Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.

The effectiveness of drug abuse treatment for clients coerced into care remains controversial. Some studies find clients with legal pressure do better than those without legal pressure, while others report the exact opposite. Opposing views are often fueled by the wide-ranging models that guide delivery of addiction treatment. The present study examined how participants with and without legal pressure to attend treatment responded to a motivational (MET) vs. traditional (TAU) form of addiction treatment. Additionally, the predictive value of the Readiness to Change (RTC) score, from the URICA, was assessed across days of substance use and treatment retention. Legal status was shown to have a significant effect on days of primary substance use per week and treatment retention, regardless of intervention condition. The RTC score was shown not to be predictive of days of primary substance use or treatment retention. Research and clinical implications and future directions are discussed.

Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.

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