Abstract Overview The Client Language Assessment – Proximal/Distal (CLA-PD) is a language rating system for measuring client decision-making in interventions that target a specified behavior change ...(e.g., alcohol or other drug use). In the CLA-PD, there are five dimensions of change language (Reason, Ability, Commitment, Taking Steps, Other) adapted from the client portion of the Motivational Interviewing Skill Code (MISC). For the CLA-PD, language codes are sub-divided to discriminate statements regarding the primary, or target behavior change ( distal change ) from the intermediate coping activities ( proximal change ) that are prescribed to facilitate that target behavior change. The goal of the CLA-PD is to allow for higher specificity than existing client language measures, when process studies consider interventions that are multi-session and skill-based (e.g., cognitive behavioral therapy). Method Three raters received 40 hours of training on the use of the CLA-PD. The data were a sample of therapy session audio-files from a completed clinical trial ( N = 126), which enabled examination of client language across four sessions (i.e., first three and final attended) of three evidence-based alcohol interventions (cognitive behavioral therapy, twelve-step facilitation therapy, motivational enhancement therapy). Results Inter-rater reliability results for summary scores showed “excellent” reliability for the measure. Specifically, two-way mixed intraclass coefficients ranged from .83 to .95. Internal consistency reliability showed alphas across sessions that ranged from “fair” to “good” (α = .74–.84). In convergent and discriminant validity analyses using data independently measured with MISC-based ratings, the pattern of results was as would be expected. Specifically, convergent correlations, by valence (i.e., change and sustain talk), between CLA-PD Distal and MISC-based language scores were moderate ( r = .46–.55, p < .001) while discriminant correlations by valence for CLA-PD Proximal and MISC-based language scores were small ( r = .22–.24, p < .05). Finally, proportion Change Talk Proximal predicted subsequent session coping behaviors (i.e., processes of change) as well as 3-month Alcoholics Anonymous involvement and attendance ( p s < .05–.005), but not 3-month alcohol abstinence self-efficacy. Further, analyses of criterion predictive validity showed that proportion Change Talk Distal predicted 3- and 12-month drinking frequency and quantity measures ( p s < .05–.005). Conclusions When behavior change treatments are multi-session and/or skill-based, the present analyses suggest the CLA-PD is a promising, psychometrically sound observational rating measure of client verbalized decision-making.
Abstract Background The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences ...compared to other racial/ethnic groups.
Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment.
However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult. Objective The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI. Methods and design CAMI2, a large, 12 month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community ( n = 257).
Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences).
A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition. Summary The CAMI2 study design protocol is presented and the theory of adaptation is presented.
Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.
The importance of conducting empirical research for the future of psychodynamics is presented in this excellent new volume. In Handbook of Evidence Based Psychodynamic Psychotherapy: Bridging the Gap ...Between Science and Practice, the editors provide evidence that supports this type of research for two primary reasons. The first reason concerns the current marginalization of psychodynamic work within the mental health field. Sound empirical research has the potential to affirm the important role that psychodynamic theory and treatment have in modern psychiatry and psychology. The second reason that research is crucial to the future of psychodynamic work concerns the role that systematic empirical investigations can have in developing and refining effective approaches to a variety of clinical problems. Empirical research functions as a check on subjectivity and theoretical alliances in on-going attempts to determine the approaches most helpful in working with patients clinically. Handbook of Evidence Based Psychodynamic Psychotherapy: Bridging the Gap Between Science and Practice brings together a panel of distinguished clinician-researchers who have been publishing their findings for decades. This important new book provides compelling evidence that psychodynamic psychotherapy is an effective treatment for many common psychological problems.
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