The adherence of motivational interviewing in the initial substance abuse setting and its effect on clients´substance abuse harm reduction

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Linna building, Väinö Linna auditorium, address: Kalevantie 5.


Maria Rakkolainen

Doctoral defence of M.Soc.Sc. Maria Rakkolainen

Motivoivan haastattelun toteutuminen päihdehoidon alkutapaamisissa ja yhteys asiakkaan päihdehaittojen vähenemiseen (The adherence of motivational interviewing in the initial substance abuse setting and its effect on clients´substance abuse harm reduction)

The field of science of the dissertation is Social Psychology.

The opponent is docent Jari Lahti (University of Helsinki). Professor Martti Tuomisto acts as the custos.

The language of the dissertation defence is Finnish.

The proficient listening skills in the first substance abuse counselling sessions motivates clients to talk about change and reduce their substance abuse harm

A good relationship between the client and the counsellor in the first substance abuse counselling sessions is crucial in terms of the client’s motivation for change. It is known that the results of substance abuse treatment fluctuate according to the counsellor´s treatment fidelity. This was also true in the dissertation that aimed to evaluate the realization of motivational interviewing in the first substance abuse treatment sessions. The counsellors’ proficient reflective listening skills were related to the clients´ motivation for change as well as their later substance abuse harm reduction.

The clients´ motivation to change as the central challenge in the first substance abuse sessions  

Motivational interviewing is a therapeutic interaction method for substance abuse. Good collaboration with the client is essential and it is created with client-centred interaction and change oriented communication style. In practice the method is skilfully implemented when the counsellor guides the conversation with the help of open questions, reflective listening, and affirmations to the clients’ concerns about their problem and to their reasons, desire, need and actual intention to change. In motivational interviewing, clients change language is the most promising candidate for its mechanism of action.

Since the 80´s, the method has been known in Finland and it has been trained and applied in many fields, like lifestyle consultation. However, the fidelity of its implementation has not yet been studied in Finland. This dissertation is part of a project funded by the Academy of Finland 2007-2010, aimed at filling this gap of knowledge. Thirty-six first substance abuse counselling sessions were studied analysing the counsellors’ and clients´ behaviour with methods designed for coding this interaction. The reliability and validity of MITI-coding as well as its practical usability in Finnish language were also assessed. The validity of MITI-coding was assessed by scrutinizing passages that were difficult to code by conversation analysis. Finally, the study evaluated how the interaction in the first session was related to clients´ change language during treatment and substance abuse harm reduction over the six-month follow-up period.

The counsellor’s listening skill matters

The study showed that the counsellors implemented the interaction style of motivational interviewing quite well. Half of 16 counsellors in this study worked in collaboration with the client, supported their autonomy and evoked their intrinsic motivation, thereby implementing the spirit of motivational interviewing sufficiently. However, very few of the basic interaction skills were used. More attention should be paid especially to using open questions, as only one fifth of the sessions included enough of them, leading the interaction to many so called traps. The essential skill for counsellors was reflective listening that promoted clients´ change talk and substance abuse harm reduction. Sufficient amount of particularly complex reflections targeted on clients’ meanings and feelings predicted their change talk and substance abuse harm reduction in the six-month follow-up.

In the future more effort should be paid to learning motivational interviewing and especially using open questions and reflective listening based on accurate empathy. The way to do this effectively is to get personalized feedback on one’s own recorded sessions. This practice should be a natural part of learning and maintaining therapeutic interaction skills in training and supervision. The translated MITI is a reliable and practical tool for evaluating the counsellors´ basic skills of motivational interviewing. In implementing the Finnish MITI attention should be paid to suggested improvements in coding questions and reflections, and to the way in which the interaction realizes motivational interviewing as an open dialogue.

The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2301, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1804, Tampere University Press 2017.

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