In this book, E. Summerson Carr explores the cultural history of motivational interviewing (MI), a widely adopted therapeutic approach utilised in behaviour change interventions. Carr investigates the dissemination of MI, emphasising its intersections with science, spirituality, and therapeutic practice. She describes how MI practitioners use rhetorical techniques and poetic devices, such as unusually lengthy pauses, copious false starts, and pronounced hedging, to create a collaborative therapeutic dialogue that integrates scientific credibility with a humanistic, spiritual ethos, enhancing MI’s transformative impact and cultural adaptability.
Carr delves into the historical development and evolution of MI, tracing its roots in clinical psychology to being widely adopted in various areas, including healthcare, addiction services, and social work around the world. She introduces the concept of ‘working the difference’, which describes how practitioners of MI manage the contradictory demands of maintaining scientific rigour, incorporating spiritual elements, and addressing practical challenges of therapeutic practice. The book explores the evolution of MI, drawing on Anglo-American strands of spirituality, humanism, and political philosophy and dissent. Carr focuses on how these influences shape MI’s legitimacy and adaptability. She highlights how MI’s evolution reflects its ability to transcend cultural and institutional boundaries by integrating scientific principles with a broadly resonant spiritual framework.
Carr includes reflections from practitioners of the therapeutic intervention, her discussants, who share insights on the training and application of MI skills. She deliberately brackets the question of whether MI is therapeutically effective for clients, noting that this has been extensively researched elsewhere. Instead, she focuses on how practitioners cultivate and transmit the ‘spirit’ of MI—a concept defined through its projected and experienced qualities, which foster transformative effects for both practitioners and clients. MI requires a high level of expertise to perform, which Carr views as an interactional process. She demonstrates how MI adopters relearn how to speak and illustrates how MI is reshaping professions such as social work by altering the ways practitioners communicate with their clients.
The book’s key themes include the interplay between scientific authority and spiritual or humanistic values in therapeutic approaches, the global spread and adaptation of MI across diverse cultural and institutional settings, and the influence of language, persuasion, and performance in establishing professional legitimacy and achieving positive client outcomes. Carr’s analysis demonstrates that therapeutic practices become accepted not only because of scientific evidence but also because they resonate and align with shared moral values, contributing to their global spread.
Working the difference is a significant contribution to understanding the social and cultural dynamics of modern therapeutic interventions. Carr’s detailed exploration reveals how MI reconciles conflicting knowledge systems—science and spirituality—to achieve broad impact. This book is a critical resource that provides profound insights into how MI has become an influential approach.
