Motivational interviewing (or MI) is a widely used counseling approach across professional fields, including social work, medicine, and public health, and targets a growing variety of behaviors, ranging from substance use and HIV risk behavior to water use practices in Sub-Saharan Africa. Several established instruments, including the Motivational Interviewing Treatment Instrument 3.1 (MITI), are commonly used in research and training to assess practitioners' competence in conducting MI. This paper introduces a novel approach to assessing MI practice by applying conversation analysis (or CA), a highly technical analytic method that recognizes linguistic and paralinguistic phenomena that are not typically identified by clinical assessment instruments, such as the MITI. The paper asks: what sociolinguistic features of motivational interviews does CA reveal that the MITI does not? And, do these features help us understand more about the active ingredients of a technically and stylistically sophisticated motivational interview?
To answer these questions, this study compares the MITI and CA as ways to transcribe and code a video-recorded MI session that has been identified by MI's lead proponents as an exemplar of skillful practice. This recorded session was developed for use with the MITI, and pre-coded transcripts of the session have been provided, on-line, by the developers of the instrument. In this study, key sections of this video-recorded session are re-transcribed using CA notation. A side-by-side analysis of the differently coded transcripts allows for the identification of sociolinguistic features of motivational interviews that are revealed by CA and are not captured by the MITI. The paper then considers whether these features are consistent with what MITI developers consider the active ingredients of MI.
CA reveals linguistic and paralinguistic features of this motivational interview that are not captured by MITI. The CA coded and analyzed transcript shows that the MI expert consistently crafts what are called first pair parts designed to elicit preferred seconds from the client. This finding suggests that the MI goal of “rolling with resistance” is achieved sociolinguistically through careful control of what CA calls preference structure. Additionally, what the MITI codes as a “reflection” of the content of the client's utterances, CA views as co-telling a narrative. Co-telling may be a key ingredient in reducing client resistance and building therapeutic alliance.
These preliminary findings have implications for researchers developing MI treatment fidelity instruments and those developing strategies for training practitioners in MI. The crafting of first pair parts to avoid dispreferred responses may be a core skill that underlies skillful MI practice, one which could be measured by treatment fidelity instruments and incorporated into training curricula. These findings also suggest that both crafting first pair parts and co-telling client narratives may be linguistic micro-processes involved in avoiding resistance and developing therapeutic alliance. As such, these findings may be of interest both to MI researchers and those interested in identifying the sociolinguistic features of successful clinical encounters.