Motivational Interviewing Treatment Integrity Extra Credit Assignment This is a extra credit assignment about miti motivational interviewing. You have to f

Motivational Interviewing Treatment Integrity Extra Credit Assignment This is a extra credit assignment about miti motivational interviewing. You have to find something that relates to the topic and write around 2 pages about it. I also have attached a paper where they explain what miti is. PLS in the reference page make sure to cite the miti packet and as well the item you choose that relates to it. do not forget to cite and in text citations. Otherwise everything is explained in the extra credit assignment and on the miti package pls it should be in APA thanks. Extra Credit
Extra Credit-Paper
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?
?
?
Find a video, movie, song, poem, work of art,
etc. that depicts some part of MI that is
important to you.
Explain why your selection is important to
you, what part of MI it represents, research
to support it’s efficacy w/references, and
how you will use it in your practice.
1-2 pages, due on or before the beginning of
last class. Turnitin only.
10 points available
Extra Credit Example
Extra Credit-Example
To me, this represents empathy which I find
to be extremely important in bringing the
Spirit of MI to my interactions with clients.
By exhibiting a willingness to meet the
client where they are, my hope is to exhibit
not only empathy, but by using the skills of
MI, accurate empathy-thus strengthening
the therapeutic alliance.
Therapeutic Alliance
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The therapeutic alliance (therapeutic
alliance or therapeutic relationship) refers
to the relationship between a healthcare
professional and a client (or patient).
?
The means by which a therapist and a
client hope to engage with each other,
and effect beneficial change in the client.
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1
Motivational Interviewing Treatment Integrity
Coding Manual 4.2.1
T.B. Moyers1, J.K. Manuel2, & D. Ernst3
University of New Mexico
1Center on Alcoholism, Substance Abuse, and Addictions (CASAA)
2Department of Veterans Affairs
3Denise Ernst Training & Consultation
Recommended citation:
Moyers, T.B., Manuel, J.K., & Ernst, D. (2014). Motivational Interviewing Treatment Integrity
Coding Manual 4.1. Unpublished manual.
We are grateful to the following editors of this manual:
Lisa Hagen Glynn
Cristiana Fortini
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2
Revisions for 4.1
Text change in Persuade with Permission to clarify the length and extent of permission
Correction of formatting errors
Revision of examples
Revisions for 4.2
A. Sustain Talk
Added sentence to Softening Sustain Talk global indicating that therapists may receive high
scores on this scale even if no sustain talk is present in the session. Also added this point as FAQ
# 6.
Added FAQ to elaborate on use of sustain talk to build empathy and how this might be reflected
in scoring for Softening Sustain Talk(FAQ #7)
Added FAQ to elaborate on how Softening Sustain Talk should be scored in decisional balance
exercise (FAQ #8)
B. Change Talk
Added sentence to Cultivating Change Talk indicating that clinicians should not be penalized if
clients do not offer change talk despite their efforts.
C. Seeking Collaboration
Added sentence to indicate that Seek Collaboration code need not be assigned when therapists
are querying client’s intellectual grasp of their statements (FAQ #9)
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A.
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INTRODUCTION TO THE MITI
Purpose of the MITI
How well or poorly is a clinician using motivational interviewing? The MITI is a behavioral
coding system that provides an answer to this question. The MITI also yields feedback that can
be used to increase clinical skill in the practice of motivational interviewing. The MITI is
intended to be used as a:
1) Treatment integrity measure for clinical trials of motivational interviewing.
2) Means of providing structured, formal feedback about ways to improve practice in nonresearch settings.
3) Component of selection criteria for training and hiring (for more information about
this, see the FAQ section in Appendix B; in progress).
The MITI evaluates component processes within motivational interviewing, including engaging,
focusing, evoking, and planning. Sessions without a specific change target or goal may not be
appropriate for evaluation with the MITI (see Designating a Change Goal; Section C), although
some of the elements may be useful for evaluating and giving feedback about engaging skills.
B.
COMPONENTS OF THE MITI
The MITI has two components: the global scores and the behavior counts.
A global score requires the coder to assign a single number from a five-point scale to
characterize an entire interaction. These scores are meant to capture the rater’s global
impression or overall judgment about the dimension, sometimes called the “gestalt”. Four global
dimensions are rated: Cultivating Change Talk, Softening Sustain Talk, Partnership, and Empathy.
This means that each MITI review will contain four global scores.
A behavior count requires the coder to tally instances of particular interviewer behaviors. These
running tallies occur from the beginning of the segment being reviewed until the end. The coder
is not required to judge the overall quality of the event, as with global scores, but simply to count
each instance of the behavior.
Typically, both the global scores and behavior counts are assessed within a single review of the
audio recording. A random 20-minute segment is the recommended duration for a coding
sample. Shorter or longer segments may be used, but caution is warranted in assigning and
interpreting global scores for longer or shorter samples. Careful attention should be paid to
ensure that the sampling of the segments is truly random, especially within clinical trials, so that
proper inferences about the overall integrity of the MI intervention can be drawn.
The recording may be stopped as needed, but excessive stopping and restarting during actual
coding (as opposed to training or group review) may disrupt the ability of the coder to form a
gestalt impression needed for the global codes. Coders may therefore decide to use two passes
through the recording until they are proficient in using the coding system. In that case, the first
pass should be used for the global scores and the second for the behavior counts.
C.
DESIGNATING A CHANGE GOAL
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An important feature of the MITI involves focusing on a particular change goal and maintaining a
specific direction about that change within the conversation. Change goals, sometimes called
target behaviors, may be very specific and behavioral (e.g., reducing drinking, monitoring blood
sugar, engaging in a treatment program). Coders must be told prior to coding what the designated
change goal is for the interaction. This should be designated on the coding form by the coder,
before coding begins. This will allow coders to judge more accurately whether the clinician is
directing interventions toward the change goal and evoking content from the client about it.
D.
GLOBAL SCORES
Global scores are intended to capture the rater’s overall impression of how well or poorly the
clinician meets the description of the dimension being measured. Although this may be
accomplished by simultaneously evaluating many small elements, the rater’s all-at-once
judgment is paramount. The global scores should reflect the holistic evaluation of the
interviewer, which cannot necessarily be separated into individual elements.
Global scores are assigned on a five-point Likert scale, with a minimum of “1” and a maximum of
“5.” The coder assumes a default score of “3” and moves up or down as indicated. A “3” may also
reflect mixed practice. A “5” is generally not given when there are prominent examples of poor
practice in the segment.
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Cultivating Change Talk
Low
High
1
2
3
4
5
Clinician shows no
explicit attention to,
or preference for,
the client’s language
in favor of changing
Clinician sporadically
attends to client
language in favor of
change – frequently
misses opportunities
to encourage change
talk
Clinician often
attends to the client’s
language in favor of
change, but misses
some opportunities
to encourage change
talk
Clinician
consistently attends
to the client’s
language about
change and makes
efforts to encourage
it
Clinician shows a
marked and
consistent effort to
increase the depth,
strength, or
momentum of the
client’s language in
favor of change
This scale is intended to measure the extent to which the clinician actively encourages the
client’s own language in favor of the change goal, and confidence for making that change. To
achieve higher ratings on the Cultivating Change Talk scale, the change goal must be obvious in
the session and the conversation must be largely focused on change, with the clinician actively
cultivating change talk when possible. Low scores on this scale occur when the clinician is
inattentive to the client’s language about change, either by failing to recognize and follow up on
it, or by prioritizing other aspects of the interaction (such as history-taking, assessment or nondirective listening). Interactions low in Cultivating Change Talk may still be highly empathic and
clinically appropriate.
Care should be taken not to penalize clinicians if clients do not offer change talk or do not
respond to efforts to evoke it.
Verbal Anchors
1. Clinician shows no explicit attention to, or preference for, the client’s language in favor of
changing.
Examples:
• Asks only for a history of the problem
• Structures the conversation to focus only on the problems the client is experiencing
• Shows no interest or concern for client values, strengths, hopes or past successes
• Provides education as only interaction with the client
• Supplies reasons for change rather than encouraging them from the client
• Ignores change talk when it is offered
2. Clinician sporadically attends to client language in favor of change – frequently misses
opportunities to encourage change talk.
Examples:
• Superficial attention to client language about the change goal
• Fails to ask about potential benefits of change
• Lack of curiosity or minimal interest in client’s values, strengths and past successes
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3. Clinician often attends to the client’s language in favor of change, but misses some
opportunities to encourage change talk.
Examples:
• Misses opportunities to encourage client language in favor of change
• May give equal time and attention to sustain talk and change talk, for example using
decisional balance after momentum for change is emerging
4. Clinician consistently attends to the client’s language about change and makes efforts to
encourage it.
Examples:
• More often than not, acknowledges client reasons for change and explores when they are
offered
• Often responds to change talk with reflections that do not encourage deeper exploration
from the client
• Expresses curiosity when clients offer change talk
• May explore client’s values, strengths, hopes and past successes related to target goal
5. Clinician shows a marked and consistent effort to increase the depth, strength, or momentum
of the client’s language in favor of change.
Examples:
• Over a series of exchanges, the clinician shapes the client’s language in favor of change
• Uses structured therapeutic tasks as a way of eliciting and reinforcing change talk
• Does not usually miss opportunities to explore more deeply when client offers change talk
• Strategically elicits change talk and consistently responds to it when offered
• Rarely misses opportunities to build momentum of change talk
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Softening Sustain Talk
Low
High
1
2
3
4
5
Clinician consistently
responds to the
client’s language in a
manner that
facilitates the
frequency or depth of
arguments in favor of
the status quo.
Clinician usually
chooses to explore,
focus on, or respond
to the client’s
language in favor of
the status quo.
Clinician gives
preference to the
client’s language in
favor of the status
quo, but may show
some instances of
shifting the focus
away from sustain
talk.
Clinician typically
avoids an emphasis
on client language
favoring the status
quo.
Clinician shows a
marked and
consistent effort to
decrease the depth,
strength, or
momentum of the
clients language in
favor of the status
quo.
This scale is intended to measure the extent that the clinician avoids a focus on the reasons
against changing or for maintaining the status quo. To achieve high scores, clinicians should
avoid lingering in discussions concerning the difficulty or undesirability of change. Although
therapists will sometimes choose to attend to sustain talk to build rapport, in general they
should spend only as much time as needed to bring the discussion into more favorable territory
for building motivation. High scores may also be achieved in the absence of sustain talk during a
session, if the clinician does not engage in behaviors to evoke it. Low scores in Softening Sustain
Talk are appropriate when clinicians focus considerable attention to the barriers of change, even
when using MI-consistent techniques (e.g., asking open questions, offers reflections, affirmations
and other MI Adherent techniques) to evoke and reflect sustain talk throughout the session.
1. Clinician consistently responds to the client’s language in a manner that facilitates the
frequency or depth of arguments in favor of the status quo.
Examples:
• Explicitly asks for arguments against change, queries difficulties
• Actively seeks elaboration when sustain talk is offered through questions, reflections, or
affirmations
• Preferential attention and reinforcement of sustain talk when it occurs alongside change
talk
• Sustained curiosity and focus about reasons not change
2. Usually chooses to explore, focus on, or respond to client’s reasons to maintain the status quo.
Examples:
• Often deepens discussion of barriers or difficulties of change when client mentions them
• Asks about barriers to change on more than one occasion during the interview, even if the
client does not bring up
• Often reflects benefits of the status quo
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3. Clinician gives preference to the client’s language in favor of the status quo, but may show
some instances of shifting the focus away from sustain talk.
Examples:
• Some missed opportunities to shift focus away from sustain talk
• Attends to benefits of status quo even when client offers change talk
4. Clinician typically avoids an emphasis on client language favoring the status quo.
Examples:
• Does not explicitly ask for reasons not to change
• Minimal attention to sustain talk when it occurs
• Does not seek elaboration of sustain talk
• Lack of curiosity and focus on client’s reasons to maintain the status quo
• Does not linger in discussions about barriers to change
5. Clinician shows a marked and consistent effort to decrease the depth, strength, or momentum
of the client’s language in favor of the status quo.
Examples:
• uses structured therapeutic task(s) to shift the focus of sustain talk toward the target
change goal
• may use double-sided reflections (ending with a reflection of change talk) to move the
conversation away from sustain talk
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9
Partnership
Low
High
1
2
3
4
5
Clinician actively
assumes the expert
role for the
majority of the
interaction with
the client.
Collaboration or
partnership is
absent.
Clinician
superficially
responds to
opportunities to
collaborate.
Clinician
incorporates
client’s
contributions but
does so in a
lukewarm or
erratic fashion.
Clinician fosters
collaboration and
power sharing so
that client’s
contributions
impact the
session in ways
that they
otherwise would
not.
Clinician actively
fosters and
encourages
power sharing in
the interaction in
such a way that
client’s
contributions
substantially
influence the
nature of the
session.
This scale is intended to measure the extent to which the clinician conveys an understanding that
expertise and wisdom about change reside mostly within the client. Clinicians high on this scale
behave as if the interview is occurring between two equal partners, both of whom have
knowledge that might be useful in solving the change under consideration. Clinicians low on the
scale assume the expert role for a majority of the interaction and have a high degree of influence
in the nature of the interaction.
Verbal Anchors
1. Clinician actively assumes the expert role for the majority of the interaction with the client.
Collaboration or partnership is absent.
Examples:
• Explicitly takes the expert role by defining the problem, prescribing the goals, or laying
out the plan of action
• Clinician actively forces a particular agenda for the majority of the interaction with the
client
• Denies or minimizes client ideas
• Dominates conversation
• Argues when client offers alternative approach
• Often exhibits the righting reflex
2. Clinician superficially responds to opportunities to collaborate.
Examples:
• Clinician rarely surrenders the expert role
• Minimal or superficial querying of client input
• Often sacrifices opportunities for mutual problem solving in favor of supplying knowledge
or expertise
• Minimal or superficial responses to client’s potential agenda items, knowledge, idea, and
/or concerns
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•
10
Occasionally may correct the client or refutes what the client has said
3. Clinician incorporates client’s contributions but does so in a lukewarm or erratic fashion.
Examples:
• May take advantage of opportunities to collaborate, but does not structure interaction to
solicit this
• Misses some opportunities to collaborate when initiated by the client
• The righting reflex is largely absent
• Sacrifices some opportunities for mutual problem solving in favor of supplying knowledge
or advice
• Seems to be in a stand-off with the client; not wrestling and not dancing
4. Clinician fosters collaboration and power sharing so that client’s contributions impact the
session in ways that they otherwise would not.
Examples:
• Some structuring of session to ensure client input
• Searches for agreement on problem definition, agenda setting, and goal setting
• Solicits client views in more than a perfunctory fashion
• Engages client in problem solving or brainstorming
• Does not attempt to educate or direct if client “pushes back” with sustain talk
• Does not insist on resolution unless client is ready
5. Clinician actively fosters and encourages power sharing in the interaction in such a way that
client’s contributions substantially influence the nature of the session.
Examples:
• Genuinely negotiates the agenda and goals for the session
• Indicates curiosity about client ideas through querying and listening
• Facilitates client evaluation of options and planning
• Explicitly identifies client as the expert and decision maker
• Tempers advice giving and expertise depending on client input
• Clinician favors discussion of client’s strengths and resources rather than probing for
deficits
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Empathy
Low
High
1
2
3
4
5
Clinician gives little
or no attention to
the client’s
perspective.
Clinician makes
sporadic efforts to
explore the client’s
perspective.
Clinician’s
understanding may
be inaccurate or may
detract from the
client’s true meaning.
Clinician is actively
trying to
understand the
client’s perspective,
with modest
success.
Clinician makes
active and repeated
efforts to understand
the client’s point of
view. Shows evidence
of accurate
understanding of the
client’s worldview,
although mostly
limited to explicit
content.
Clinician shows
evidence of deep
understanding of
client’s point of view,
not just for what has
been explicitly stated
but what the client
means but has not
yet said.
This scale measures the extent to which the clinician understands or makes an effort to grasp the
client’s perspective and experience (i.e., how much the clinician attempts to “try on” what the
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