Beyond Change Talk... Looking at the role of language in MI

1. Beyond Change Talk... Looking at the role of language in MI Claire Lane, PhD1, 2 Trainee Clinical Psychologist 1University of Birmingham, UK 2Black Country Partnership Foundation Trust, UK

2. Aim of Workshop • To reflect on what we know and don’t know about the use of language in MI • To introduce discourse analysis as an approach for understanding language use • To give an overview of my ClinPsyD research project to date • To understand why looking at language in this way may be useful for trainers, practitioners and researchers

3. Your starter for 10... How much do you know about how language is used in MI?

4. What does the literature tell us? • Studies looking at how language is used • By the client • By the practitioner • The interaction between the two • It’s relationship with outcome • An emphasis on client change talk, client sustain talk and specific practitioner behaviours • Such as OARS, simple and complex reflections, MICO, MIIN Lane, Copello & Rolfe (in preparation)

5. Three questions... • Why do you think the research has gone this direction? • What are the positives of the research as it stands? • What are the negatives?

6. Another way to look at language • Discourse Analysis • A qualitative method of research, concerned with the structure and function of language in different contexts • Potter and Wetherall (1987) • Language as a form of social action • Constructing ‘verbal objects’ through talk • How is the language put together? • What are the effects of putting language together in that way?

7. My study • How do clients and therapists co-construct the process of change in MI sessions? • Alcohol, behaviour, self, relationship, other things • Sample: MET tapes from the UK Alcohol Treatment Trial (UKATT) • Approximately 8-12 sessions • Fair to good quality MET as measured by the UKATT Process Rating Scale (Tober et al., 2008) • Variations in session number & gender

8. Analytic Framework • Georgaca and Avdi (2011) • Level 1: How are phenomena constructed in this talk? • Level 2: How do speakers present their accounts, and what effect does this have? • Level 3: Where do speakers position themselves and others through their talk? • Level 4: To what extent does this talk challenge or maintain dominant institutions, beliefs or practices? • Level 5: What is the impact of adopting a particular position within this talk, or positioning another?

9. Beyond change talk... Let’s have a go at Level 1

10. Desire Ability Reason Need Commitment Language Action Taking Steps Change Talk Sustain Talk Open Questions Reflections Affirmations Summaries

11. How is ‘the self’ of the client constructed in this piece of talk? • Some tips to help you: • Look for instances where the client’s ‘self’ is explicitly or implicitly mentioned • ‘This client is someone who is.....’ • How is the client’s ‘self’ talked about? • Are there any other things/people (outside of this piece of talk) that are talked about in a similar way? • Who is doing the talking?

12. ‘So what?’ Summary • Why might any of this stuff be important for trainers, practitioners and researchers to consider? • Our ‘knowledge and understanding’ of MI is something that is situated. It is heavily influenced by what we know already, and by dominant viewpoints in the field. • There may be important factors at work in MI that we aren’t aware of yet. • This impacts on our practice as trainers, researchers and practitioners in MI.

13. Acknowledgements • Alex Copello and Alison Rolfe (supervisors) • Gillian Tober and Leeds Addiction Unit

14. Any Questions?