Motivational interviewing in relational context

Responds to M. Stanton's comments (see record 2010-08987-013) on the current author's original article (see record 2009-13007-002). One of the puzzles of motivational interviewing is why it works at all. How can it be that an individual interview or two yields change in a long-standing problem behavior even without any effort to alter social context? The time involved is such a tiny part of the person’s ongoing daily life. How does it work? That is a question that has fascinated us and that prompted our article (Miller & Rose, September 2009). The model we proposed is intentionally focused on individual intervention, for that is how motivational interviewing (MI) has been delivered and tested in most studies. The current science base is drawn primarily from MI interventions that do not include concerned significant others (CSOs). Of course it is possible for CSOs to be included in MI sessions. CSO involvement was an option within MI components of treatment in at least three multisite trials: the COMBINE study (Anton et al., 2006), the UK Alcohol Treatment Trial (UKATT Research Team, 2005), and Project MATCH (Babor & Del Boca, 2003). The primary purpose of the MATCH trial was to evaluate, as Stanton (2010) suggested, a range of factors that might mediate or moderate the relationship between treatments and behavior change (Babor & Del Boca, 2003). One of these factors was social context, or more specifically, the person’s level of social support for drinking versus sobriety. A wide variety of external factors might mediate or moderate the efficacy of MI (or of any psychotherapy). Our article focused on the therapeutic interaction, not on a comprehensive model of all that influences behavior change. The domain of “social context” encompasses a broad range of factors (such as employment, family history, peer influence, and religious involvement), and any number of other components might also be considered in predicting substance use outcomes (e.g., age, conceptual level, severity of dependence, comorbidity). The model that we proposed (Miller & Rose, 2009) was focused on interpersonal and intrapersonal factors involved when a therapist interacts with an individual client. MI as an individual intervention has been found to be efficacious across a broad range of problem areas. As the processes and efficacy of MI become better understood, it will also be possible to explore how these operate within the person’s ongoing social context. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)