Therapist influence on client language during motivational interviewing sessions Theresa B. Moyers, (Ph.D.) 4 , Tim Martin, (Ph.D.) Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131-1161, USA Received 11 August 2005; received in revised form 12 December 2005; accepted 18 December 2005 Abstract Client language in favor of change is hypothesized to be a causal mechanism for motivational interviewing (MI), and specific therapist behaviors are prescribed to elicit such speech. This project examined 38 motivational enhancement therapy sessions from Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), using a sequential behavioral coding system to investigate the relationship between therapist behaviors and client speech. Conditional probabilities were calculated between MI-consistent (MICO) therapist behaviors, MI-inconsistent (MIIN) therapist behaviors, and immediately subsequent client speech. MICO behaviors were more likely to be followed by self-motivational statements, whereas MIIN behaviors were more likely to be followed by client resistance. These results lend support to the importance of therapist behaviors in shaping client speech during MI sessions. D 2006 Elsevier Inc. All rights reserved. Keywords: Motivational enhancement therapy; Motivational interviewing; Project MATCH 1. Introduction The process of eliciting and shaping client language in favor of change during therapy sessions has been implicated as a causal mechanism for motivational interviewing (MI). Consistent with self-perception theory (Bem, 1972), Miller and Rollnick (1991, 2002) hypothesized that it is the actual speaking of an opinion, either for or against change, that engenders belief in it. Thus, clients who speak in favor of change during MI sessions are actually convincing them- selves to change as they speak. For this reason, Miller and Rollnick prescribed a particular focus on eliciting bchange talk Q (CT; i.e., those statements that indicate a client’s recognition of a need, intent, optimism, or desire to make a specific change). They clearly delineate this particular type of client language as a mechanism of eventual change, rather than merely a marker of it, and accordingly provide examples of methods that therapists might use to elicit it directly from clients, with the overall goal of increasing the probability of adaptive behavior change. Indeed, this ability to elicit and intensify client CT is one of the markers of the expert use of MI (Miller & Moyers, in press). Eliciting and strengthening CT can be an end goal for many of the common techniques used in the practice of MI, including decisional balance exercise, readiness rulers, and values card sort. These interventions, in addition to provoking discrepancy and increasing efficacy, provide opportunities for CT to be elicited. The hypothesized connection between client speech and subsequent behavior change has received support in the empirical literature, although few studies to date have measured in-session CT directly. In nonclinical populations, Gollwitzer (1999) has shown that specific verbal commit- ments, called implementation intentions, facilitate the initiation of intended actions across a variety of behav- ioral domains. Formation of specific verbal intention has been associated with increases in vigorous exercise, breast self-examination, and increased consumption of fruits and 0740-5472/06/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2005.12.003 4 Corresponding author. Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM 87131-1161, USA. Tel.: +1 505 925 2375; fax: +1 505 925 2393. E-mail address: tmoyers@unm.edu (T.B. Moyers). Journal of Substance Abuse Treatment 30 (2006) 245 – 251