Stabilizing a fluid intervention: The development of Motivational Interviewing, 1983–2013

Abstract

Introduced in 1983, Motivational Interviewing (MI) is now widely regarded as an efficacious psychosocial intervention in the addiction treatment field. Drawing on research literature, this article asks how this was achieved. Contrary to common conceptions of the dissemination of psychosocial interventions within the addiction treatment field, this analysis takes neither MI's identity nor its efficacy to be inherent qualities, but sees them as being constructed by various actors. This construction work is described as stabilizing processes. Being loosely structured and flexible, it is suggested that MI can be regarded as a fluid intervention. This has presented difficulties for its subsequent stabilization. As MI has been differently operationalized in clinical trials, it was not obvious at first to talk about the efficacy of MI as a single object of concern in systematical reviews and meta-analyses. The article discusses some of the complexities involved in the production and dissemination of efficacious psychosocial interventions. Compared with other cases, MI displays a somewhat different mode of stabilization. It is argued that MI has been stabilized enough to be considered an efficacious intervention while simultaneously incorporating fluidity, which makes it useful in a wide range of clinical settings.

• Motivational interviewing
• stabilization
• treatment fidelity
• historical account
• evidence-based practice

Notes

Notes

1. For a discussion about diffusion theory in general from an STS perspective, see Latour (1987, p. 132–144).

2. In this respect, my analysis differs from Rogers’ (2010) diffusion theory. Whereas Rogers discusses intrinsic qualities of the innovation such as relative advantage and trialability as important factors favoring dissemination, the point made here is that MI's dissemination in part can be explained by the fact that MI can be many different things.

3. This conclusion comes with two limitations. First, it is only possible to analyze those statements that have been articulated, i.e. published in the research literature. Second, I have limited this analysis to the research literature about MI. In other research contexts, the efficacy of MI might be a contested question. For example, advocates of the so-called contextual model (see Norcross, Beutler, & Levant, 2006) might argue that it is not the specific ingredients in MI that contribute to the effects, but factors that are common to all psychosocial interventions. This argument would imply a de-stabilization of the statement about MI's efficacy, but this objection has not affected MI's stabilization within this particular context.