Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles

J Consult Clin Psychol. 1993 Jun;61(3):455-61. doi: 10.1037//0022-006x.61.3.455.


To investigate the impact of counselor style, a 2-session motivational checkup was offered to 42 problem drinkers (18 women and 24 men) who were randomly assigned to 3 groups: (a) immediate checkup with directive-confrontational counseling, (b) immediate checkup with client-centered counseling, or (c) delayed checkup (waiting-list control). Overall, the intervention resulted in a 57% reduction in drinking within 6 weeks, which was maintained at 1 year. Clients receiving immediate checkup showed significant reduction in drinking relative to controls. The 2 counseling styles were discriminable on therapist behaviors coded from audiotapes. The directive-confrontational style yielded significantly more resistance from clients, which in turn predicted poorer outcomes at 1 year. Therapist styles did not differ in overall impact on drinking, but a single therapist behavior was predictive (r = .65) of 1-year outcome such that the more the therapist confronted, the more the client drank.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Alcoholism / psychology
  • Alcoholism / rehabilitation*
  • Double-Blind Method
  • Feedback
  • Female
  • Humans
  • Male
  • Motivation*
  • Outcome and Process Assessment, Health Care
  • Patient Compliance / psychology
  • Person-Centered Psychotherapy / methods
  • Psychotherapy / methods*