Pace Brian T, Dembe Aaron, Soma Christina S, Baldwin Scott A, Atkins David C, Imel Zac E
Department of Educational Psychology, University of Utah.
Department of Psychology, Brigham Young University.
Psychol Addict Behav. 2017 Aug;31(5):524-533. doi: 10.1037/adb0000280. Epub 2017 Jun 22.
Motivational interviewing (MI) theory proposes a process whereby a set of therapist behaviors has direct effects on client outcomes and indirect effects through in-session processes (e.g., client change talk). Despite clear empirical support for the efficacy of MI across settings, the results of studies evaluating proposed links between MI process and outcome have been less clear. In the present study, we used a series of multivariate meta-analyses to test whether there are differential relationships between specific MI-consistent and MI-inconsistent therapist behaviors, MI therapist global ratings, client change language, and clinical outcomes. Based on 19 primary studies (N = 2,614), we found a significant relationship between MI-consistent therapist behaviors and greater client change talk, as well as greater client sustain talk. Higher therapist global ratings (empathy and MI spirit) were significantly related to increased MI-consistent behaviors, decreased MI-inconsistent behaviors, increased client change talk, yet also increased client sustain talk. Therapist global ratings were not significantly related to clinical outcomes. Client sustain talk was a significant predictor of worse clinical outcomes, while client change talk was unrelated to outcome. Variability within the correlations indicated that MI-consistent and MI-inconsistent therapist behaviors were differentially related to therapist global ratings of empathy and MI spirit. Similar to past research, present findings provide equivocal support for hypothesized MI process outcome relationships. Clinical implications and future areas of MI mechanism research are discussed. (PsycINFO Database Record
动机性访谈（MI）理论提出了一个过程，即一系列治疗师行为通过治疗过程中的环节（如来访者的改变谈话）对来访者的治疗结果产生直接影响和间接影响。尽管有明确的实证支持MI在各种情境下的有效性，但评估MI过程与结果之间的假设联系的研究结果却不太明确。在本研究中，我们使用了一系列多元荟萃分析来检验特定的与MI一致和与MI不一致的治疗师行为、MI治疗师整体评分、来访者改变语言和临床结果之间是否存在差异关系。基于19项原始研究（N = 2614），我们发现与MI一致的治疗师行为与更多的来访者改变谈话以及更多的来访者维持谈话之间存在显著关系。更高的治疗师整体评分（同理心和MI精神）与增加的与MI一致的行为、减少的与MI不一致的行为、增加的来访者改变谈话显著相关，但也增加了来访者维持谈话。治疗师整体评分与临床结果没有显著关系。来访者维持谈话是临床结果较差的一个显著预测因素，而来访者改变谈话与结果无关。相关性中的变异性表明，与MI一致和与MI不一致的治疗师行为与治疗师同理心和MI精神的整体评分存在差异关系。与过去的研究相似，目前的研究结果为假设的MI过程与结果关系提供了模棱两可的支持。讨论了临床意义和MI机制研究的未来领域。（PsycINFO数据库记录）
