Learning to Manage Resistance and Ambivalence: Can Deliberate Practice Training Reduce the Influence of Differences in Pretraining Empathic Skill?

Motivational Interviewing (MI) is an evidence-based approach for appropriately responding to client expressions of resistance to, and ambivalence about, change. Existing MI training programs typically produce only modest improvements to observer-rated MI skill; improvements that quickly erode without post-training enrichments and which are largest for therapists with high pretraining empathic skill. This study examines whether the relationship between baseline therapist empathy and sustained MI skill is moderated by training type: a deliberate practice (DP) workshop, versus a traditional workshop with fewer opportunities for practice and feedback. Data were derived from an MI training study in which these workshops were delivered to 88 randomly assigned therapists (44 per group). Before training, therapists completed measures of general empathy (across client contexts) and responsive empathy (for the specific context of resistance). At 4-month follow-up, therapists completed test interviews with ambivalent individuals to assess three observer-rated training outcomes: level of resistance, errors in responsivity to ambivalence, and appropriate responsivity to ambivalence. Workshop type was a significant moderator of only the relationships between baseline responsive empathy and follow-up outcomes of resistance and responsivity errors. While higher levels of baseline responsive empathy were associated with better outcomes for the traditional training group (less resistance, fewer errors), DP-trained therapists achieved superior outcomes regardless of their initial level of responsive empathy. Results suggest that DP training may lessen the importance of possessing strong pretraining responsive empathy skills. This research has implications for facilitating dissemination of MI through clarifying which training procedures are most effective for which therapists.