| Although numerous studies have demonstrated the efficacy of motivational interviewing (MI)-based interventions, very few studies have examined the processes postulated to contribute to positive outcomes. The present study examined MI counseling sessions conducted within a group-randomized comparison-controlled trial for smoking cessation among 43 public housing residents (72% female; mean age = 47.9). MI-consistent therapist behaviors and subjective global ratings of "MI spirit" were examined as predictors of within-session observer-rated working alliance and client engagement. ANOVA analyses indicated the MI spirit index (average of the global ratings of collaboration, egalitarianism, and empathy) was a significant predictor of alliance and engagement, accounting for 44% and 45% of the variability respectively. Additionally, three covariates (treatment condition, session sequence, and counselor practice effect) were significant in the alliance and MI spirit model, while two (session sequence and counselor practice) were significant in the engagement and MI spirit model. Confrontation was significantly and negatively related to alliance whereas the association between confrontation and engagement was negative and approached significance (p = .13). Small to moderate effect sizes were found for affirming, asking open-ended questions, confronting, reflecting, and summarizing. Results provided evidence that MI spirit index and confrontation significantly relate to important within-session outcomes. Consistent with Miller and Rollnick's (2002) emphasis on the "MI spirit," results indicated this variable accounts for a large portion of alliance and engagement. In addition, any tears or ruptures in the alliance through the use of confrontation could significantly relate to poor treatment outcomes. |
