Beyond Change Talk and Sustain Talk: Identity Construction and Therapeutic Change in Motivational Interviewing

Motivational interviewing (MI) has established itself as an evidence-based practice, but little is known about what occurs in a MI session from a qualitative perspective. This study utilized discourse analysis and conversation analysis to examine how MI facilitated therapeutic change in a seminal video-recorded training session by William Miller, a founder of MI, with a client with alcohol and cigarette use issues. Results revealed identity construction as a mechanism both the client and the therapist engaged in. The client negotiated normalcy out of a stigmatized subject position of a person with addiction via two pathways: Ascribing himself qualities embedded in individualism discourses and othering. The therapist discursively saved the client's face through validation and normalization, strengthening the therapeutic rapport. Finally, the therapist used selective reflection to enlist the client in co-constructing an identity in the direction of change. The findings highlight the importance of understanding the complex interactions and therapeutic change in MI through the lens of identity construction. Practical implications are discussed.