Lyssn MITI Metrics Guide

Summary Scores

These calculated scores provide an overall measure of MI skillfulness based on the Global Ratings and Behavior Counts.

• Relational Global: A composite score that averages the Partnership and Empathy Global Ratings. It reflects the clinician's engaging skills and the foundation of the therapeutic relationship.
  • Benchmark: 3.5 (Fair), 4.0 (Good)
• Technical Global: A composite score that averages the Cultivating Change Talk and Softening Sustain Talk Global Ratings. It reflects the clinician's ability to use MI strategies to evoke motivation for change
  • Benchmark: 3.5 (Fair), 4.0 (Good).
• Percent Complex Reflections (% CR): The percentage of reflections that are complex (add substantial meaning or emphasis) versus simple (convey basic understanding). This measures the depth of reflective listening.
  • Benchmark: 40% (Fair), 50% (Good)
• Reflection-to-Question Ratio (R:Q): The total number of Reflections (Simple + Complex) divided by the total number of Questions. This indicates the balance between listening and asking.
  • Benchmark: 1:1 (Fair), 2:1 (Good)

Global Ratings

These four scales measure, on a 1-5 scale, overall quality of MI practice in each area during the session.

Technical Components 

• Cultivating Change Talk: Measures the extent to which the clinician actively encourages, attends to, and responds to the client's language that favors the change goal.
• Softening Sustain Talk: Measures the extent to which the clinician avoids lingering in discussions about the client's language that favors the status quo, strategically guiding the focus toward change.

Relational Components 

• Partnership: Measures the degree to which the clinician conveys an understanding that expertise and wisdom about change reside mostly within the client, fostering collaboration and power sharing.
• Empathy: Measures the extent to which the clinician attempts to grasp the client's perspective and experience, and conveys that understanding accurately (not to be confused with sympathy or warmth).

Lyssn High Points: The Lyssn MITI report also highlights "High Points" marking exemplary instances of these behaviors in the transcript for positive feedback and coaching.

Provider Behavior Counts 

These are frequency counts of specific clinician utterances observed during the session.

• Giving Information: Providing information, educating, or offering feedback in a neutral manner without persuading.
• Persuade: Overt attempts to change the client's opinion or behavior using logic, arguments, or advice without explicit permission or autonomy support (MI Non-Adherent).
• Persuade with Permission: Persuasion accompanied by an explicit statement or contextual cue emphasizing the client's autonomy or seeking permission.

• Question: Any question asked during the session, including open or closed questions.

• Simple Reflection: Reflections that convey basic understanding or facilitate client-clinician exchanges by repeating or rephrasing client content.
• Complex Reflection: Reflections that add substantial meaning or emphasis, capturing implicit content or suggesting a new direction.
• Affirm: Statements that accentuate something positive about the client's strengths, efforts, intentions, or worth. These are typically seeking to reinforce client behavior.
• Seeking Collaboration: Explicit attempts to share power, seek consensus, or gain permission before providing advice or information.
• Emphasizing Control: Utterances that clearly focus responsibility with the client for decisions, highlighting their control and freedom of choice.

• Confront: Directly and unambiguously disagreeing, arguing, correcting, shaming, blaming, or questioning the client's honesty.