Leading With the Relationship: The Role of the Therapeutic Relationship in Motivational Interviewing

Motivational Interviewing (MI) is a brief evidence-based treatment that is most commonly used to treat addictive behaviors and to encourage diet and lifestyle changes and treatment adherence in health care settings. In recent years MI's use has been expanded to multiple other client populations in clinical psychology, as well as to other sectors, such as in education, and international non-profit work (Hettema at al., 2005). MI was inspired by research that demonstrated a high correlation between therapist application of the client-centered skill of accurate empathy and a reduction in drinking behaviors (Miller et al., 1980). MI contains both relational and technical components that are intended to operate synergistically. Despite a large body of research on MI treatment outcomes, variation in effectiveness has been found among studies, and the active ingredients of MI, particularly the relational aspects, are not well understood. As a result, the use of MI in many treatment settings is limited to the technical components of MI without a theory-based integration of the therapeutic relationship. This paper focuses on the contribution of the relational component to the effectiveness of MI, and explores the synergistic relationship between the technical and relational components of MI. A literature review of MI and the trans-theoretical literature on the therapeutic relationship is followed by two case illustrations. The paper concludes with recommendations for the field.

An Empirical Comparison of Reuse in Embedded and Nonembedded Systems

High-quality software, delivered on time and budget, constitutes a critical part of most products and services in modern society. Our government has invested billions of dollars to develop software assets, often to redevelop the same capability many times. Recognizing the waste involved in redeveloping these assets, in 1992 the Department of Defense issued the Software Reuse Initiative. The vision of the Software Reuse Initiative was "To drive the DoD software community from its current "re-invent the software" cycle to a process-driven, domain-specific, architecture-centric, library-based way of constructing software.'' Twenty years after issuing this initiative, there is evidence of this vision beginning to be realized in nonembedded systems. However, virtually every large embedded system undertaken has incurred large cost and schedule overruns. Investigations into the root cause of these overruns implicates reuse. Why are we seeing improvements in the outcomes of these large scale nonembedded systems and worse outcomes in embedded systems? This question is the foundation for this research. The experiences of the Aerospace industry have led to a number of questions about reuse and how the industry is employing reuse in embedded systems. For example, does reuse in embedded systems yield the same outcomes as in nonembedded systems? Are the outcomes positive? If the outcomes are different, it may indicate that embedded systems should not use data from nonembedded systems for estimation. Are embedded systems using the same development approaches as nonembedded systems? Does the development approach make a difference? If embedded systems develop software differently from nonembedded systems, it may mean that the same processes do not apply to both types of systems. What about the reuse of different artifacts? Perhaps there are certain artifacts that, when reused, contribute more or are more difficult to use in embedded systems. Finally, what are the success factors and obstacles to reuse? Are they the same in embedded systems as in nonembedded systems? The research in this dissertation is comprised of a series of empirical studies using professionals in the aerospace and defense industry as its subjects. The main focus has been to investigate the reuse practices of embedded systems professionals and nonembedded systems professionals and compare the methods and artifacts used against the outcomes. The research has followed a combined qualitative and quantitative design approach. The qualitative data were collected by surveying software and systems engineers, interviewing senior developers, and reading numerous documents and other studies. Quantitative data were derived from converting survey and interview respondents' answers into coding that could be counted and measured. From the search of existing empirical literature, we learned that reuse in embedded systems are in fact significantly different from nonembedded systems, particularly in effort in model based development approach and quality where the development approach was not specified. The questionnaire showed differences in the development approach used in embedded projects from nonembedded projects, in particular, embedded systems were significantly more likely to use a heritage/legacy development approach. There was also a difference in the artifacts used, with embedded systems more likely to reuse hardware, test products, and test clusters. Nearly all the projects reported using code, but the questionnaire showed that the reuse of code brought mixed results. One of the differences expressed by the respondents to the questionnaire was the difficulty in reuse of code for embedded systems when the platform changed. The semistructured interviews were performed to tell us why the phenomena in the review of literature and the questionnaire were observed. We asked respected industry professionals, such as senior fellows, fellows and distinguished members of technical staff, about their experiences with reuse. We learned that many embedded systems used heritage/legacy development approaches because their systems had been around for many years, before models and modeling tools became available. We learned that reuse of code is beneficial primarily when the code does not require modification, but, especially in embedded systems, once it has to be changed, reuse of code yields few benefits. Finally, while platform independence is a goal for many in nonembedded systems, it is certainly not a goal for the embedded systems professionals and in many cases it is a detriment. However, both embedded and nonembedded systems professionals endorsed the idea of platform standardization. Finally, we conclude that while reuse in embedded systems and nonembedded systems is different today, they are converging. As heritage embedded systems are phased out, models become more robust and platforms are standardized, reuse in embedded systems will become more like nonembedded systems.

The Health Behavior Change Competency Checklist (HBCCC): Instrument development and psychometric evaluation.

More than half of morbidity and mortality in the United States can be attributed to behavior-related disease, such as tobacco use, physical inactivity, poor diet and alcohol consumption. Given the increased prevalence of behaviorally related medical health concerns, physician competence in the implementation of effective behavior change strategies is quickly becoming an essential skill. However, only recently have primary care residency programs begun to systematically teach and evaluate motivational interviewing skills critical to influencing health behavior, and use of standardized, objective assessment tools to assess skillfulness has been largely absent. This paper reports the development of a checklist, the Health Behavior Change Competency Checklist (HBCCC). The instrument captures the theoretical model of behavior change, motivational interviewing, in a practical and versatile manner. Psychometric evaluation demonstrated moderate efficacy. Namely, results indicated the HBCCC possesses good reliability, as evidenced by high internal consistency, and adequate construct validity. It also displayed considerable utility and practical application. While these results provide several reasons for confidence in the HBCCC, item revision and additional testing are required in order to establish it as a meaningful and valuable instrument.

A Case Study: Recycling in the Residence Halls at Howard University

Howard University was recently identified as a school that lacks recycling initiatives and policies. In response, Howard University drafted a plan to become the greenest college in the United States. This study was conducted to identify if there were existing recycling practices on the campus, compare the practices, if applicable, to the local recycling regulations, and present potential obstacles and recommendations to be used by Howard University while designing their recycling program. This study was performed by visiting the campus to identify recycling practices and interviewing campus occupants, and comparing the findings to the local recycling regulations. The key finding of this study is that Howard University does not have a recycling program and does not comply with local recycling regulations.

Hiring Manager Training for Strategically Selecting the Best Human Capital

The selection process is arguably the most important part of the employee life cycle in an organization, but a process often underdeveloped in many organizations. Successful selection processes can put the right people into critical positions, whereas failure to focus on selection can result in poor performance, turnover, and loss of productivity critical to the continuing success of organizations. This paper creates a model for a hiring manager training that focuses on a strategic selection process to maximize chances for successful hires. Utilizing leadership and selection models, human resources can engage hiring managers in a strategic applicant selection process as well as give tools for screening, interviewing, and selecting the best candidates for employment throughout all levels of their organization.