Research on MI in Equipoise: The Case of Living Organ Donation

Residual ambivalence prior to live organ donation has been shown to predict worse physical and psychological outcomes for the donor following surgery. We are studying whether MI can help individuals who have agreed to become living organ donors to resolve residual ambivalence about their decision. In this situation, ethical practice demands that the counselor take up a stance of equipoise, equally welcoming of strengthened resolve to donate or a decision not to do so. This paper describes our adaptations of MI for this unique applicati

A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents

Study Objective: To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. Design, Setting, Participants, Interventions, and Main Outcome Measures: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. Results: We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. Conclusion: Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents

Motivational interviewing and recovery: Experiences of hope, meaning, and empowerment

Purpose: Non-participation in outpatient dual diagnosis services presents a challenge for providers assisting clients in their recovery. To better understand factors that facilitate participation, the purpose of this paper is to examine positive recovery states - hope, meaning, and empowerment - as they relate to motivational interviewing (MI) and service use. Design/methodology/approach: Six dually diagnosed adults completed four baseline assessments, four MI sessions, a post-MI tape-assisted recall interview, and one-month follow-up measures. Simulation modeling analysis of phone survey responses, comparisons of baseline and intervention phase data, and grounded theory analysis of interviews were conducted to determine MI\u27s relationship to the dependent variables. Findings: MI was associated with modest improvement in levels of participation, hope, empowerment, and with greater change in life purpose. Key recovery themes were: positive sense of self, increased self-efficacy, and improved relationships. Feelings of safety and trust were tied to greater self-disclosure while more active emotions were more closely linked to the discussion of recovery progress. Research limitations/implications: The paper\u27s finding are limited by small sample size and phone survey response sets. Practical implications: To better help dually diagnosed clients sustain treatment involvement, MI practitioners should pay special attention to recovery accomplishments, values, abilities, and self-esteem, while linking these attributes to service participation where appropriate and creating a safe, valuing atmosphere conducive to self-disclosure. Originality/value: This is the first paper to measure key recovery constructs within MI process, and to explore the role of positive emotions related to MI, recovery, and service participation

Female adolescents\u27 educational choices about reproductive health modules

Purpose: To assess girls\u27 reproductive educational choices, satisfaction with choice, and relationship between demographics, module choice, and satisfaction. Methods: We recruited 286 girls, aged 13 to 21 years, from a hospital-based adolescent clinic, from advertisements, and by word of mouth. At enrollment, participants completed a 60-minute computerized assessment. Those who were randomized to receive didactic counseling were asked to select which module they preferred to receive (abstinence, STD prevention or contraception) at enrollment. After the first counseling visit, participants rated their satisfaction with the counseling session on the computer. Results: At enrollment, 40.5% of the entire sample chose the contraception module, 34.3% chose the STD prevention module and 25.2% chose the abstinence module for their first counseling module. There were differences in module choice by age, STD and sexual history, but not by race or pregnancy history. Most were satisfied with the module; there were no differences in satisfaction by module choice. Conclusions: When allowed to choose the order of reproductive health modules, the majority of girls chose the contraception module first, followed by the STD prevention and abstinence modules. Age, sexual and STD history were associated with the module adolescents chose first. However, satisfaction was high regardless of which module was chosen. Given time limitations for counseling, health care providers and educators may consider age, sexual and STD history when choosing together with adolescents which reproductive health topics they wish to discuss first

Increasing Treatment Adherence Among Outpatients With Depression and Cocaine Dependence: Results of a Pilot Study

Objective:This pilot study examined the effect of a modified motivational therapy intervention on outpatient treatment adherence and completion for patients with comorbid depressive disorder and cocaine dependence.Method:Depressed cocaine patients, stabilized with antidepressant medications on an inpatient psychiatric unit, were consecutively assigned on discharge to motivational therapy (N=11) or treatment-as-usual (N=12) during the first month of outpatient care. Patients were compared on treatment adherence and completion and on 1-year rehospitalization rates. Results:Motivational therapy patients attended significantly more treatment sessions during month 1, completed 30 and 90 days of outpatient care at higher rates, and experienced fewer psychiatric rehospitalizations and days in the hospital during the first year from entry into outpatient treatment.Conclusions:An outpatient program combining individual and group motivational therapy sessions holds promise for improving treatment adherence and completion among depressed patients with cocaine dependence. Am J Psychiatry 1998; 155: 1611-161

Measuring Client Perceptions of Motivational Interviewing: Factor Analysis of the Client Evaluation of Motivational Interviewing Scale

Motivational interviewing (MI) is an intervention approach that has solid evidence of efficacy with substance use disorders. Research and training have benefitted from the development of observational measures to assess MI fidelity and competence. However, one untapped area of assessment is the client perception of the clinician use of MI. Client perceptions of MI have been found through qualitative interviews to relate to motivation to change, view of the therapist and safety of therapy. The Client Evaluation of MI (CEMI) scale was developed to assess client perception of clinician MI use. This study further evaluated the CEMI through exploratory and confirmatory factor analysis with a sample of 500 individuals with dual diagnosis pre-discharge from an inpatient unit. Participants completed an MI based session prior to completing CEMIs. A two factor (relational and technical) model explained 51.1% of the cumulative variance and was supported through confirmatory factor analysis. Suggestions for revisions are provided as well as potential uses of the CEMI and future directions for research. (C) 2013 Elsevier Inc. All rights reserved