The Causes of Change and No-Change in Substance Users’ Talk During Motivational Interviewing in the Probation Service in Finland

Abstract

This article explores the beliefs regarding the causes of change and no-change of substance-using clients during motivational interviewing (MI) sessions in probation service context. The analyses are based on videotaped and transcribed data consisting of 98 MI sessions in 12 probation service offices in Finland from 2007 to 2009. The analysis relies on coding of client’s change-related talk utterances and qualitative semiotic framework. The results show that the clients attributed various causes to change and no-change. It seems that the sociocultural, psychological, biological, and contextual causes play an important role in substance users’ change talk and motivation to change. It is suggested that aspects of the social and contextual factors should not be overlooked in MI and other substance use treatment.

Keywords

causal attributions substance use change motivational interviewing probation service

Introduction

Motivational interviewing (MI) has become a well-recognized and widespread approach to counseling since its introduction by William R. Miller in 1983 (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010; Miller, 1983). This approach and conversation style has been defined as a collaborative, person-centered, and goal-oriented style of communication. It is designed to strengthen personal and intrinsic motivation to specific goal by exploring and eliciting the person’s own reasons for change with particular attention to the language of change. The spirit of MI emphasizes the client–counselor partnership and the idea that the client inherently has what is needed to make changes in their lives (Miller & Rollnick, 2013).

MI has strong empirical evidence for its efficacy, and it is one of the leading evidence-based methods for helping people with substance abuse and other behavioral problems (Burke, Arkowitz, & Menchola, 2003; Hettema, Steele, & Miller, 2005; Project MATCH Research Group, 1998; UK Alcohol Treatment Trial Research Team, 2005). However, the results of the studies give rise to new questions about “what works” in MI. The links between MI’s processes and outcomes are not yet fully understood (Apodaca & Longabaugh, 2009; Burke et al., 2003; Lundahl et al., 2010; Miller & Rose, 2009). In recent years, several studies have focused on the client’s language as a predictor of the MI outcome. These studies have demonstrated that MI increases client’s “change talk”—talk that indicates the recognition of a reason, need, ability, desire, commitment, or taking a step to change—and positive change talk predicts better outcomes, whereas negative change talk—language against change—predicts poorer outcomes after MI (Amrhein, Miller, Yahne, Palmer, & Fulcher, 2003; Bertholet, Faouzi, Gmel, Gaume, & Daeppen, 2010; Campbell, Adamson, & Carter, 2010; Gaume, Gmel, & Daeppen, 2008; Moyers et al., 2007; Walker, Stephens, Rowland, & Roffman, 2011). Therefore, it seems that the client’s language during sessions is an important predictor of the outcome following MI.

Although several studies have focused on the client’s change talk, there is a paucity of qualitative research investigating aspects of the client’s language during MI sessions (but see Sarpavaara, 2010, 2013, 2014a, 2014b, 2015; Sarpavaara & Koski-Jännes, 2013). The aim of this study is to provide new insights into client’s talk to expand the current understanding about the significance of the change talk during MI. In particular, the present study explores substance-using clients’ talk about the factors that they believe have facilitated or hindered their change during MI sessions in Probation Service. Much research has been carried out focusing on the individual and social factors of change in substance use status (e.g., Adamson, Sellman, & Frampton, 2009; Hunter-Reel, McCrady, & Hildebrandt, 2009; Orford et al., 2006; Orford, Hodgson, Copello, Wilton, & Slegg, 2009), and the psychological, sociocultural, and biological factors of substance use (e.g., Abadinsky, 2007; Fergusson, Horwood, & Ridder, 2007; Rudgley, 1998; Sadock, Sadock, & Kaplan, 2007; Tarter & Vanyukov, 2001; Wynn, Karlsen, Lorntzsen, Bjerke, & Bergvik, 2009). Less work has been carried out in exploring the beliefs regarding the causes of change and no-change of substance-using clients during MI treatment. Knowledge about substance users’ change-related causal attributions may improve mutual understanding and interaction between the client and counselor during treatment sessions and also possibly allow for better outcome of the treatment. Two research questions guide the analyses:

Research Question 1: To what causes do the substance-using clients themselves attribute positive change during MI sessions?

Research Question 2: To what causes do the clients attribute no-change in their substance use during MI sessions?

Method

Study Setting and Data Collection

The data for this study were collected during the counseling sessions of the Finnish Probation Service. The Probation Service is a part of the criminal sanctions system of Finland. It is in charge of the enforcement of community sanctions and other activities related to sanctions served outside imprisonment. Community sanctions consist of the supervision of conditionally sentenced young offenders, juvenile punishment, community service, and the supervision of parolees. In community sanction work, particular attention is paid to evaluating substance use problems and in increasing the use of programs for substance users.

In 2007, a Swedish MI-based program called Beteende–Samtal–Förändring (BSF [Behavior–Interviewing–Change]) developed specifically for the needs of the Probation Service was also introduced in the Finnish Probation Service. The BSF program is a structured adaptation of MI where the employees of the Probation Service are expected to use MI techniques to motivate clients to change their behaviors with regard to offending and substance use. The employee acts as a counselor who helps clients to enhance their intrinsic motivation to change by working in a client-centered but directive manner. The BSF program is a semistructured five-session MI-based intervention focusing on drug use and criminal behavior. During sessions, the client is encouraged to elicit change talk and to discover his or her personal strengths. The client is also encouraged to examine different stages of change, to see the positive side of change, to explore the discrepancies between his or her values and current behavior, and to map his or her social network (Farbring & Berge, 2006; Farbring & Johnson, 2008).

Even though the criminal justice context is perhaps not an ideal environment for MI due to its oppressive, directive, and autonomy-limiting features (Ashton, 2005), the BSF program is designed to be as open as possible for client autonomy. In the current study, the clients were under probation, but they were volunteers in this particular MI program. The counselors were not required to report to legal authorities of any possible drug use revealed by the client.

The analyses presented here are based on viewing 98 videotaped BSF sessions and studying the transcripts of these sessions. This database involves the first two counseling sessions of 49 client–counselor pairs. These initial sessions were chosen because previous research (Horvath & Greenberg, 1994) has shown that the key moments for bonding with treatment are often restricted to the very first sessions. What happens in that time frame is decisive for what follows. The sessions were approximately 1 hr long and were conducted in urban settings in Finland. They were videotaped in 12 probation services offices between 2007 and 2009.

The approval for the study was obtained from the Finnish Criminal Sanctions Agency, and informed written consent was obtained from all participating clients and MI counselors. The participants were volunteers, and they were not provided any incentives for their participation. All clients who participated in this study had either an alcohol or a drug use problem. Their problematic substance use was the main reason why they were in the BSF program. All counselors were trained to use BSF and MI techniques to motivate the clients of the Probation Service to change.

Sample

In this article, the focus is on the analysis of clients’ talk about the causes of change and no-change. It is concentrated on the 47 substance-using clients (out of 49) whose change talk utterances concern the factors of change and/or no-change. The data from the 47 clients were elicited in both of the videotaped sessions. Thus, the data source is 94 one-hour-long sessions. The average age of these clients was 35 years (SD = 11.3 years, range = 19-62 years), and they were predominantly male (44, 94%).

Analysis

The procedure used to analyze the data involved several steps. The first one consisted of identifying the client’s goal with regard to their use of alcohol and drugs (e.g., to quit or cut down the use of alcohol, cannabis, or other drugs). Identifying the goal was fairly easy because it was usually discussed at the beginning of the videotaped sessions. The second step was to search for sequences that are central from the point of view of this goal.

The third step was to code the client’s change-related talk in these central sequences. The author was trained on coding clients’ change talk in two workshops given by professor Paul Amrhein (Columbia University) who has developed the change talk coding system, in the spring of 2008 and 2009. It has also consulted with Dr. Theresa Moyers (University of New Mexico) on issues concerning MI sessions coding. Also, Dr. Carl Åke Farbring who has developed the BSF program has provided some advice. Two commonly used coding manuals (Amrhein, 2007; Miller, Moyers, Ernst, & Amrhein, 2008) were relied on for coding this change talk. After some experimentation with the data, the core ideas of these manuals were combined by focusing on the following categories of client’s change talk utterances:

Problem recognition: The client shows that he or she is aware or unaware of the problem, or that he or she considers or does not consider the problem.

Reasons: The client states a particular motive, rationale, basis, or incentive to change or not to change.

Need: The client indicates a necessity, urgency, or requirement to change or not to change.

Desire: The client indicates wanting, wishing, and willing to change or not to change.

Ability: The client indicates his or her personal perceptions of capability or incapability of change.

Commitment: The client implies an agreement, intention, or obligation to change or not to change.

Taking steps: The client states that he or she has taken specific behavioral steps toward or away from change in the recent past.

There were both positive and negative change talks. In positive change talk utterances, the client moves toward his or her goal, whereas in negative change talk (sustain talk) utterances, he or she talks about his or her intention to maintain the status quo.

The fourth step was to identify all the causal attributions from the sequences of the client’s change talk. A main focus of the analysis was to explore the factors that substance-using clients believe have facilitated or hindered their change. Thus, as the fifth step, only the clients’ causal attributions with regard to substance use and change or no-change were chosen to analyze.

The data were subjected to an analysis inspired by semiotic theory. This study is part of the ongoing research project, which was launched with an aim to apply Charles S. Peirce’s theory of signs. The basic idea of the project is to map the semiotic features of MI sessions that appear to predict clients’ willingness to change their addictive behaviors. According to Peirce, the action of signs (semiosis) is a triadic process whose components include sign, object, and interpretant. Any sign is in a triadic relation with an object and an interpretant. The first division focuses on the sign as such. Peirce calls this division into qualisigns, sinsigns, and legisigns. The second division focuses the reference of signs to objects. Peirce calls this division into icons, indexes, and symbols. The third division focuses on the interpretation of signs and on the effects of signs on interpreters. Peirce calls this division into rhemes, dicents, and arguments (Liszka, 1996; Peirce, 1965; Short, 2007).

The second division of signs is relevant from the viewpoint of this study because it concerns the sign’s relation to its object. Icons refer to their object by means of similarity (e.g., an image, a diagram, or a metaphor); indexes refer by means of contiguity, causality, or by some other actual connection (e.g., smoke as the sign for fire); and symbols refer by means of a habit, convention, disposition, or law (e.g., words and numbers; Liszka, 1996; Peirce, 1965; Short, 2007). In this article, by applying Peirce’s theory, it is concentrated on the causal relations between signs and their object: The client’s utterance about causal attributions of change and no-change was explored as an indexical sign. So, as the sixth step, it was investigated change and no-change as an effect or object, and analyzed what kind of causes (indexical signs) the clients attribute to change and no-change.

Results

In all, there were 47 clients (out of a total of 49 clients) who mentioned the specific causes of their change (27 clients) or no-change (41 clients). The situations in which the clients talked about these factors varied from session to session. In some sessions, the topic was raised by the counselors and in others, by the clients.

In by far the majority of cases, the client’s utterance about the causes of change occurs in the change talk categories reasons, desire, ability, and taking steps. In other words, the clients usually talked about the causes of change when they stated a particular motive, rationale, basis, or incentive to change (14 clients); when they indicated wanting, wishing, and willing to change (9 clients); when they indicated their personal perceptions of capability of change (9 clients); or when they stated that they have taken specific behavioral steps toward change (11 clients).

In most cases, the client’s utterance about the causes of no-change occurs in the change talk categories problem recognition, reasons, and ability. Thus, the clients usually talked about the causes of no-change when they showed that they were aware of the problem (17 clients) or when they stated a particular motive, rationale, basis, or incentive to not change (13 clients) or when they indicated their personal perceptions of incapability of change (19 clients).

On the basis of the semiotic analysis of the clients’ change talk utterances, it seems that the clients attributed various causes to change or no-change. An examination of these indexical signs with illustrative examples from the data corpus is presented in the following sections. The quotations are translated from original Finnish data. The translations are as exact as possible, but the sentence structure of the spoken language has been edited to a more comprehensible form. It should be noted that Finnish-speaking addiction clients often use the “zero-person construction” (similar to the passive tense in English; for example, “There’s always a risk that one starts to drink”) instead of the more active first-person language when talking about themselves. In this construction, there is no stated subject or object, or agent (Halonen, 2008).

The Causal Attributions of Change

The factors that the clients believe have facilitated their change can be divided into five categories of causes:

Significant others (16 clients)

Personal properties (15 clients)

Bodily health (5 clients)

Job and study (3 clients)

Religion (2 clients)

The clients frequently mentioned family members and friends as the indexical signs of change. These significant others were seen as an important social cause of positive substance use change. In these cases, spouses, parents, children, other relatives, and friends appear as significant and supporting factors in the resolution of substance use problems. The forms of family and friend support vary between clients. The support encourages the change but is also controlling, thereby preventing and restricting the substance use. Extract (1) shows a case where a client with a goal of reducing his cannabis use reflects on his addiction in response to a counselor’s request. The client brings up the role of his parents. In the client’s change talk, they appear as the cause of reducing drug use. In certain situations, the parents make him restrict the use of cannabis. The client gained support from the parents by their placing strict limits on cannabis use during visits to their home. In a Peircean sense, the parents are indexical signs that refer to reducing substance use as an effect.

(1) Yes, I think that I am dependent on cannabis, even though there are no withdrawal symptoms from it. However, I am dependent on cannabis in such a way that it is really difficult to refuse when it is offered. But there have also been situations in which I have been able to refuse it. My parents have banned me visiting them when I’ve been smoking. If you have been offered cannabis when you have been about to go to your parents’ house, you are able to say “no.” So, I am still able to refuse to smoke. Perhaps I’m not totally addicted [to cannabis]. (Client 1, age 25, male, change talk category: ability to change)

Several of the clients reported that intrinsic personal properties, such as the strength of mind, willpower, decision, intrinsic motivation, desire, and the ability for hard mental work, are factors that they believe have enabled their positive change. Extract (2) involves the client with a goal of maintaining abstinence. In the session, the counselor has raised the question about the supporting factors of this goal (“What are the personal factors that make you believe in yourself?”). The client’s response indicates that she thinks that her own decision, her own motivation and desire, and her willpower are the highly significant causes of her abstinence.

(2) Well, at least my obstinacy is one. When I decide something, I will do it . . . motivation to stay sober comes from your own head. It does not help if other people want me to stay sober. It does not keep me sober. (Client 18, age 22, female, change talk categories: ability to change, desire to change)

The clients quite frequently mentioned the importance of bodily health as a factor in the positive change of substance use behavior. In these cases, the clients reported that anxiety for their health and worries about their body are a cause of change. In other words, worry about bodily health is a sign that refers to reducing or cutting down substance use as an effect in the clients’ talk. Extract (3) is taken from a session with a client with a reduced drinking goal. The client has told that he has used drugs in the past but does not now. In the extract, he talks about his experiences with substance use. Here, health seems to be a particular cause of change.

(3) It [using drugs] causes you bad health, and possible, leads to withdrawal symptoms. I have experienced them also . . . it does not do any good . . . I have seen how much damage the drugs are doing. I have experienced it myself. [The use of drugs] changes a person—you are not yourself. It affects your mental health and your health in general. There is a risk of developing many serious infectious diseases . . . well, my health should be better . . . I know how much alcohol can damage your liver. Therefore, I reduced the drinking, but still I think that I drink too much . . . It makes me sick. (Client 48, age 29, male, change talk categories: problem recognition, reason to change, taking steps)

Some clients talked about their working and studying life situation. These clients reported that unemployment and inactivity are a reason to drink or use drugs. If they got a job or study place, they could reduce the use of alcohol and other drugs. In these cases, a job and study place is an indexical sign that refers to reducing substance use as an effect. Examples of this kind of change talk appear in Extract (4). In the extract, a client with a goal of reducing his drinking brings up the significance of unemployment in the changing of his drinking habits. The finding of a job seems to be important factor that would help the client succeed in reaching his goal.

(4) This situation in life should be repaired. You should get a job or study. You drink a couple of times a week. It is precisely because there is nothing to do. That’s why you drink. You wouldn’t drink if you had something to do. You wouldn’t drink if you had a job. (Client 6, age 39, male, change talk category: reason not to change)

Religion was also suggested as a factor that facilitated change. It was discussed how religion and faith can play an important part in the resolution of substance use problems. In Extract (5), the client with a goal of maintaining abstinence brings up the significance of her faith as a facilitator of change.

(5) Faith gives me the strength. Faith fills the vacuum that left when drug use is terminated. It gives strength to live without drugs . . . to become a believer was the good decision. I decided to follow Jesus, I decided to change my life . . . when I was in prison, there were my enemies. When they began to threaten me, I was afraid to die. I was afraid that I might be killed in the prison. I knew that I couldn’t get to heaven without faith. It was the starting point. I wanted to get to heaven. (Client 18, age 22, female, change talk categories: ability to change, commitment to change, reason to change)

The Causal Attributions of No-Change

The factors of no-change/status quo in clients’ change talk utterances can be divided into five categories of causes:

Cultural causes (19 clients)

Significant others (15 clients)

Personal properties (14 clients)

Working life (11 clients)

Lifestyle (8 clients)

The importance of alcohol and drug culture as a factor in the substance abuse was frequently mentioned by the clients. In these mentions, weekends, party culture, holidays, and summertime appeared as important factors. In particular, the weekend was seen as a significant cultural factor in the substance use. In these change talk utterances, weekend is strongly connected with the use of alcohol. It could be seen that this is reflection of Finnish and even wider substance use culture, in which particularly alcohol is mostly consumed on the weekends (Allamani, Hope, Burne, Room, & the ECAS Research Team, 2002; Heath, 2000; Mustonen, Metso, & Mäkelä, 2010; National Research and Development Centre for Welfare and Health, 2001). Extract (6) is taken from a MI session between a counselor (CO) and a client (CL) with a reduced drinking goal. During the session, the counselor and the client have discussed the client’s ability to reach his goal. The counselor brings up the topic of weekend and asks the client to tell about his experiences. We can see that the client doubts his ability to reach his goal of reducing drinking. This doubt is related to the experienced need to drink, and it appears when the client talks about weekend.

(6) CO: Does it depend on the day . . . whether it is weekend or not . . . Are there some days when you feel like it [reducing drinking] can succeed? On the other hand, are there . . .

CL: Yeah, that’s the way it really is. There’s an internal clock for the weekend. It can truly be noticed.

CO: Quite so. So, the risk that you suddenly find yourself standing next to the beer shelves in a supermarket, that risk always increases before weekend.

CL: Well, yeah, yes.

(Client 20, age 42, male, change talk category: incapability to change)

Significant others were often seen as a significant social cause of substance use by the clients. In particular, friends and family members are connected with substance use. In these cases, significant others appear as an obstacle or a threat to change. An example of an obstacle to change–type change talk appears in Extract (7). It involves a client with a goal of reducing his drinking. He says that he has taken steps toward change, but the external setting is not ideal from the point of view of reaching the goal. It is difficult for the client to reduce his drinking because his circle of acquaintances drinks plenty of alcohol. The family’s drinking habits, particularly those of the father and uncle, expose the client to the risk of a relapse. In this case, the family seems to be a cause of drinking even if the client also gets support from his father.

(7) Although progress has been achieved, the drinking problem is not completely gone . . . sometimes [I] also drink too much because there is drinking in my social circle. It seems that my uncle also has quite a serious drinking problem. My father has some kind of drinking problem but we have helped each other. But sometimes we have relapsed together too. (Client 48, age 29, male, change talk categories: taking steps toward change, incapability to change)

Several of the clients reported that personal properties such as suggestibility, obstinacy, asociality, self-indulgence, and lack of self-control, social tools, and problem-solving skills are a cause of their substance use. Extract (8) shows a case where a client with a goal of reducing her drinking brings up the significance of her obstinacy. This obstinacy seems to be an important cause that threatens the goal. Because of this personal aspect, it is difficult for the client to change her drinking habits.

(8) If I decide that I want to drink, nobody can prevent me. I will go even through the wall. No one can stop me. I am so stubborn that no one can change my mind. (Client 22, age 52, female, change talk category: problem recognition)

A number of clients talked about their working life situation. In these cases, unemployment and pressures in working life appear as a cause of substance use. Examples of a change talk where unemployment as an indexical sign stands for substance use as an effect appear in Extract (9) and also in Extract (4). In Extract (9), the goal of the client is to quit using drugs. He mentions idleness and unemployment as the main causes of his drug use.

(9) There are those days when you feel really bored. Today, for example, was such a risk of relapse. . . . Now there is a feeling that you need to get to work or something. . . . [I] have awakened a desire to get to work. In the past when I have been bored, I used drugs. But, now I have started to think about alternatives [to drug use]. I want to go to work, get money and do something else [than to use drugs to manage boredom]. (Client 12, age 42, male, change talk categories: problem recognition, desire to change)

Lifestyle was also mentioned by quite several of the clients as a cause of no-change. It was discussed how habits and routines can play an important part in life and substance use. In these cases, lifestyle, habits, and routines appear as the cause of substance use. In Extracts (10) and (11), the clients doubt their ability to reach the goal of reducing their use of alcohol or amphetamine. In a Peircean sense, these change talk utterances about lifestyle are indexical signs that refer to substance use as an effect.

(10) Drinking is a familiar way of life to you. It is surely not easy to give it up. (Client 2, age 27, male, change talk category: incapability to change)

(11) So [I] have a desire for change, but on the other hand, it [the use of amphetamine] has been a way of life for so long. (Client 28, age 34, male, change talk category: incapability to change)

Conclusion and Discussion

This qualitative study of the causes of change and no-change finds that the substance-using clients attributed various causes to the change and no-change during MI sessions in the Probation Service. By applying Peirce’s semiotic theory of signs, it was explored the clients’ utterances about these causal attributions as the indexical signs. The analysis showed that these indexical signs were divided into the categories, which defined the cause of positive change as follows: significant others, personal properties, bodily health, job and study, and religion; and the cause of no-change as follows: cultural factors, significant others, personal properties, working life, and lifestyle.

The client usually talked about specific causes of positive substance use change when they stated a particular motive to change, when they indicated willingness to change or the personal perceptions of capability of change, or when they told that they have taken steps toward change. The client commonly uttered about the causes of no-change when they showed that they were aware of their substance use problem or when they stated a particular motive to not change, or when they indicated their personal perceptions of incapability of change in their change talk utterances during MI sessions.

It seems that beliefs about the causes of change and no-change played an important role in the clients’ motivation to change. The causal attributions about positive change and status quo are important with regard to how the change and substance use are understood and handled by clients. The findings show that the clients believed that a range of different factors facilitates their change. There was also variety in the causes of no-change. The results of the analysis show that the sociocultural, psychological, biological, and contextual causes seem to be important factors that can contribute to or hinder change. This raises a question about one of the basic premises of MI. In the theory of MI, the significance of personal and intrinsic motivation is emphasized (Miller & Rollnick, 2013), but is it enough that we focus on enhancing intrinsic motivation? In the light of this study, the client’s belief about his or her personal properties and intrinsic factors is important, but the role of contextual factors is often at least as crucial. If, in the substance use treatment, it is too strongly emphasized that motivation is an issue that relates to the client’s internal world and to his or her personal responsibility for behavior change, then the significance of sociocultural factors will receive too little attention (see also Sarpavaara, 2014a, 2014b; Stanton, 2010). Therefore, the focus on internal motivation should not neglect external factors. Rather, internal motivation should be interpreted as an invitation for the client to consider the meaning and value of external factors to the client’s goals in life.

Thus, it is suggested that aspects of the social and contextual factors should not be overlooked during MI and other substance use treatment. The beliefs about the external causes of change and no-change are one factor among others that contributes to substance-using clients’ motivation to change. Moreover, recent studies have shown that there is a link between external factors such as supporting social networks and outcomes of substance use treatment (Ellis, Bernichon, Yu, Roberts, & Herrell, 2004; Hunter-Reel et al., 2009; Longabaugh, Wirtz, Zywiak, & O’Malley, 2010; Sarpavaara, 2014b). In addition, the findings of this study show that it is important to assess the client’s beliefs regarding both the internal and external causes of change and no-change to estimate how these causal attributions might be supportive or not in achieving treatment goals. However, further research is needed to examine a possible relationship between causal attributions, motivation, treatment strategy, and outcome.

This study provided new insight into substance-using clients’ change talk during MI sessions. The findings demonstrate that by analyzing the semiotic aspect of the client’s change talk, we can find the significant features of the client’s talk that relate to his or her motivation to change. Therefore, paying attention to the indexical and other semiotic signs in the analysis of the client’s talk during treatment sessions is recommended. The results of this study suggest that it is not only the forms of the client’s change talk (problem recognition, reasons, need, desire, ability, commitment, and taking steps) that can play an important role in motivation to change but also the personal meanings attached to the client’s utterances (such as the causal attributions of change and no-change). In my previous articles, I have tried to demonstrate the same by analyzing the role of metaphors, friends, family, and counselors’ interpretation in interaction between clients and counselors during substance use treatment (Sarpavaara, 2010, 2013, 2014a, 2014b; Sarpavaara & Koski-Jännes, 2013).

This study has some limitations. The study is a qualitative exploratory attempt to apply a semiotic approach to the analysis of client’s change talk utterances during MI sessions. It is also possible that other events in those sessions are more decisive for the outcome. Thus, the results are tentative but do highlight the significance of the clients’ causal attributions for motivation. This study, as with qualitative study in general, seeks in-depth information from relatively small sample size to clarify the meanings that people attach to their lives and the world (Rhodes & Coomber, 2010). The value of this study is not, therefore, in its quantitative substantiation, but rather in bringing forth a potentially important new perspective on the focus and methods of exploring the significant features in the client’s change talk not only in MI interventions, but also, more generally, in any motivational intervention with substance users. It is believed that the findings of this study would benefit from further development of the professional theories and practices of motivational interaction in probation services and in other institutional contexts.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Academy of Finland (Grant 118424, 250125504623, 25012561453) and the Finnish Criminal Sanctions Agency (Grant 21126).

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