Use of language is thought to be particularly important when considering an individual’s motivation to change. The present thesis has expanded on existing knowledge of the relation between motivation to change and psychotherapy outcome for individuals with anorexia nervosa. This was accomplished by rating 148 audiotaped psychotherapy sessions with four measures of motivation to change. Data were derived from an existing clinical trial of three types of psychotherapy (Cognitive-Behaviour Therapy, Interpersonal Therapy, and Specialist Supportive Clinical Management). Three sessions were rated for each of the 53 participants who received up to twenty sessions of psychotherapy, early (sessions 1-5, middle (sessions 6-14), and late (sessions 15-20). Participant expressions of motivation to change were analysed across sessions, within sessions (beginning, mid, and end intervals), by change talk type, and therapy type for those with good and poor outcomes. Resistance and readiness to change, positive psychotherapy process, and readiness to recover from anorexia nervosa were also examined. The main findings were significantly more positive change talk expressed in the beginning than mid and end therapy intervals and significantly more negative change talk expressed in the beginning than end therapy interval and in the mid than end interval. When change talk type was examined, a significant difference in the ratio of positive to negative change talk expressed between change talk types was found. Results from other motivation measures indicated that readiness to change was expressed significantly more frequently in the middle and late than early phase of therapy. There were higher levels of positive process in psychotherapy in the late than early phase of therapy, and higher levels in those with good than poor outcomes. There were significantly higher levels of readiness to recover from anorexia nervosa expressed in the middle and late phases of therapy than in the early phase, and higher levels in those with good than poor outcomes. Limitations to these results include a modest sample size, rater biases, and lack of reliability measures. Notwithstanding these limitations, the present study has produced several potentially important findings that merit further investigation.

Motivational Interviewing (MI) is a person-centred and collaborative form of guiding individuals to elicit and strengthen their motivation for change. It has achieved success in the treatment of substance disorders, and has shown promise in several other areas of interest, such as behaviour management in chronic illness. The process through which MI exerts its influence on outcome however, is still in its infancy. This research set out to explore the nature of Type 1 and Type 2 diabetes patients‟ utterances in Motivational Enhancement Therapy (MET) sessions (Change Talk), and the associations between their Change Talk and diabetes outcome (clinically significant change in blood glucose levels). Data for this study was taken from a multiple baseline designed study in a diabetes clinic in Christchurch (Britt, 2008). Nine patients who were referred to the clinic for help with their diabetes self-management were administered MET by Diabetes Nurse Educators (DNEs) which comprised four sessions over a six week period. In the current study participants were divided into those who did (BG Change participants; n = 4) or those who did not (BG No Change participants; n = 5) achieve a clinically significant change in their blood glucose levels (HbA1c) post intervention. All client utterances from the 36 transcripts were coded with the Motivational Interviewing Skills Code, version 2.0 (MISC, 2.0), and data analysed accordingly. This is a unique study in that it investigated both the mean frequency and strength of Change Talk in the different participant sets, as well as their patterns of Change Talk within and across sessions. Trends and directions in data suggest support for parts of the theory of the inner workings of MI. In particular, the BG Change participants uttered stronger Desire Language, a higher frequency of Commitment language, and weaker Ability language than the BG No Change participants. In addition, a general increasing pattern of strength across and within sessions, and frequency across sessions was found for the BG Change participants, while a similar pattern was found for the BG No Change participants regarding strength, but not frequency. The role of Sustain Talk strength and its relationship to the findings is highlighted. Implications of findings, as well as limitations of the current research and suggestions for future areas of research are discussed.

Adolescent obesity has increased exponentially over the past three decades in the United States. In response, behavioral interventions have been developed and implemented to address this epidemic; however, treatment adherence is often suboptimal. Motivational interviewing (MI) is a directive, person centered approach to reducing patient ambivalence about change, which has been shown to increase engagement in obesity interventions. The current study investigated the underlying process of MI by exploring two different, but related pathways that explain how change happens (e.g., the technical and relational hypotheses) in the context of a multidisciplinary obesity intervention with African American adolescent girls (N = 30). Results demonstrated that MI-consistent skills were associated with client “change talk,” or language consistent with their desire, ability, reasons, need, taking steps or commitment to change. Specifically, clinician reflection of client change language and support of client autonomy were especially important for increasing change language. Furthermore, client language related to change was associated with three-month treatment adherence, and increased fruit and vegetable intake. However, the clinician’s ability to embody the MI “spirit” was not related to either client language or three-month treatment adherence. Findings suggest that the technical aspect of MI helps explain this approach's effects on treatment adherence among African American girls with obesity.

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Motivational Interviewing (MI) is a client-centered, directive approach for behavior change. Self-Determination Theory (SDT) is a theory of human motivation and self-determined growth. Both of these social-cognitive theories aim to explain motivation and health behavior change and have generated a lot of research on how to increase human motivation. However, MI lacks a definite theory on mechanisms of behavior change and SDT offers a theory of motivation based on extensive research on human interactions. This paper aims to critically look at facilitators of client motivation for behavior change in-session from a social-cognitive perspective on one hand, and neural correlates related to client behavior change on the other hand. MI and SDT somewhat similarly explain what most importantly determines client motivation for change in-session. However, SDT mainly focus on psychological needs such as fostering client autonomy, and MI focus on the therapeutic alliance and on generating client change talk in-session. Efforts to bridge the two methods aim at generating a clearer definition of motivation in MI, and a better framework of practice in SDT. Studies on neural correlates of behavior change support and challenge elements of both approaches, indicating the importance of autonomy and relatedness for motivating positive behavior change.