonstrate that the listener (in this case the sport psychologist) has accurately heard
the athletes perspective and attempts to clarify deeper understanding of meaning; Summaries that
extend the reflections to provide a composite and consolidation of key points presenting them back
with varying levels of reflection. These technical skills are extremely helpful in building rapport, gaining
a deeper understanding of athlete issues, facilitating discussions, avoiding discord in the relationship,
reframing topics to more useful considerations of change and eliciting and strengthening athlete
commitment toward change behaviors (Wagner & Ingersoll, 2013). For more detail on both the spirit
and micro skills (technical components) of MI see Miller & Rollnick (2013), Breckon (2015) and
Rosengren (2009).
The four (‘+’) processes of MI
The four processes of MI are: Engaging; Focussing, Evoking; and Planning (Figure 1). This is not
a linear process (engagement is clearly a fundamental facet of the interaction) but rather the four
processes are a Meta framework which underpin the MI therapeutic approach (Miller & Rollnick,
2013).
The language of change
MI has traditionally been employed when working with clients who are experiencing
ambivalence or resistance towards behavioral change, and are perhaps disengaging from treatment
services. By being particularly sensitive to the language clients use regarding change, MI practitioners
work to elicit self-expressed arguments in favour of change from the client themselves (referred to as
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
change talk; Miller & Rollnick, 2013). This guiding style and evocative strategy is generally preferred
to other more directive, practitioner-led strategies, such as educating, advising or convincing, which
can have the opposite of the desired effect, where client resistance is increased and the client finds
themselves in the position of arguing for the status quo (referred to as sustain talk; Miller & Rollnick,
2013; Rollnick et al., 2005). Research is beginning to better understand how MI practitioners initiate
change through their use of language (e.g., Apodaca et al., 2016), and this may be beneficial for sport
psychologists to consider when working with athletes, particularly those who appear to be reluctant,
resistant, disengaging or unmotivated.
Using Motivational Interviewing to build the athlete-psychologist relationship
The salience of the athlete-psychologist relationship in sport has been repeatedly emphasised
(Andersen & Speed, 2010; Petitpas, Giges, & Danish, 1999; Sharp, Hodge, & Danish, 2015), particularly
regarding counseling skills and the ‘working alliance’, yet trainee sport psychologists are often less
clear on how to develop these engagement skills (Katz & Hemmings, 2009). While measuring the
influence of the professional relationship on outcomes, 'therapeutic alliance' has emerged as a
consistent predictor of outcomes and is an essential component of any talking therapy (Baldwin,
Wampold, & Imel, 2007; Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012; Norcross, 2002). A
collaborative and empathic consultation style is critical for building rapport (Leach, 2005), and
managing ruptures in the alliance (Moyers, Miller, & Hendrickson, 2005). MI is one approach which
seeks to maximise this working alliance, in order to ‘gain access’, through its underpinning philosophy
and inherent four processes, mobilised through overt verbal communication skills which may be
missing from early sport psychology training. Motivational Interviewing can be viewed as an effective
method for communicating with athletes, a framework for delivering PST and other interventions, and
for offering support for non-performance related issues, due to its evocative and collaborative nature.
An athlete’s ability to use psychological skills is determined by their level of self-awareness, which in
turn enables self-regulation (Behncke, 2004). The exploratory, client-centred nature of MI aims to
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
increase self-awareness, potentially leading to increased effectiveness of PST and self-regulation. In
addition to providing a framework or roadmap for relationship building, MI may also contribute to an
underpinning theoretical framework in the intervention process, which is important in providing a
cohesive structure against which progress toward change can be measured (Markland et al., 2005) as
well as ensuring validity, reliability and evidence-based practice.
Athlete concerns about performance should not be viewed narrowly in the context initially
presented by the athlete, but rather take a holistic perspective on a broader scale incorporating the
athlete’s entire life (Gardner & Moore, 2006). This may include “... transitional, developmental,
interpersonal, intrapersonal and more serious psychological issues...” (Gardner & Moore, 2006, p.11).
This is in keeping with the need for a holistic approach for enhancing athletic performance (Simons &
Andersen, 1995), an approach inherent in the 'relational ethos' of counseling psychology (Owen, 2010).
Motivational Interviewing, with its exploratory tools and collaborative empathic nature, is one
approach which may be effective for investigating the fundamental causes of underperformance,
while also developing the personal and psychological wellbeing of the athlete.
The role of MI in sport psychology from an integrative perspective: The Trellis analogy
A useful analogy of MI in sport psychology settings is to consider a garden trellis. Here, MI
provides a framework or trellis (Figure 2) upon which other interventions and techniques can be grown
and can thrive. Each intervention (plant) can be clearly identified as a unique contributor to the overall
‘crop’ which can be measured in terms of athlete performances, outcomes, and wellbeing. Obviously
the types of ‘plants’ or interventions that can be grown on the trellis (e.g., integrating MI with
traditional CB and PST) can vary depending on the athlete, the situation or the context and agreed in
collaboration between all stakeholders (ideally the athlete and sport psychologist).
The role of a sport psychologist is a multifaceted one, for “our athletes have many needs, are
of many personalities, and are embedded in organisations and settings of varying complexities”
(Gardner & Moore, 2006, p. ix). A sport psychologist may also be required to work with other
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
stakeholders, such as coaches and parents, each with their own values and priorities. There may be
an element of discord between parties, and MI could prove a valuable approach for mediation,
through reflective listening, values exploration, building discrepancy and triangulation of perspectives.
Athletes may harbour ambivalence towards engaging with sport psychology support, which the
practitioner would need to recognise and address if any practical work is to be successful. MI is one
potential strategy for doing this (although is not limited to those athletes presenting as ambivalent or
resistant to change). Often a sport psychologist forms part of a multi-discipline scientific support team,
where other practitioners may be utilising the principles of sport psychology or MI to increase
adherence to target behaviors, for example, injury rehabilitation (Arvinen-Barrow & Walker, 2013),
strength and conditioning (Radcliffe, Comfort, & Fawcett, 2013), nutrition (Campbell et al., 2009),
lifestyle behaviors (e.g., balancing training, competition, social and personal demands) (Jones, Hanton,
& Connaughton, 2002), and anti-doping (Morse, 2013).
Case Study
Case study methodology can provide a valuable platform for practitioners to help bridge the
gap between theory and practice (Kuntz & Hessler, 1998; McArdle & Moore, 2012). Case studies have
previously been used to demonstrate the effectiveness of using MI with a single patient to increase
healthy behaviors during cardiac episode rehabilitation (Pietrabissa et al., 2015); to show increased
adherence to medication for a patient with schizophrenia (Ertem & Duman, 2016); and to illustrate
how MI can be integrated into career counseling interventions (Rochat & Rossier, 2016). The case
study method is also now commonplace in sport psychology research (e.g., Thompson & Andersen,
2012; Wood, Barker & Turner, 2017). The following case example (a single session) is therefore
employed to provide an example of the use of MI with an ambivalent athlete and will explicitly
highlight the application of MI with regards to: the four processes; the spirit and relational
components; the technical components (OARS); and, common tools (e.g., scaling rulers). We
acknowledge the limitations of presenting a single session, but this example illustrates the potential
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
for using MI to build an alliance with an athlete prior to developing intervention strategies. It will
showcase the theoretical underpinning, and applied techniques of MI described earlier, and are based
on a real client of the third author. The practitioner was registered in Australia at the time of the case
and operated according to the Australian Psychological Society (APS) code of practice. The individual
engaged in supervision which ensured that any ethical issues arising in practice were addressed in an
appropriate manner, and to maintain the athlete's anonymity details including name and age have
been changed.
The Client: John (pseudonym), a 25-year old central defender who at the time of the sessions
was playing for a football (soccer) club in a state league in Australia. He had played for the national
under 21 team and been touted as a future representative in the national senior team. As the team's
consultant sport psychologist, John was sent to me by the manager on account of his lack of discipline
and excessive (unhelpful) aggression on the pitch. John had developed a reputation for giving away
free kicks and receiving frequent yellow cards. He had been sent off twice in the previous season and
had been suspended six times over the last 3 years.
Engaging phase:
The first thing that struck me about John was the level of discord between us. Speaking with
John I got a very clear sense that he was reluctant to work with me (or any other sport psychologist
for that matter) - he was there because he had been sent. This 'mandated attendance' presented a
substantial barrier to our working relationship and I therefore focussed in the opening exchanges on
the core MI process of engagement (Breckon, 2015). It was essential to explore the discord that John
was exhibiting through the combination of predominantly simple reflections (using John's own words)
and open ended questions to increase engagement and demonstrate empathy and a non-judgemental
approach (Rosengren, 2009). I explored his ambivalence and it emerged that he had been “sent” to
the team's previous sport psychologist about this very issue last season and the psychologist
suggested that John needed to calm down in order to approach the game in a more relaxed state. He
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
then proceeded to try and engage John in some anger management training (cognitive-behavioral)
and taught John a relaxation technique (PST) and asked him to keep a record of his thoughts associated
with this anger (record keeping: CBT; Kennerley, Kirk & Westbrook, 2016). John responded very
negatively to this previous strategy as he liked to play ‘angry’ and consequently did not return to see
the psychologist about this or any other matter last season. Through a combination of simple and
complex reflections (offering John a deeper level interpretation of his comments) and use of reflective
summaries (several reflective statements combined to capture the previous few dialogue exchanges)
I conveyed to John that I understood that he feels that he performs best when he plays angry and it is
important for him to be in this state (empathy as opposed to sympathy). I then concluded the opening
phase with an amplified reflection (an overstatement to gently challenge John's absolute view and
status quo) in which I stated “you play best when you’re angry and what you’re doing now is working
for you”. John responded that his lack of discipline was typically in retaliation to disparaging personal
comments from his opponents – directed to fire him up. He also acknowledged that he had developed
a reputation for losing it and that he now realised that players had begun to target him because of
this. This moving forward and building upon the practitioner's reflection is typical of an effective
complex reflection in MI (Naar-King et al., 2013). Here, I used a double-sided reflection (offer two sides
of an argument): “on the one hand you feel a need to retaliate to the comments of opponents and on
the other hand you don’t like the reputation you are developing because of this”. John again expanded
on both the content and emotion behind his perspective and elaborated on how he wanted to
distance himself from this reputation. This was accompanied by a considerable change in his body
language, where he appeared less tense. It was clear that this empathic approach had begun to reduce
the level of discord between us with John relaxing more, smiling and beginning to ask questions. Now
that there were very clear signs of engagement and the absence of discord, it was considered
appropriate to begin the process of focusing.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Focusing phase:
Having begun to develop a shared understanding in the opening (engagement) phase,
focusing began with an exploration of what (if anything) he would like to change. Through the
appropriate use of reflection, affirmations (reflective statements which acknowledge strengths, values
or self-efficacy) and open ended questions I was able to ascertain that John would like to play angry
but in a way that advantaged the team; a way that was within the rules. A form of ambivalence was
clearly evident in regard to how he would like to play, but unsure of how he might do this without
impacting negatively on the team. Ambivalence is normative in the early phases (Engle & Arkowitz,
2006). John wanted to change his reputation of being a player that would lose it quickly and that other
teams would target. Instead he wanted to: run hard, pressure and harass opponents, tackle hard but
within the rules and not react to the negative comments of opponents. In response to this I used a
combination of complex reflections and affirmations. For example, I noted that “You are very much a
team player that likes to play tough but in a way that benefits the rest of the team and you are the
kind of person who wants to set a good example for your younger teammates.” John reacted in a
positive way in terms of both his body language (he sat up straighter and began to smile more) and
produced some more discussion around what he wanted to achieve specifically for both himself and
the team. It was clear that engagement was still underpinning our relationship and that change talk
(CT; Amrhein et al., 2003) was beginning to emerge. Given that we now had an agreed focus for what
John would like to modify, our next goal was to actively promote dialogue from John that was
consistent with this change plan. Change talk is important because it positively correlates with change
outcomes (Amrhein et al., 2003; Magill et al., 2014) and this phase enabled me to move toward
evoking from John his own thoughts and beliefs about why this change would useful, how confident
he is about achieving this and how he might go about it.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Evoking phase:
Given that the production of CT is a primary goal of MI, I decided to focus on a combination
of simple and complex reflections and open ended questions that are specifically designed to promote
this self-generated language in clients (Rosengren, 2009). These open ended questions can be
represented by the DARN-CAT acronym - that is, questions that evoke CT related to people’s desire,
abilities, reasons, need, commitment, activation and taking steps toward change (Amrhein et al.,
2003). Using a directional open question to evoke further CT, based on his desire to change, I asked
John how things would be different if he was implementing the change strategies (i.e., PST). John
responded that he would enjoy his football more, would gain greater respect amongst his teammates,
and would improve his chances of selection in the national team. I followed up with an 'ability'
question to elicit some further change talk; specifically I asked “How might you achieve this?". John
stated that he would like to play the game like some of the players he admired most in the league –
hard yet legal and relatively unaffected by what others say. I asked him if he could visualise (integrating
PST techniques) what this might look like and he responded positively, noting that he had a particular
player in mind. After asking how John might use this image to his advantage (using the client as the
resource), he came up with the idea of using imagery before games to visualise how he would like to
play. Whilst he seemed quite engaged with this idea I got a sense from his body language he may not
have been particularly confident about following through with this. I therefore decided to follow up
with a further ability-based question in which I asked John about how confident he was about being
able to engage in this visualisation before games. A very useful strategy for evoking change talk related
to areas such as confidence and importance is the use of rulers (i.e., 0-10 rating scales). Specifically, I
asked John to rate his level of confidence using a scale where 0 = not at all confident to 10 = extreme
confidence. John’s initial response was 5 out of 10. I asked what made it a 5 and with the evocation of
more preparatory CT (Amrhein et al., 2003) and use of reflection when John told me about the fact
that he is the type of person who will tend to follow through with things once he sets his mind to it,
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
he was able to shift quite quickly to an 8/10 in terms of confidence. John was now displaying most of
the core signs that he was ready to commit to change (Miller & Rollnick, 2013). He was producing
substantially increased CT, there was little (if any) resistance to change (or sustain talk; Miller &
Rollnick, 2013), and he was starting to talk about how much more he would enjoy his football once
these things had changed. I therefore decided that it was appropriate to move to planning.
Action planning phase:
Given John was clearly committed we began planning by discussing when he would begin, and
how he would do it. John was quite clear that he was committed to spending at least 15 minutes every
night before a game visualising opponents trying to agitate him and then seeing himself respond in
the way he would like to play. I then spent some time checking with John about how he might use
visualisation (collaboration) and how it has worked for him in the past, and we then discussed
strategies that can be followed to facilitate the effectiveness of this technique. This was a clear
example of the integration of PST within an MI framework. Consistent with MI, I thought it important
to incorporate some troubleshooting in order to prepare for times when things become challenging
for John, therefore facilitating maintenance. Here John discussed occasions when he might struggle
with this, such as when extremely tired, and certain opponents that agitated him the most. We really
focused on imagining these scenarios and how he would respond to these situations with his new
philosophy of how he would like to play the game. John also came up with the idea of visualising
momentary lapses in which he lost control and then regained it. This evocation from the athlete
maintained a sense of engagement and trust between both parties and valued their resourcefulness
and autonomy toward change (Resnicow & McMaster, 2012) in an efficient and non-judgemental
manner.
Outcomes
Immediate: John reported very positive results in terms of his ability to play how he would like
for the next two games. In order to try and build in some maintenance, we scheduled in a further two
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
fortnightly sessions and then a monthly booster session in which we reviewed his successes and any
challenges he faced.
Longer term: John gave away substantially fewer free kicks, the number of yellow cards he
received was reduced by 85% and he went 4 seasons without being suspended. His form substantially
improved and he enjoyed his football more. While the application of MI alone cannot be claimed to
achieve these outcomes, it was clear to me that the increased engagement and collaborative working
that MI provided created the opportunity for the interventions to be delivered and accepted by the
athlete - something that had not been achieved with previous approaches.
Discussion
It has previously been stated that the athlete-psychologist relationship is akin to the client-
counselor relationship (Petitpas, Giges, & Danish, 1999). While factors which should be present during
the design, implementation and evaluation of psychological services with athletes have been
identified (Poczwardowski, Sherman, & Henschen, 1998), there are still limited descriptions of the
therapeutic content, structure and style of consultations and interventions in sport psychology. One
consequence of this has been a dearth of research into the minutia of sport psychology interventions
beyond describing headline content such as the type of PST delivered (e.g., mental rehearsal and goal
setting). Moreover, a lack of understanding of the mechanisms which influence the therapeutic
alliance and relationship between the athlete and psychologist, including aspects such as building
empathy and utilising athletes as an autonomous resource, often means we do not fully understand
the influential mediators of success in these sessions. Sport psychology support is concomitant with
the therapeutic relationship within which it was delivered. It is through this relationship that the
practitioner facilitates change in the athlete, and the success of an intervention should not be assessed
independently of the relationship that fostered it (Poczwardowski, Sherman & Henschen, 1998). As
the case study clearly illustrated, there is real potential for future collaboration once engagement has
been achieved and resistance or ambivalence from the athlete has been managed. The case example
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
also demonstrated the value of applying technical (and therefore measurable) skills such as the use
of appropriate reflections and an emphasis on evoking change talk from clients, in order to have the
athlete take greater responsibility for change in an empathetic relationship.
With MI the inclination to confront, convince or persuade athletes is replaced by evoking their
own reasons for change and adapting behaviors, which minimises athlete resistance (Lundahl et al.,
2013). MI even explores the subtleties of language about change (Amrhein et al., 2003) providing clear
frameworks for appropriate responses (Miller & Rollnick, 2013). Since MI is a clearly-defined approach
with clear and measureable technical and relational components, it appears well placed to provide a
basis for sport psychology interventions and a framework (or trellis) upon which intervention
components can be mapped and delivered in a holistic way that respects the athlete’s own motives
and needs. This is illustrated by the sport psychologist in the case study who, following a process of
engagement, worked in partnership with the athlete to develop an intervention (visualisation) that he
could use to play football the way he wanted to.
A further benefit of applying MI is the clear structure (engagement, focusing, evoking,
planning) and direction that the approach offers - which can be readily tailored to the athlete's needs
- with adaptable and bespoke responses avoiding 'off the shelf' inflexible interventions (Rosengren,
2009) or a 'cookbook' (Poczwardowski, Sherman & Henschen, 1998) approach which often fails to
acknowledge the wide variety of factors which can influence an athlete's performance. These flexible,
non-linear four processes can guide the practitioner in supporting athletes on a session-by-session
basis (as in this case study), or globally for the duration of a professional relationship, by providing a
conscious awareness of where the athlete is in the change process, and facilitating the practitioner in
moving fluidly with the athlete throughout.
After investigating the use of MI by expert practitioners in applied sport contexts, it may be
possible to make recommendations for the use of MI in sport, and to develop coherent and evidence-
based training curricula for neophyte practitioners.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Implications for applied practice
The case study has shown MI to be a valuable approach for practitioners to consider adopting
when working with an athlete who has been forced to attend, and/or presents initially as sceptical or
resistant to engaging, in order to begin building a professional relationship and get the athlete to the
point of being ready for some sport psychology work. Further, it is a valuable approach to slip into as
and when ambivalence or resistance arises over the course of the professional relationship, perhaps
during the intervention phase of the relationship which athletes may find particularly challenging.
It has been shown here that MI can be successfully integrated with at least one dominant
intervention in sport psychology (PST), which raises considerations regarding which other
interventions MI might integrate with and enhance, and how practitioners are integrating different
approaches in their work (Norcross, Karpiak & Lister, 2005), which could potentially lead to a more
holistic and athlete-centred delivery of service. It has been identified that some elements of MI are
being used already by sport psychologists in their applied work, both explicitly and implicitly, but it
appears that elements of MI are being 'cherry picked' rather than embraced holistically (Mack et al.,
2017), which is in keeping with previous research (e.g., scaling rulers; Hays, Thomas, Butt & Maynard,
2010). As illustrated in this case study, there are benefits to a more comprehensive application of an
MI framework as part of athlete conversations.
MI has the potential to greatly enhance the ongoing reflective processes and professional
development of sport psychology practitioners through the use of a range of validated competency
and fidelity coding instruments. The clear identification of components of MI enables practitioners to
be assessed in their use of the approach in conversations with athletes. These tools include the
Motivational Interviewing Treatment Integrity (MITI 4.2; Moyers, Manuel & Ernst, 2014) which
assesses both the technical and relational components of MI, including both practitioner behavior
counts and client responses. Such assessment should enable practitioners to be considerate of how
they are responding to ambivalence and resistance, how they use technical skills to form effective
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
working alliances, and whether or not they are able to initiate change in their clients, among other
things. Importantly, practitioners can also begin to understand athlete perceptions of practitioner
behaviors during consultations, how their MI work is being received and their professional
relationships in general using the Client Evaluation of Motivational Interviewing scale (CEMI; Madson
et al., 2013).
MI looks easy, but is difficult to do well – it is important that the integrity of MI delivery is
assessed in order to determine that it is actually MI that is being implemented with athletes. Fidelity
checks (Bellg et al., 2004; Breckon, Johnston & Hutchison, 2008) of MI in sport settings could be
applied to ensure reliability and integrity. This also avoids reliance on athlete performance and
competition outcomes as the sole measure of successful sport psychology interventions. Clearly
reporting the content, frequency and delivery of MI and integrative therapy components, including an
evaluation of the therapeutic alliance (Fluckiger et al., 2012) is becoming widespread in many
randomised controlled trials and clinical intervention settings, and applied sport psychology could
potentially learn and benefit from such practices.
Implications for future research and training
In considering these implications for applied practice, there are also implications for future
research. These centre on the need to further explore how practitioners with extensive training and
knowledge in the MI approach are applying it in their daily work in sport settings, to determine best
practice guidelines for practitioners wishing to add this approach to their repertoire. Given that
several approaches from within the broader discipline of psychology (e.g., REBT, CBT, MAC, solution-
focused) are becoming popular for working with athletes, future research should seek to identify and
delineate the processes and efficacy of integrating MI with these different interventions. This may be
achieved through production of case studies which provide in-depth explanations of an integrated
model. For example, a case study outlining the use of CBT underpinned by MI (and vice versa - MI
applying CB intervention components) to support an athlete who is experiencing a drop in
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
performance due to irrational or intrusive thoughts. Such a case study could outline the processes of
integrating CBT with MI, the impact of this on the therapeutic alliance, and impact on the athlete's
wellbeing and sport performance. While it is believed that MI can underpin delivery of many
interventions because of the technical and relational aspects, it may be more compatible with some
interventions than others. For example, greater emphasis may be placed on challenging illogical and
irrational thinking than on collaborating and building an alliance with an athlete when using a
traditional REBT approach, when compared with more traditional CBT (Brown, 2011).
Research of this nature will require not only in-depth interviews or focus groups, but also
analysis using previously mentioned coding instruments and client evaluations of their work, to
understand the mechanisms of action by which they are being effective, and even identify strategies
proving ineffective. This knowledge would be invaluable for the training of current and neophyte
practitioners, given that “There is now a greater emphasis on counseling and clinical training in sport
psychology” (Weinberg & Gould, 2012, p.18). These findings would also add to the wealth of material
already used to train practitioners in the MI approach, and could be considered for inclusion in
university degree curricula, to give students a foundation in relational and technical skills prior to
introducing intervention skills and strategies.
From a curricula and training perspective the training of MI is a mature approach with over
1300 trainers worldwide (www.motivationalinterviewing.net) and the content of existing training
would offer a valuable foundation for trainee sport psychologists in an aspect of their work that
currently receives scant attention. While MI training is being delivered extensively to groups such as
physiotherapists, physicians, physical activity professionals and dieticians, there is a lack of training
for neophyte and practising sport psychologists. It is important that research also begins exploring
sport-specific uses or adaptations to the MI model and develops sport-specific training materials, to
fill this previously-identified gap (Mack et al., 2017).
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Regardless of these specific suggestions and recommendations, moving forward it is essential
that applied practice, research and practitioner training in this area continue to inform each other in
order to narrow the gap between the science and the service.
Conclusion
While it has been suggested that sport psychologists must be competent in both PST and
therapeutic counseling (Herzog & Hays, 2012) this suggests they are exclusive of one another, whereas
the delivery of PST within a counseling framework appears to be a more efficient and effective
approach. MI has been shown to increase treatment engagement and improve treatment outcomes
(Britton, Patrick, Wenzel, & Williams, 2011), particularly when combined with other treatments such
as CBT (Flynn, 2011; Geller & Dunn, 2011; Leahy, 2006; Westra & Arkowitz, 2011). As the case study
illustrated, it is delivering PST within an evidence-based framework which has the potential to enhance
the efficacy of treatments, through working in partnership with athletes, respecting their autonomy
and evoking ideas about techniques from the athlete. MI is not being proposed as a panacea here but
rather we are proposing this evidence-based approach, used extensively in other psychological
domains, can complement and enhance current sport psychology interventions through enhanced
therapeutic engagement.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
References
Amrhein, P.C., Miller, W.R., Yahne, C.E., Palmer, M., & Fulcher, L. (2003). Client commitment
language during motivational interviewing predicts drug use outcomes. Journal of Consulting
and Clinical Psychology, 71, 862-878. DOI:10.1037/0022-006X.71.5.862.
Andersen, M. B., & Speed, H. D. (2010). Therapeutic relationships in applied sport psychology. In S. J.
Hanrahan & M. B. Andersen (Eds.), Routledge Handbook of Applied Sport Psychology (pp. 3–
11). London: Routledge. http://doi.org/10.4324/9780203851043.ch1
Apodaca, T. R., Jackson, K. M., Borsari, B., Magill, M., Longabaugh, R., Mastroleo, N. R., & Barnett, N.
P. (2016). Which Individual Therapist Behaviors Elicit Client Change Talk and Sustain Talk in
Motivational Interviewing? Journal of Substance Abuse Treatment, 61, 60–65.
http://doi.org/10.1016/j.jsat.2015.09.001
Arvinen-Barrow, M., & Walker, N. (2013). The psychology of sport injury and rehabilitation. New
York, NY: Routledge.
Aviram, A. & Westra, H.A. (2011). The impact of motivational interviewing on resistance in cognitive
behavioral therapy for generalized anxiety disorder. Psychotherapy Research, 21(6), 698-
708. DOI:10.1080/10503307.2011.610832.
Baldwin, S.A., Wampold, B.E., & Imel, Z.E. (2007). Untangling the alliance-outcome correlation:
exploring the relative importance of therapist and patient variability in the alliance. Journal
of Consulting and Clinical Psychology, 75(6), 842–852. DOI:10.1037/0022-006X.75.6.842.
Behncke, L. (2004). Mental Skills Training For Sports : A Brief Review. The Online Journal of Sport
Psychology, 6(1), 1–19. ISSN 1536-0431.
Bellg, A.J., Borrelli, B., Resnick, B.,et al. (2004). Enhancing treatment fidelity in health behavior
change studies: best practices and recommendations from the NIH behavior change
consortium. Health Psychology, 23, 443–451. DOI:10.1037/0278-6133.23.5.443.
Breckon, J.D. (2015). Motivational Interviewing to promote physical activity and nutrition behavior
change. In, Doing Exercise Psychology (M. Anderson & S. Hanrahan, Eds.). Human Kinetics,
Champaign, Ill. ISBN: 9781450431842.#
Breckon, J.D., Johnston, L.H. & Hutchison, A. (2008). Physical activity counseling content and
competency: a systematic review. Journal of Physical Activity and Health, 5(3), 398-417.
PMID: 18579918.
Britton, P.C., Patrick, H., Wenzel, A., & Williams, G.C. (2011). Integrating Motivational Interviewing
and Self-Determination Theory With Cognitive Behavioral Therapy to Prevent Suicide.
Cognitive and Behavioral Practice, 18, 16–27.
Brown, J.L. (2011). Cognitive-behavioral strategies. In J. K. Luiselli & D. D. Reed (Eds.), Behavioral
sport psychology: Evidence-based approaches to performance enhancement (pp. 113–126).
New York, NY: Springer.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Campbell, M.K., Carr, C., Devellis, B., Switzer, B., Biddle, A., Amamoo, M.A., … Sandler, R. (2009). A
randomized trial of tailoring and motivational interviewing to promote fruit and vegetable
consumption for cancer prevention and control. Annals of Behavioral Medicine: A
Publication of the Society of Behavioral Medicine, 38(2), 71–85. DOI: 10.1007/s12160-009-
9140-5.
Corlett, J. (1996). Professional Practice Sophistry , Socrates , and Sport Psychology. The Sport
Psychologist, 10, 84–94.
Cunliffe, M., & Hemmings, B. (2016). Case Study 4: A case study of cognitive behavior therapy in
tennis. Sport and Exercise Psychology Review, 12(2), 51–63.
Cromarty, P. (2016). Improving access to psychological therapies (IAPT) in Australia: Evidence-based
cognitive-behavior therapy interventions for anxiety, depression and gambling addiction. In
R. G. Menzies, M. Kyrios, & N. Kazantzis (Eds.), Innovations and Future Directions in the
Behavioral and Cognitive Therapies (pp. 272–276). Samford Valley, QLD: Australian
Academic Press.
Driessen, E. & Hollon, S.D. (2011). Motivational Interviewing from a cognitive behavioral perspective.
Cognitive and Behavioral Practice, 18, 70-73. DOI: 10.1016/j.cbpra.2010.02.007.
Engle, E.D. & Arkowitz, H. (2006). Ambivalence in Psychotherapy: Facilitating Readiness to Change.
New York: Guilford Press.
Ertem, M., & Duman, Z. Ç. (2016). Motivational Interviewing in a Patient With Schizophrenia to
Achieve Treatment Collaboration: A Case Study. Archives of Psychiatric Nursing, 30(2), 150–
154. http://doi.org/10.1016/j.apnu.2015.08.003
Flückiger, C., Del Re, A.C., Wampold, B.E., Symonds, D., & Horvath, A.O. (2012). How central is the
alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling
Psychology, 59(1), 10. DOI:10.1037/a0025749.
Fishman, D. B. (1999). The case for pragmatic psychology. London: New York University Press.
Flynn, H.A. (2011). Setting the Stage for the Integration of Motivational Interviewing With Cognitive
Behavioral Therapy in the Treatment of Depression. Cognitive and Behavioral Practice, 18,
46–54. DOI: org/10.1016/j.cbpra.2009.09.006.
Gardner, F.L. & Moore, Z.E. (2012). Mindfulness and acceptance models in sport psychology: A
decade of basic and applied scientific advancements. Canadian Psychology/Psychologie
Canadienne, Vol 53(4), 309-318. DOI: org/10.1037/a0030220.
Gardner, F.L., & Moore, Z.E. (2006). Clinical Sport Psychology. Champaign, IL: Human Kinetics.
Gardner, F.L., & Moore, Z.E. (2004a). A mindfulness-acceptance-commitment-based approach to
athletic performance enhancement: Theoretical considerations. Behavior Therapy, 35(4),
707–723. DOI: 10.1123/jcsp.3.4.320.
Gardner, F. L., & Moore, Z. E. (2004b). The Multi-Level Classification System for Sport Psychology
(MCS-SP). The Sport Psychologist, 18, 89–109. DOI:org/10.1123/tsp.18.1.89.
Geller, J., & Dunn, E. C. (2011). Integrating Motivational Interviewing and Cognitive Behavioral
Therapy in the Treatment of Eating Disorders: Tailoring Interventions to Patient Readiness
for Change. Cognitive and Behavioral Practice, 18, 5–15. DOI: 10.1016/j.cbpra.2009.05.005.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Hays, K., Thomas, O., Butt, J., & Maynard, I.W. (2010). The development of confidence profiling for
sport. The Sport Psychologist, 18, 373–392.
Herzog, T., & Hays, K. F. (2012). Therapist or Mental Skills Coach ? How to Decide. The Sport
Psychologist, 26, 486–499. DOI: org/10.1123/tsp.26.4.486.
Hettema, J.E. & Hendricks, P.S. (2010). Motivational Interviewing for Smoking Cessation: A Meta-
Analytic Review. Journal of Consulting and Clinical Psychology. 78(6), 868–884. DOI:
10.1037/a0021498.
Høigaard, R., & Johansen, B.T. (2004). The Solution-Focused Approach in Sport Psychology. The Sport
Psychologist, 18, 218–228. DOI: org/10.1123/tsp.18.2.218.
Holmes, J. (2002). All you need is cognitive behavior therapy? British Medical Journal, 324(7332),
288–294.
Holt, N.L., & Strean, W.B. (2001). Reflecting on initiating sport psychology consultation: A self-
narrative of neophyte practice. The Sport Psychologist, 15, 188-204. DOI:
org/10.1123/tsp.15.2.188.
Jones, G., Hanton, S., & Connaughton, D. (2002). What Is This Thing Called Mental Toughness? An
Investigation of Elite Sport Performers. Journal of Applied Sport Psychology, 14, 205–218.
DOI: org/10.1080/10413200290103509.
Katz, J., & Hemmings, B. (2009). Counseling Skills Handbook for the Sport Psychologist. The British
Psychological Society.
Kennerley,H., Kirk, J. & Westbrook, D. (2016). An introduction to cognitive behavior therapy: Skills
and applications (3rd Edition). Sage: Los Angeles.
Knight, K.M., McGowan, L., Dickens, C. & Bundy, C. (2006). A systematic review of motivational
interviewing in physical health care settings. British Journal of Health Psychology, 11, 319–
332. DOI:10.1348/135910705X52516.
Kuntz & Hessler, (1998). Bridging the Gap between Theory and Practice: Fostering Active Learning
through the Case Method. ERIC.
Leach, M.J. (2005). Rapport: a key to treatment success. Complementary Therapies in Clinical
Practice, 11(4), 262–5. DOI:10.1016/j.ctcp.2005.05.005.
Leahy, R.L. (2006). Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges Into
Opportunities for Change. Guilford: London.
Lindsay, P., Breckon, J.D., Thomas, O., & Maynard, I.W. (2007). In Pursuit of Congruence : A Personal
Reflection on Methods and Philosophy in Applied Practice. The Sport Psychologist, 21, 335–
352. DOI: org/10.1123/tsp.21.3.335.
Longstaff, F. & Gervis, M. (2016). The use of counseling principles and skills to develop practitioner-
athlete relationships by practitioners who provide sport psychology support. The Sport
Psychologist. 30, 276-289. DOI: 10.1123/tsp.2015-0029.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Lundahl, B., Moleni, T., Burke, B.L., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2013).
Motivational interviewing in medical care settings: a systematic review and meta-analysis of
randomized controlled trials. Patient Education and Counseling, 93(2), 157–168. DOI:
10.1016/j.pec.2013.07.012.
Mack, R., Breckon, J., Butt, J., & Maynard, I. (2017). Exploring the Understanding and Application of
Motivational Interviewing in Applied Sport Psychology. The Sport Psychologist, (31), 396–
409. http://doi.org/10.1123/tsp.2016-0125
Madson, M.B., Mohn, R.S., Zuckoff, A., Schumacher, J.A., Kogan, J., Hutchison, S., … Stein, B. (2013).
Measuring client perceptions of motivational interviewing : factor analysis of the Client
Evaluation of Motivational Interviewing scale. Journal of Substance Abuse Treatment, 44,
330–335. DOI: 10.1016/j.jsat.2012.08.015.
Magill, M., Gaume, J., Apodaca, T.R., Walthers, J., Mastroleo, N.R., Borsari, B. & Longabaugh, R.
(2014). The technical hypothesis of motivational interviewing: A meta-analysis of MI’s key
causal model. Journal of Consulting and Clinical Psychology, 82(6), 973-983. DOI:
10.1037/a0036833.
Marker, I., & Norton, P. J. (2018). The efficacy of incorporating motivational interviewing to cognitive
behavior therapy for anxiety disorders: A review and meta-analysis. Clinical Psychology
Review, 62, 1–10. DOI: 10.1016/j.cpr.2018.04.004
Markland, D., Ryan, R.M., Tobin, V.J. & Rollnick, S.R. (2005). Motivational Interviewing and self-
determination theory. Journal of Social and Clinical Psychology, 24(6), 811-831. DOI:
org/10.1521/jscp.2005.24.6.811
Massey, W. V., Gnacinski, S. L., & Meyer, B. B. (2015). Psychological Skills Training in NCAA Division I
Athletics: Are Athletes Ready for Change? Journal of Clinical Sport Psychology, 9(4), 317–334.
http://doi.org/10.1123/jcsp.2014-0042
McArdle, S., & Moore, P. (2012). Applying Evidence-Based Principles From CBT to Sport Psychology.
The Sport Psychologist, 26, 299–310. DOI: org/10.1123/tsp.26.2.299.
Miller, W.R., & Rollnick, S. (2013). Motivational Interviewing: Preparing people for change (3rd
edition). London, England: Guilford Press.
Moloney, P., & Kelly, P. (2004). Beck never lived in Birmingham: Why CBT may be a less useful
treatment for psychological distress than is often supposed. Clinical Psychology, 34, 4–9.
Morse, E.D. (2013). Substance Use in Athletes. In D. A. Baron, C. L. Reardon, & S. H. Baron (Eds.),
Clinical Sports Psychiatry: An International Perspective (pp. 3–12). Wiley-Blackwell.
Moyers, T.B., Manuel, J.K., & Ernst, D. (2014). Motivational Interviewing Treatment Integrity Coding
Manual 4.1. Unpublished manual.
Moyers, T.B., Miller, W.R., & Hendrickson, S.M.L. (2005). How does motivational interviewing work?
Therapist interpersonal skill predicts client involvement within motivational interviewing
sessions. Journal of Consulting and Clinical Psychology, 73(4), 590–598. DOI: 10.1037/0022-
006X.73.4.590.
Murphy, S. M. (Ed.). (1995). Sport Psychology Interventions. Champaign, IL: Human Kinetics.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Naar, S. & Safren, S. (2017). Motivational Interviewing and CBT: Combining Strategies for
Maximum Effectiveness. New York, Guilford Press.
Naar-King, S., Earnshaw, P. & Breckon, J. (2013). Towards a Universal Maintenance Intervention:
Integrating Motivational Interviewing with Cognitive-Behavioral Strategies for Maintenance
of Behavior Change. Cognitive and Behavioral Practice, 27(2), pp.126-137. DOI:
org/10.1891/0889-8391.27.2.126.
Norcross, J.C. (2002). Psychotherapy relationships that work: Therapist contributions and
responsiveness to patients. Oxford University Press.
Norcross, J. C., Karpiak, C. P., & Lister, K. M. (2005). What’s an integrationist? A study of self-
identified integrative and (occasionally) eclectic psychologists. Journal of Clinical Psychology,
61(12), 1587–1594. http://doi.org/10.1002/jclp.20203
Owen, J. (2010). Working with sport and exercise psychologists - A winning combination. In M.
Milton (Ed.), Therapy and Beyond: Counseling Psychology Contributions to Therapeutic and
Social Issues (pp. 213–228). West Sussex: Wiley & Sons.
Petitpas, A.J., Giges, B., & Danish, S.J. (1999). The sport psychologist-athlete relationship -
implications for training. The Sport Psychologist, 13, 344–357. DOI:
org/10.1123/tsp.13.3.344.
Pietrabissa, G., Ceccarini, M., Borrello, M., Manzoni, G. M., Titon, A., Nibbio, F., … Castelnuovo, G.
(2015). Enhancing behavioral change with motivational interviewing: A case study in a
Cardiac rehabilitation unit. Frontiers in Psychology, 6(298), 1–9.
http://doi.org/10.3389/fpsyg.2015.00298
Poczwardowski, A., Sherman, C.P., & Henschen, K.P. (1998). A Sport Psychology Service Delivery
Heuristic: Building on Theory and Practice. The Sport Psychologist, 12, 191–207. DOI:
org/10.1123/tsp.12.2.191.
Poczwardowski, A., Sherman, C.P., & Ravizza, K. (2004). Professional philosophy in the sport
psychology service delivery: Building on theory and practice. The Sport Psychologist, 18, 445-
463. DOI: org/10.1123/tsp.18.4.445.
Radcliffe, J.N., Comfort, P., & Fawcett, T. (2013). The Perception of Psychology and the Frequency of
Psychological Strategies used by Strength and Conditioning Practitioners. Journal of Strength
and Conditioning Research, 27(4), 1136–1146. DOI: 10.1519/JSC.0b013e3182606ddc.
Resnicow, K. & McMaster, F. (2012). Motivational Interviewing: moving from why to how with
autonomy support. International Journal of Behavioral Nutrition and Physical Activity, 9(19),
2-9. DOI: 10.1186/1479-5868-9-19.
Rochat, S., & Rossier, J. (2016). Integrating motivational interviewing in career counseling: A case
study. Journal of Vocational Behavior, 93, 150–162.
http://doi.org/10.1016/j.jvb.2016.02.003
Rogers, C. (1959). Psychology: A Study of a Science. Study 1, Volume 3: Formulations of the Person
and the Social Context, edited by Sigmund Koch. (McGraw-Hill, 1959, pages 184-256).
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Rollnick, S., Butler, C. C., McCambridge, J., Kinnersley, P., Elwyn, G., & Resnicow, K. (2005).
Consultations about changing behavior. British Medical Journal, 331(7522), 961–963.
http://doi.org/10.1136/bmj.331.7522.961
Rosengren, D. (2009). Building motivational interviewing skills: A practitioner workbook. London:
Guilford Press.
Ryle, A. (2012). Critique of CBT and CAT. In E. McCormack (Ed.), Change for the Better (Vol. 4, pp. 1–
8). New York, NY: Sage.
Sharp, L.A., Hodge, K., & Danish, S. (2015). Ultimately It Comes Down to the Relationship:
Experienced Consultants? Views of Effective Sport Psychology Consulting. The Sport
Psychologist, 29(4), 358–370. http://doi.org/10.1123/tsp.2014-0130
Shortway, K. M., Wolanin, A., Block-Lerner, J., & Marks, D. (2018). Acceptance and Commitment
Therapy for Injured Athletes: Development and Preliminary Feasibility of the Return to
ACTion Protocol. Journal of Clinical Sport Psychology, 12, 4–26.
http://doi.org/10.1123/jcsp.2017-0033
Simons, J.P. & Andersen, M.B. (1995). The Development of Consulting Practice in Applied Sport
Psychology: Some Personal Perspectives. The Sport Psychologist, 9(4), 449-468. DOI:
10.1123/tsp.9.4.449
Soderlund, P. D. (2018). Effectiveness of motivational interviewing for improving physical activity
self-management for adults with type 2 diabetes: A review. Chronic Illness, 14(1), 54–68.
http://doi.org/10.1177/1742395317699449
Thompson, C., & Andersen, M. B. (2012). Moving Toward Buddhist Psychotherapy in Sport: A Case
Study. The Sport Psychologist, 26(4), 624–643. http://doi.org/10.1123/tsp.26.4.624
Turner, M.J., & Barker, J.B. (2014). Using Rational Emotive Behavior Therapy With Athletes. The
Sport Psychologist, 28(1), 75–90. DOI: org/10.1123/tsp.2013-0012.
Wagner, C.C & Ingersoll, K.S. (2012). Motivational Interviewing in groups. London: Guilford Press.
Weinberg, R.S. & Gould, D. (2012). Foundations of Sport and Exercise Psychology, 6th Edition.
Champaign, ILL.: Human Kinetics.
Westra, H. (2012). Motivational interviewing in the treatment of anxiety. London: Guilford Press.
Westra, H.A., & Arkowitz, H. (2011). SPECIAL SERIES: Integrating Motivational Interviewing With
Cognitive Behavioral Therapy for a Range of Mental Health Problems. Introduction. Cognitive
and Behavioral Practice, 18, 1–4. DOI: 10.1037/ccp0000098.
Wood, A. G., Barker, J. B., & Turner, M. J. (2017). Developing Performance Using Rational Emotive
Behavior Therapy (REBT): A Case Study with an Elite Archer. The Sport Psychologist, 31(1),
78–87. http://doi.org/10.1123/tsp.2015-0083
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Figure 1 – The four (‘+’) processes of MI (Adapted from: Breckon, 2015).
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19

“Enhancing Athlete Engagement in Sport Psychology Interventions Using Motivational Interviewing: A Case Study”
by Mack RJ, Breckon JD, O’Halloran PD, Butt J
The Sport Psychologist
© 2018 Human Kinetics, Inc.
Figure 2 – Motivational Interviewing as a framework for delivering sport psychology interventions.
Downloaded by SHEFFIELD HALLAM UNIV on 02/19/19