FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1638760892> ?p ?o ?g. }

• W1638760892 endingPage "345" @default.
• W1638760892 startingPage "343" @default.
• W1638760892 abstract "Those interested in the history of clinical endeavour will be engaged by Miller's description of the nativity of motivational interviewing (MI): Motivational interviewing began in a barber shop in Norway [1, p. 835]. From these humble beginnings two decades ago, MI has been widely adopted and adapted for use with a diverse range of clients. There are several reviews of the accumulating evidence attesting to the impact and limitations of MI, and the intrepid reader can explore the evidence thoroughly through the library devoted to this issue at http://www.motivationalinterview.org/library/biblio.html. To date there is a limited number of rigorous studies assessing the impact of MI (e.g. see [2]) and it will be important for systematic reviews to help interpret the accumulating body of evidence. However, interpretation of the accumulated evidence is not helped by diverse descriptions of what MI is and is not. In order to build and reliably interpret the evidence for MI, there is a need to have agreed definitions, to assess fidelity in application and to understand the processes by which MI is alleged to affect clinical outcomes. The history of MI provides an interesting case study for students of knowledge diffusion and utilization. This ‘client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’[3, p. 25] was rapidly embraced. ‘Clinical researchers noticed these developments and got going’[4, p. 1769] initially ahead of efficacy data [5]. The intervention emerged at a time of increasing frustration with the unsubstantiated, and clinically unsustainable belief that one should confront and coerce clients to change. These latter practices were inconsistent with the increasingly influential humanist psychotherapies and also with emerging evidence about treatment and treatment outcome. One suspects that the appealing rationale and the emerging evidence were bolstered by the fact that many clinicians were more comfortable with an approach that fostered collaboration as opposed to some of the more confrontational methods commonly sanctioned. Some early reports of improved treatment retention signified that clients also found MI more engaging (e.g. see [6]). Miller & Rollnick have emphasized consistently that the spirit of MI is as important as the various techniques. Indeed, they have counselled that if MI is simply reduced to a bag of techniques or tricks, then it cannot be properly considered as MI. Those who have claimed a particular intervention to be MI appear to vary in the degree to which they have embraced this counsel. Determining fidelity has been difficult due to three main (related) factors: first, adoption of MI has advanced with a limited theoretical base. This has made it difficult to determine, and thus understand, the critical and effective ingredients and processes of MI; secondly, there has been a lag in the development of reliable and practical instruments and methods that allow assessment of training and supervision outcomes, and similarly make it difficult to assess treatment fidelity and quality; thirdly, many research reports either fail to give sufficient detail to determine treatment fidelity and/or claim to use MI but fail to adhere to important, indeed critical, principles and techniques. A theoretical understanding of MI is lacking, partly because most research has focused on assessing efficacy, neglecting questions about the processes that are involved in and affected by the intervention [2]. A few studies have attempted to examine the impact of the constituents of MI (e.g. see [7]). Even when MI has been associated with improved treatment outcome, there has been little assessment regarding its impact on motivational variables. Miller & Rollnick have both acknowledged this weakness, which precludes bold conclusions about how and why MI has an influence, and limits inference regarding which of the various components might be important and why. Markland and colleagues concluded that: while various aspects of the principles and practice of motivational interviewing have been linked to a variety of social psychological and social cognitive models, this has been largely on a piecemeal and descriptive basis [8, p. 812]. Theory contributes to the development of testable hypotheses that can help us understand, refine and improve clinical discovery. We should therefore welcome the Markland and colleagues' recent examination of MI in relation to self-determination theory. Their sortie into the theoretical realms can help us understand the potential impact of MI on motivational processes. They have facilitated the generation of testable hypotheses, for example around the issues of external regulation, self-regulation and internal and external autonomy, that can help us better comprehend the impact of MI on treatment adherence. MI is a complex intervention, demanding judicious application. Unfortunately, with limited evidence to guide us on who is best placed to deliver MI, considered clinician selection and comprehensive training programmes appear to be overshadowed by a plethora of short courses. Despite their popularity, they may be insufficient to train clinicians adequately, or worse, they could create an unfounded sense of capability. Miller has commented that embracing the spirit of MI might not only involve learning new behaviours—existing behaviours may need to be suppressed. For example, Miller & Mount [9] reported that while training in MI enhanced adoption of the spirit and skills of MI, pre-existing behaviours that may be inconsistent with MI were retained. They also noted that increased confidence gained from a workshop might not always be matched by competence, a worrying combination. Insufficient clinical training may: . . . even serve as a kind of inoculation against further learning, inflating clinician self-efficacy without altering practice behaviour enough to improve client outcomes [9, p. 468]. Miller has observed that even highly skilled practitioners demonstrate varied adherence to interventions such as MI. He has also advised that self-report of clinical practice can be an unreliable guide. For example, many clinicians may be unaware of their shortcomings or errors they make. Such concerns have led him to conclude that the only reliable method to assess adherence to a clinical style is to directly monitor practice. He has actively encouraged the adoption of standards for training and measurement of treatment fidelity and quality across treatment domains. For example, in one treatment report (not specifically related to MI), Miller and colleagues [10] described what could be considered a highly desirable approach to select, train and support clinical staff. As part of a clinical research programme, they described a process of screening and selecting clinicians and detailed training that involved skill rehearsal and performance assessment. Clinicians were certified when a given level of performance was met, a process involving on-site supervision, strategies to maintain fidelity and taping and analysis of treatment delivery. However, in general and specifically in relation to MI, Miller and others have noted that currently there is limited evidence about which training, supervision and accreditation processes are associated with improved clinical outcomes. Consequently, we do not know which clinicians are best suited to deliver MI and what training and supervision they may require to make a difference to clinical outcomes. Assessing the effectiveness of MI clinical skills training and treatment fidelity have been restrained by a paucity of reliable, valid and practical assessment tools. Recent work has attempted to fill this void, but the quintessential style of MI has presented a substantial challenge. The Motivational Interviewing Skill Code (MISC) [9, 11] was criticized as having limited application, particularly because it is complex and labour intensive (for example, it can take 4 hours to rate one therapy session) (e.g. see [12, 13]). Madson and colleagues [12] responded to criticisms of the MISC by developing the Motivational Interviewing Supervision and Training Scale (MIST), which measures adherence to and quality of implementation of MI. While the instrument has, to some extent, combined good psychometric qualities with practicality, the lack of understanding of the relative importance of the various constituents of MI may have contributed to some psychometric limitations and more work on the reliability and validity of this and other instruments is required. The approach will also need to result in tools that are easy to use, a critical consideration if we expect their widespread adoption. Poor description of complex treatments used in clinical research is not restricted to MI. Guidelines on quality reporting of clinical interventions exist, but are not always observed. The absence of reliable and valid treatment fidelity measures, sometimes combined with compliance with editorial demands for more succinct research reports, may contribute to this omission. Crudely put, the consequence is that some reports inform us that the intervention was or was not efficacious, with little reliable information describing what was delivered, by whom and how. As already noted, in relation to MI, the task may be further complicated because, while defining and measuring MI techniques are comparatively straightforward, the spirit of MI is a more challenging prospect. Nevertheless, the scientific veracity of MI research and clinical application will be much advanced by adopting and ensuring adherence to guidelines for reporting evidence-based interventions. Innovative methods to respond to the pressure of journal space could also be explored—for example, using electronic links to provide more detail on interventions, clinician selection and education and training and the context of intervention. This is not just a challenge for MI, but for all quality journals that publish reports of clinical trials. As noted by Miller and colleagues: . . . treatment process and adherence data should be given the same status as outcome data in behavioural intervention research [10, p. 194]. Miller & Rollnick have enriched clinical training and practice and there is some evidence attesting to the efficacy of MI in a range of treatment settings. They have set clinical researchers some critical challenges. We are yet to explore substantively the theoretical basis of MI or its impact on motivational processes and we have little that can help us understand the relative importance of its constituents. Attempts to address and measure treatment fidelity, especially in relation to the alleged critically important spirit of MI, are in their infancy and the current instruments are somewhat cumbersome. Building on the seminal work of Miller, Rollnick and their colleagues, we are left with some critical questions: What theoretical models best help us understand and advance MI? How do we effectively assess the impact of MI and what does the current body of evidence tell us? Why, or by what processes, does MI work? How do we define, operationalize and measure the essence, or spirit, as well as the techniques of MI? How do we measure reliably and practically the effective application of MI? Until we answer these questions, it will be difficult to advance our understanding of what MI is and importantly what it is not. Nor will we be able to interpret effectively the evidence about its impact. If we do not endeavour to explore these complex issues, there is the risk that this valuable clinical approach will be diluted to a folk science, or craft, adopted and adapted by the whims or persuasions of individual advocates. We should ensure that this does not occur. I am indebted to Celia Wilkinson and Tanya Chikritzhs for helpful comments on an initial draft and to Maggie Halls and Patricia Niklasson for technical support. Steve Allsop is funded through the Australian Government Department of Health and Ageing." @default.
• W1638760892 created "2016-06-24" @default.
• W1638760892 creator A5072478312 @default.
• W1638760892 date "2007-02-08" @default.
• W1638760892 modified "2023-10-18" @default.
• W1638760892 title "What is this thing called motivational interviewing?" @default.
• W1638760892 cites W2042665594 @default.
• W1638760892 cites W2072930729 @default.
• W1638760892 cites W2102979096 @default.
• W1638760892 cites W2112347775 @default.
• W1638760892 cites W2132661063 @default.
• W1638760892 cites W2133161874 @default.
• W1638760892 cites W2133661531 @default.
• W1638760892 cites W9706599 @default.
• W1638760892 doi "https://doi.org/10.1111/j.1360-0443.2006.01712.x" @default.
• W1638760892 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/17298637" @default.
• W1638760892 hasPublicationYear "2007" @default.
• W1638760892 type Work @default.
• W1638760892 sameAs 1638760892 @default.
• W1638760892 citedByCount "24" @default.
• W1638760892 countsByYear W16387608922012 @default.
• W1638760892 countsByYear W16387608922014 @default.
• W1638760892 countsByYear W16387608922015 @default.
• W1638760892 countsByYear W16387608922017 @default.
• W1638760892 countsByYear W16387608922018 @default.
• W1638760892 countsByYear W16387608922020 @default.
• W1638760892 countsByYear W16387608922022 @default.
• W1638760892 crossrefType "journal-article" @default.
• W1638760892 hasAuthorship W1638760892A5072478312 @default.
• W1638760892 hasConcept C118552586 @default.
• W1638760892 hasConcept C144024400 @default.
• W1638760892 hasConcept C15744967 @default.
• W1638760892 hasConcept C19165224 @default.
• W1638760892 hasConcept C24845683 @default.
• W1638760892 hasConcept C2777016617 @default.
• W1638760892 hasConcept C2780665704 @default.
• W1638760892 hasConcept C542102704 @default.
• W1638760892 hasConcept C77805123 @default.
• W1638760892 hasConceptScore W1638760892C118552586 @default.
• W1638760892 hasConceptScore W1638760892C144024400 @default.
• W1638760892 hasConceptScore W1638760892C15744967 @default.
• W1638760892 hasConceptScore W1638760892C19165224 @default.
• W1638760892 hasConceptScore W1638760892C24845683 @default.
• W1638760892 hasConceptScore W1638760892C2777016617 @default.
• W1638760892 hasConceptScore W1638760892C2780665704 @default.
• W1638760892 hasConceptScore W1638760892C542102704 @default.
• W1638760892 hasConceptScore W1638760892C77805123 @default.
• W1638760892 hasIssue "3" @default.
• W1638760892 hasLocation W16387608921 @default.
• W1638760892 hasLocation W16387608922 @default.
• W1638760892 hasOpenAccess W1638760892 @default.
• W1638760892 hasPrimaryLocation W16387608921 @default.
• W1638760892 hasRelatedWork W1981237115 @default.
• W1638760892 hasRelatedWork W1992320422 @default.
• W1638760892 hasRelatedWork W2008351457 @default.
• W1638760892 hasRelatedWork W2041747241 @default.
• W1638760892 hasRelatedWork W2075849703 @default.
• W1638760892 hasRelatedWork W2128541546 @default.
• W1638760892 hasRelatedWork W2748952813 @default.
• W1638760892 hasRelatedWork W2899084033 @default.
• W1638760892 hasRelatedWork W2943032816 @default.
• W1638760892 hasRelatedWork W4365505225 @default.
• W1638760892 hasVolume "102" @default.
• W1638760892 isParatext "false" @default.
• W1638760892 isRetracted "false" @default.
• W1638760892 magId "1638760892" @default.
• W1638760892 workType "article" @default.