Counsellor behaviours and patient language during brief motivational interventions: a sequential analysis of speech

TLDR

The study empirically tests whether counsellor motivational‑interviewing skills predict patient change talk during brief motivational interventions for at‑risk alcohol use. Using sequential analysis of MISC‑coded speech from 97 patients in a secondary analysis of an emergency‑department RCT, the authors examined transition frequencies and odds ratios between counsellor behaviours (MI‑consistent, MI‑inconsistent, other) and patient language (change talk, counter‑change talk, unrelated utterances). MI‑consistent behaviours were significantly more likely to be followed by patient change talk and change exploration, whereas MI‑inconsistent and other behaviours predicted unrelated utterances and less change talk, supporting the hypothesized link between MI techniques and patient language.

Abstract

ABSTRACT Aims To investigate empirically the hypothesized relationship between counsellor motivational interviewing (MI) skills and patient change talk (CT) by analysing the articulation between counsellor behaviours and patient language during brief motivational interventions (BMI) addressing at‐risk alcohol consumption. Design Sequential analysis of psycholinguistic codes obtained by two independent raters using the Motivational Interviewing Skill Code (MISC), version 2.0. Setting Secondary analysis of data from a randomized controlled trial evaluating the effectiveness of BMI in an emergency department. Participants A total of 97 patients tape‐recorded when receiving BMI. Measurements MISC variables were categorized into three counsellor behaviours (MI‐consistent, MI‐inconsistent and ‘other’) and three kinds of patient language (CT, counter‐CT (CCT) and utterances not linked with the alcohol topic). Observed transition frequencies, conditional probabilities and significance levels based on odds ratios were computed using sequential analysis software. Findings MI‐consistent behaviours were the only counsellor behaviours that were significantly more likely to be followed by patient CT. Those behaviours were significantly more likely to be followed by patient change exploration (CT and CCT) while MI‐inconsistent behaviours and ‘other’ counsellor behaviours were significantly more likely to be followed by utterances not linked with the alcohol topic and significantly less likely to be followed by CT. MI‐consistent behaviours were more likely after change exploration, whereas ‘other’ counsellor behaviours were more likely only after utterances not linked with the alcohol topic. Conclusions Findings lend support to the hypothesized relationship between MI‐consistent behaviours and CT, highlight the importance of patient influence on counsellor behaviour and emphasize the usefulness of MI techniques and spirit during brief interventions targeting change enhancement.