Witkiewitz and her colleagues confirm three things that clinicians know: motivation matters, matching treatment styles to motivational state matters and dependence complicates things.
The experienced clinician recognizes that people who are at different points in reaching a decision to change need different interventions; that discussion of behaviour change interventions with people who have not made a decision to change is likely to elicit resistance, and resistance to change is likely to result in treatment non-adherence.
The disciplined application of motivational interviewing has assisted the experienced clinician to prepare people for decisions about behaviour change which naturally leads on to behaviour change therapies. These clinical observations have been supported by empirical evidence.
Why is it that a rigorously controlled trial such as Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity) has not, to date, supported these things we know? Why, some would ask, does it take the controlled trial approach to research so long to catch up with clinical observation and experience? > > > >
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