Pattern and role of signs of readiness for action in motivational interviewing

Abstract

Motivational Interviewing (MI) is a clinical method commonly used to help clients change through resolving their ambivalance and strengthening personal motivation and commitment to change. Various signs of readiness for action (SRAs), described as the signs clients show in MI sessions that signifying their readiness to consider taking action to make the change, have been theorized but not empirically examined. The present thesis, consisted of 2 studies, aimed at studying the pattern of these SRAs as well as their roles on change outcome. Study 1 involved a secondary data analysis that recoded in-session behaviors of the clients in 199 MI sessions obtained from 2 previous clinical trials targeted on the drinking problems of college students. Latent Profile Analysis (LPA) identified pre-transition change language trend groups, which were characterized by the different trends of change language the participants showed in the motivation building phase before transiting to the action planning phase in a MI session, and found that trend in net change strength (i.e., strength of prochange statements minus that of anti-change statements) before transition to action planning significantly predicted more pro-change language in the action planning phase. Significance of sub-categorizing activation language and commitment language was demonstrated. Structural Equation Modeling (SEM) did not support the chained mediation relationship that proposed SRAs serially mediate the effect from MI proficiency of the therapists to the drinking outcomes, through the client change language in the action planning phase. However, an indirect mediating role of pre-transition taking steps change talks (i.e., participants’ statements that they have taken some steps in the direction of change) from percent MI-consistent responses (%MIC) to the drinking outcome was found. Whether findings from MI research conducted in western cultures, such as those found above, can be applied to local cultures is unclear. Study 2 included collecting a small sample of 10 MI sessions conducted in Cantonese so as to investigate the change language expressed in Cantonese. Results showed that, compared with English-speaking clients, Cantonese-speaking clients expressed their commitment more in the form of activation language. Moreover, they expressed their reluctance to change more in the form of their perceived inability to change, on top of their perceived reasons not to change. It was concluded that MI practitioners should pay attention to and work towards promoting the net change strength and the taking steps change talks shown by the clients before the transition to action planning phase. For local clients, efforts on strengthening their activation change talks while promoting their confidence to make the change are particularly warranted.