The technical hypothesis of motivational interviewing: a meta-analysis of MI's key causal model.
OBJECTIVE
The technical hypothesis of motivational interviewing (MI) posits that therapist-implemented MI skills are related to client speech regarding behavior change and that client speech predicts client outcome. The current meta-analysis is the first aggregate test of this proposed causal model.


METHODS
A systematic literature review, using stringent inclusion criteria, identified 16 reports describing 12 primary studies. We used review methods to calculate the inverse-variance-weighted pooled correlation coefficient for the therapist-to-client and the client-to-outcome paths across multiple targeted behaviors (i.e., alcohol or illicit drug use, other addictive behaviors).


RESULTS
Therapist MI-consistent skills were correlated with more client language in favor of behavior change (i.e., change talk; r = .26, p < .0001), but not less client language against behavior change (i.e., sustain talk; r = .10, p = .09). MI-inconsistent skills were associated with less change talk (r = -.17, p = .001) as well as more sustain talk (r = .07, p = .009). Among these studies, client change talk was not associated with follow-up outcome (r = .06, p = .41), but sustain talk was associated with worse outcome (r = -.24, p = .001). In addition, studies examining composite client language (e.g., an average of negative and positive statements) showed an overall positive relationship with client behavior change (r = .12, p = .006; k = 6).


CONCLUSIONS
This meta-analysis provides an initial test and partial support for a key causal model of MI efficacy. Recommendations for MI practitioners, clinical supervisors, and process researchers are provided.
Department of Behavioral and Social Sciences.
Molly
M
Magill
Department of Behavioral and Social Sciences.
Jacques
J
Gaume
Department of Developmental and Behavioral Pediatrics, Children's Mercy Hospitals and Clinics.
Timothy R
TR
Apodaca
Department of Behavioral and Social Sciences.
Justin
J
Walthers
Department of Behavioral and Social Sciences.
Nadine R
NR
Mastroleo
Department of Behavioral and Social Sciences.
Brian
B
Borsari
Department of Psychiatry and Human Behavior.
Richard
R
Longabaugh
D000328:Adult; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome