Community program therapist adherence and competence in motivational enhancement therapy.

The extent to which clinicians in addiction treatment programs can implement empirically validated therapies with adequate fidelity that can be discriminated from standard counseling has rarely been evaluated. For this study, the authors evaluated the treatment adherence and competence of 35 therapists from five outpatient community programs who delivered either a three-session adaptation of motivational enhancement treatment (MET) or an equivalent number of drug counseling-as-usual sessions to 461 clients participating in National Drug Abuse Treatment Clinical Trials Network (CTN) protocol CTN-0004, “MET (Motivational Enhancement Treatment) to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance Abuse.” MET therapists were carefully prepared to implement MET using a combination of expert-led intensive workshop training followed by program-based clinical supervision. Independent rating of sessions demonstrated that the adherence and competence items were very reliable (mean interclass correlation coefficients for adherence = .89 and competence = .81) and converged to form two a priori defined skill factors conceptually related to motivational interviewing.

Moreover, the factors discriminated between MET therapists and those who delivered drug counseling-as-usual sessions in predicted ways, and were significantly related to in-session change in client motivation and some client treatment outcomes (percent negative drug urine screens). These findings demonstrate the reliability and validity of evaluating motivational interviewing fidelity and suggest that the combination of expert-led workshops followed by program-based clinical supervision may be an effective method for disseminating motivational interviewing in community treatment programs.

Related protocols: CTN-0004