A New International Therapy

(This article appeared in the Spring 2012 issue of SSA Magazine.)

Why is Motivational Interviewing stretching around the globe?

Motivational Interviewing has gone far beyond its roots. Created in the early 1980s as a substance abuse treatment in the U.S., the therapy is being used today in the corrections system in Singapore, for HIV risk prevention in Northern Europe and Tanzania, for water purification in Zambia and Malawi, and more.

E . Summerson Carr, an associate professor at SSA, has begun research into how this therapy has been able to travel around the globe and brought to bear on issues from weight control to couples counseling. Since 2009, Carr has examined MI and its rise to psychotherapy stardom. An anthropologist by training, she has conducted indepth fieldwork and tagged alongside a dozen motivational interviewers across the U.S. and interviewed many more.

Motivational Interviewing is based on the idea that, with the right therapeutic direction, people can talk themselves into change. It differs from many other American methods of therapy in that its primary goal is not to get people to express underlying beliefs or ideas. Rather, based on the idea that people tend to believe what they hear themselves say, MI aims to elicit “change statements,” which are thought—in themselves—to precipitate behavioral change.

“With so many American therapies, the goal in treatment is to get people to say how they really feel, particularly in addiction treatment, which has been so centered on the concept of denial,” Carr says. “MI involves a very different way of thinking about the role of language in therapy.”

One reason for MI’s success, Carr suggests, is that it’s “both clientcentered and directive. Historically, these have been two fundamentally different ways of thinking about therapy. The MI literature bridges these traditions, and this may appeal to a broad set of clinicians.” What’s more, MI trainers are devoted, says Carr: “The practitioners I’ve interviewed often claim to be personally as well as professionally transformed by MI,” Carr says. “It wouldn’t be moving like it is without that level of dedication.” Indeed, some of Carr’s American informants travel as far away as China, Iraq, Tanzania, Mexico and Singapore to train other practitioners in MI.

But there’s more to MI’s spread than enthusiastic followers. “[MI] is classified as an evidence based practice,” says Carr, which means—among other things—that insurance companies often cover it. So while practitioners may suggest that MI has a special kind of transformative spirit, they also hail its efficacy, suggesting that science is also on the side of MI. Clinical trial research is starting to be conducted in the many international settings where MI is now well underway.

Though Carr is currently working on a monograph based on her studies of MI in the United States, she is hoping to continue her research by traveling overseas to see it in action abroad. “If we don’t understand MI from the standpoint of its proponents and practitioners, and document how it actually unfolds in the various settings where is currently being practiced,” she says, “we’re missing a huge part of the story of why it is spreading.” — Virginia Brown