Motivational interviewing is a method of alcohol treatment which has the goal of establishing intrinsic motivation to change within the client through examining discrepancies between goals and behavior, and ambivalence about these discrepancies. For example, an individual may know that he or she has drinking problems but may tend to ignore the extent to which these problems are interfering with a desirable life. Motivational interviewing helps the client to see the problem in a new light and to overcome ambivalence about change.
Researchers from the University of New Mexico Center on Alcoholism, Substance Abuse, and Addictions (UNM CASAA) asked, “What is the impact of motivational interviewing in underage college drinkers?” (Feldstein & Forcehimes, 2007).
The researchers predicted that measured alliance (therapeutic relationship) and empathy in motivational interviewing sessions would affect the outcome. They evaluated alliance and empathy through participant ratings, therapist ratings, and the Motivational Interviewing Treatment Integrity (MITI) coding system.
The MITI is a behavioral coding system that measures how well (or poorly) a practitioner is using the technique of motivational interviewing. The MITI is a version of the Motivational Interviewing Skills Code (MISC) that only measures the interviewer’s behaviors (while the MISC looks at client behaviors as well). According to the MITI code version 3.1 from UNM CASAA, a low score on the empathy scale of the MITI indicates that the clinician has no apparent interest in the client’s worldview and gives little or no attention to the client’s perspective. A high score on the empathy scale of the MITI indicates that the clinician shows evidence of deep understanding of the client’s point of view, not just for what has been explicitly stated but what the client means but has not yet said.
In the study, 55 underage heavy drinkers were randomized to either one session of motivational interviewing or a no-treatment control group. At the two-month follow-up, interestingly, both groups showed reductions in alcohol-related problems. Perhaps simply participating in the control group of the study caused some participants to examine their drinking behaviors on their own.
Motivational interviewing (MI) did have a significant effect on participants: Only MI participants exhibited significant reductions in binge drinking at follow-up. The MI group also outperformed the control in terms of reductions in alcohol-related problems.
Contrary to predictions, measurements of empathy and alliance did not appear to affect outcomes. Perhaps the behavior of the therapist is of limited significance compared to the behavior of the client. Even when measures of alliance and empathy are relatively low, motivational therapy appears to be effective in helping the client examine discrepancies and resolve ambivalence. Even if motivational interviewing itself is not employed in alcohol treatment, therapeutic alliance and empathy should be important components of any addiction treatment approach. Unfortunately many addiction treatment providers continue to believe that confrontation rather than empathy is the best way to work with individuals with addiction problems.
Feldstein SW, Forcehimes AA. Motivational interviewing with underage college drinkers: a preliminary look at the role of empathy and alliance. American Journal of Drug and Alcohol Abuse. 2007; (33)5: 737-746.