An investigation into the quality of the motivational interviewing in the UKATT study using the Motivational Interviewing Treatment Integrity (MITI) scale

First published: 10 May 2019 | Last updated: 20 May 2019

Background:  Motivational interviewing is an established method of helping clients with alcohol problems explore and resolve their ambivalence and enhance their own reasons for change.  The nature of motivational interviewing, with the emphasis on the spirit of the method, does cause difficulty in making reliable measures of the therapy’s quality.  A new rating scale called the Motivational Interviewing Treatment Integrity (MITI) scale was designed to be a shorter but still reliable scale for measuring the quality of the therapy.   The United Kingdom Alcohol Treatment Trial (UKATT) found substantial reductions in alcohol consumption with motivational enhancement therapy (MET).  Internal validation of the quality of the MET was done by the UKATT team.

Aims:  To discover the quality of the motivational interviewing in the UKATT trial as measured by the MITI.

Method:  Thirty videos of therapists performing MET in the UKATT were selected stratifying for location.  Results were compared against recommended proficiency scores.  Analysis was also made of differences between the three geographical locations in which the UKATT was carried out.

Results:  The global behaviour scores achieved mean results around the competency thresholds.  Three of the four specific behaviour count summary scores however fell short of the competency thresholds.  Some differences were seen across geographical regions concerning the global score of Direction, the number of complex reflections used and the number of therapists who scored at or above the competency thresholds.

Conclusions:  The quality of motivational interviewing in the UKATT trial appears to be adequate, with global scores around the expert set competency thresholds, although questions remain about the low scores achieved on some specific behaviour counts.   The results will become less tentative when the MITI’s authors publish normative data for the scale.


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Dr Roger Lakin