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Research Proposal View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by White Rose E-theses Online 1 Clinician-client interactions in MET: The effect of clinicians' utterances on client commitment talk Michael Brown Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol.) The University of Leeds School of Medicine Academic Unit of Psychiatry and Behavioural Sciences May 2014 2 The candidate confirms that the work submitted is his/her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. © 2014 The University of Leeds and Michael Brown The right of Michael Brown to be identified as Author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988 3 ACKNOWLEDGEMENTS I would like to thank Drs Gary Latchford, Ciara Masterson and Gillian Tober for their time and efforts as supervisors, and Dr Mark Walkley and Nick Efford for their support during the analysis phase of this study. I would also like to express my profound appreciation and gratitude to my partner Katy, close family and dear friends who have provided unconditional support throughout this research project. Without their patience, selflessness and seemingly endless cups of tea, completing this research would have been much more difficult. Most importantly, my enthusiasm for and interest in such an intriguing topic would not have remained quite so alive. 4 ABSTRACT Motivational Interviewing is an effective treatment for a range of problematic behaviours. However, previous studies have revealed substantial variability in the effectiveness of clinicians. Curiously, the specific clinician behaviours which contribute to positive outcomes have rarely been studied. Previous studies have often focused on the impact of broad categories of clinician behaviour on outcomes; such outcomes have often been overt client behaviours. The current study represented a substantial shift from the dominant methodologies in the MI literature. It aimed to study the effect specific clinician behaviours had upon client’s preparatory talk and strong commitment talk, in the second-to-second interactions between clinicians and clients. A secondary analysis of Motivational Enhancement Therapy sessions was conducted, using recordings obtained during the United Kingdom Alcohol Treatment Trial (UKATT). Recordings were sampled from those clients who achieved and maintained positive changes in readiness to change following the UKATT study. Recordings were parsed and coded, with data being subjected to sequential and regression analyses. The findings revealed that clinicians’ complex reflections were associated with, and predictive of, significantly more strong commitments from clients. Open questions and complex reflections were both associated with significantly more preparatory talk. However, only complex reflections acted as a significant predictor of preparatory talk. It is concluded that complex reflections and open questions are necessary for the proficient practice of MI, and that clinicians should tailor their approach to match their client’s current motivational state. Moreover, the effectiveness of MI is likely attributable to a combination of the ‘spirit’ of MI and the proficient use of such skills, and possibly other specific skills. It is proposed that future research into MI and other psychological therapies should investigate the role of complex reflections, open questions and other specific clinician behaviours on client outcomes of interest. 5 Contents ACKNOWLEDGEMENTS ........................................................................................... 3 ABSTRACT ................................................................................................................... 4 LIST OF TABLES ......................................................................................................... 7 LIST OF FIGURES ....................................................................................................... 9 ABBREVIATIONS ..................................................................................................... 10 Introduction .................................................................................................................. 12 Aim .......................................................................................................................... 12 Literature Review..................................................................................................... 12 Change Processes in Psychological Therapy ....................................................... 12 Introduction to Motivational Interviewing........................................................... 14 The History of MI ................................................................................................ 15 The Theory of MI................................................................................................. 17 The Evolution of Motivational Enhancement Therapy ....................................... 20 Effectiveness of MI, MET and adapted MI interventions ................................... 21 Stage of Change Transition, MI and Client Outcomes ........................................ 24 Why does MI work: Part 1- Coding frameworks and definitions of types of talk .............................................................................................................................. 26 Why does MI work: Part 2- Client talk and outcomes ......................................... 28 Why does MI work: Part 3- Clinician Behaviour ................................................ 35 MI Practices and Client Change Talk .................................................................. 35 Clinician-client interactions and client outcomes ................................................ 37 Why does MI work: Part 4- Therapist Variability in Outcomes .......................... 44 Summary .............................................................................................................. 45 Research Question ................................................................................................... 46 Hypotheses ............................................................................................................... 46 Method ......................................................................................................................... 47 Overview & Context ............................................................................................ 47 Participant & Data Selection .................................................................................... 47 Participant Selection Pilot .................................................................................... 47 Possible Amendments to Participant Selection.................................................... 49 Sample Representativeness .................................................................................. 50 Data analysis ............................................................................................................ 50 CASAA Application for Coding Treatment Interactions (CACTI) ..................... 50 Amendments to CACTI ....................................................................................... 51 Selecting categories of client and clinician talk for sequential analyses ............. 58 Analyses completed ............................................................................................. 58 Sample size and the power of the analyses .......................................................... 61 The power of sequential analyses ........................................................................ 61 The power of linear regression analyses .............................................................. 62 Parsing, Coding & Reliability .................................................................................. 64 Training of the Second Coder .............................................................................. 64 Inter-Rater Reliability .......................................................................................... 64 Establishing Inter-rater reliability ........................................................................ 65 Rater Drift ............................................................................................................ 65 Reflections on the process of establishing inter-rater reliability ......................... 66 Ethics........................................................................................................................ 69 Results .......................................................................................................................... 70 Amendments to Recording Selection....................................................................... 70 Amendments to Participant Selection ...................................................................... 71 6 Preliminary Analyses ............................................................................................... 72 Collapsing Categories .............................................................................................. 73 Clinician Categories ............................................................................................
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