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Motivational Interviewing Treatment Integrity (MITI 4.2.1) — Behavior Counts

Theresa B. Moyers, Jennifer K. Manuel, Denise Ernst · 2014

The MITI behavior counts for coding a clinician's utterances in a motivational interviewing session (reflections, questions, MI-consistent and MI-inconsistent behaviors).

MITI 4.2.1 is the standard instrument for rating a clinician's fidelity to Motivational Interviewing. Alongside global scores, it tallies behavior counts — discrete, tally-able clinician utterances such as reflections, questions, affirmations, and MI-consistent or MI-inconsistent moves. These behavior counts are the instance-highlighting targets modelled here.

Each of the nine behaviour counts ships with a curated agent skill. Because the counts are tallies rather than ratings, the severity value records how clearly an utterance exemplifies its code (1 marginal, 2 clear, 3 prototypical) rather than a symptom intensity. Coding targets the clinician's utterances; the client's speech is left to the MISC client-language scale.

The skills operationalise the manual's own hard boundaries — simple versus complex reflection, giving information versus persuading, and persuade versus confront — with contrastive pairs on each line.

Domains (9)

Seeking CollaborationSC

The clinician explicitly attempts to share power or acknowledge the client's expertise about themselves.

Curated skill
QuestionQUE

The clinician asks a question of the client (open or closed).

Curated skill
AffirmationAF

The clinician accentuates something positive, affirming the client's strengths, efforts, or worth.

Curated skill
Giving InformationGI

The clinician gives information, educates, provides feedback, or gives an opinion without persuading.

Curated skill
Emphasizing AutonomyEA

The clinician highlights the client's sense of control, freedom of choice, or personal autonomy.

Curated skill
Complex ReflectionCR

A reflection that adds substantial meaning or emphasis, conveying a deeper interpretation of the client's meaning.

Curated skill
Simple ReflectionSR

A reflection that conveys understanding or repeats the client's meaning, adding little or no new content.

Curated skill
PersuadePER

The clinician overtly tries to change the client's opinion using logic, arguments, facts, or self-disclosure without emphasizing autonomy.

Curated skill
ConfrontationCON

The clinician confronts the client — disagreeing, arguing, correcting, warning, shaming, blaming, or moralizing.

Curated skill
Moyers TB, Manuel JK, Ernst D. Motivational Interviewing Treatment Integrity Coding Manual 4.2.1. University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions (CASAA); 2014.

Manuals freely downloadable (UNM CASAA / motivationalinterviewing.org); category definitions reproducible with citation. Cite Moyers et al.