Journal of Psychotherapy Integration, Vol 33(2), Jun 2023, 160-168; doi:10.1037/int0000287
Motivational interviewing (MI), originally devised for the treatment of substance use disorders, was introduced by William Miller in 1983. Of the various attempts to explain its effectiveness, the best known is the “technical hypothesis” proposed by Arkowitz and colleagues (2015). It calls for clinicians to increase in-session change talk—client verbalizations that imply or suggest movement away from the status quo—and to soften sustain talk—client commitments to maintaining existing circumstances. Recently, however, the relationships between change talk, sustain talk, and therapeutic progress have been questioned and appear to be more complex than originally assumed. In this article, we invoke a core principle of structure determinism—orthogonal interaction (OI)—to provide an alternative and potentially more powerful conceptualization of when and why MI is effective. Structure determinism is a cybernetically informed version of constructivism; within that framework, OI is posited as the main mechanism of system change. It is defined as a change in the structure of a system component that, in turn, affects the operation of the whole system. Examples are provided to illustrate how this formulation pertains to, and helps explain, therapeutic interaction, both for practitioners of MI and those who favor other therapeutic modalities. (PsycInfo Database Record (c) 2023 APA, all rights reserved)