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A Meta-Analysis of Motivational Interviewing Process: Technical, Relational, and Conditional Process Models of Change

Authors:
Molly Magill at Brown University
Molly Magill
Timothy Apodaca at Children’s Mercy Kansas City
Timothy Apodaca
Brian Borsari at UCSF University of California, San Francisco
Brian Borsari
Jacques Gaume at Lausanne University Hospital
Jacques Gaume
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Abstract

Objective: In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators. Method: A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3,025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change). Results: Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = -.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators. Conclusions: This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials. (PsycINFO Database Record
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A Meta-Analysis of Motivational Interviewing Process: Technical,
Relational, and Conditional Process Models of Change
Molly Magill
Brown University
Timothy R. Apodaca
University of Missouri–Kansas City School of Medicine
Brian Borsari
San Francisco Veterans Affairs Health System, San Francisco,
California, and University of San Francisco
Jacques Gaume
Lausanne University Hospital
Ariel Hoadley and Rebecca E. F. Gordon
Brown University J. Scott Tonigan and Theresa Moyers
University of New Mexico
Objective: In the present meta-analysis, we test the technical and relational hypotheses of Motivational
Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of
technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and
intrapersonal (i.e., client treatment seeking status) moderators. Method: A systematic review identified k⫽58
reports, describing 36 primary studies and 40 effect sizes (N⫽3,025 participants). Statistical methods
calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client
to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change).
Results: Therapist MI-consistent skills were correlated with more client change talk (r⫽.55, p⬍.001) as
well as more sustain talk (r⫽.40, p⬍.001). MI-inconsistent skills were correlated with more sustain talk (r⫽
.16, p⬍.001), but not change talk. When these indicators were combined into proportions, as recommended
in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically,
proportion MI consistency was related to higher proportion change talk (r⫽.11, p⫽.004) and higher
proportion change talk was related to reductions in risk behavior at follow up (r⫽⫺.16, p⬍.001). When
tested as two independent effects, client change talk was not significant, but sustain talk was positively
associated with worse outcome (r⫽.19, p⬍.001). Finally, the relational hypothesis was not supported, but
heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators.
Conclusions: This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future
research on the relational hypothesis should occur in the field rather than in the context of clinical trials.
What is the public health significance of this article?
Meta-analytic results suggest that MI clinicians, trainers, and implementers should adhere to MI profi-
ciency indicators in order to elicit change, rather than sustain, talk. When the balance of client ambiva-
lence is in the direction of behavior change, this is prognostic of positive outcome. Finally, study results
highlight MI technical proficiency, but the role of relational proficiency should be further examined in
primary research with naturalistic clinical samples.
Keywords: motivational interviewing, change talk, sustain talk, technical hypothesis, relational hypothesis
Supplemental materials: http://dx.doi.org/10.1037/ccp0000250.supp
This article was published Online First December 21, 2017.
Molly Magill, Center for Alcohol and Addiction Studies, Brown University;
Timothy R. Apodaca, Children’s Mercy Kansas City, University of Missouri–
Kansas City School of Medicine; Brian Borsari, San Francisco Veterans
Affairs Health System, San Francisco, California, and Department of Psychi-
atry, University of San Francisco; Jacques Gaume, Department of Community
Health and Medicine, Lausanne University Hospital; Ariel Hoadley and Re-
becca E. F. Gordon, Center for Alcohol and Addiction Studies, Brown Uni-
versity; J. Scott Tonigan and Theresa Moyers, Department of Psychology,
University of New Mexico.
This research is supported by Grant AA02366 from National Institute
on Alcohol Abuse and Alcoholism (NIAAA). The contents of this
article are those of the authors and do not necessarily represent the
views of the NIAAA or the United States Government. The authors
would like to sincerely thank the many researchers who contributed
their data to this project.
Correspondence concerning this article should be addressed to Molly
Magill, Center for Alcohol and Addiction Studies, Brown University,
Box G-S121-5, Providence RI 02913. E-mail: molly_magill@brown
.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Consulting and Clinical Psychology © 2017 American Psychological Association
2018, Vol. 86, No. 2, 140–157 0022-006X/18/$12.00 http://dx.doi.org/10.1037/ccp0000250
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