Clients' perceptions of motivational interviewing with couples: A qualitative examination of male couples' statements to counsellors in session

Background: The past two decades have seen expanding interest in the application of motivational interviewing (MI) with couples. Thus far, the literature detailing the development of MI with couples has focused primarily on elucidating counselling processes and techniques or on evaluating intervention effects. To date, no published studies have examined client perceptions of the counselling process in MI with couples.Methods: This study involved qualitative analysis of 55 sessions from 24 couples (48 individuals) who received short (three-session) courses of MI with couples in the context of a randomised controlled trial. All participants identified as cisgender male and were 18 or older. In each couple, at least one partner was aged 18-29, HIV negative and reported drug use in the past 30 days.Results: Analysis revealed that client couples attributed the benefits of MI with couples to expectancy-related effects (merely structuring time to talk) and common factors (the presence of the counsellor as a non-judgmental observer). Clients also conveyed appreciation for techniques and activities that enhanced dyadic functioning through communication skill building and the identification of shared values. Finally, clients appreciated the opportunity to discuss drug use and sexual behaviour in an integrated way.Discussion: Findings indicated the utility of counsellor-delivered behavioural interventions. They also align with recent formulations of the counsellor's role in MI with couples and the introduction of facilitating dyadic functioning as a distinct process. Finally, they highlight the potential value of training counsellors to address the intersection of drug use, sexual risk and sexual pleasure in sessions. These dimensions of practice receive inconsistent attention across counselling training programme curricula.