Anthropology, Author Essays, Interviews, and Excerpts, Religion, Sociology

Five Questions with E. Summerson Carr, author of “Working the Difference: Science, Spirit, and the Spread of Motivational Interviewing”

In the abstract, trust in both “expertise” and “the science” has been touted as panaceas to our ongoing crisis of misinformation and outright lies, but how exactly does a particular social scientific practice or form of thought gain widespread recognition as “expertise” to begin with?  In Working the Difference, E. Summerson Carr takes a look at the meteoritic rise of one such form—motivational interviewing—to understand what its success might reveal more broadly about how forms of expertise emerge and spread. Read on for an interview with the author about her research.

book cover of Working the Difference

How did you wind up in your field, and what do you love most about it?

Actually, I see myself straddling two fields: anthropology and social work/welfare. That is, I take an anthropological approach to studying North American helping professions—which, for me, means that I engage in institutionally embedded (if always historically sensitive) research and take my interlocutors seriously (however mundane, odd, or even sometimes troubling their ideas and practices may seem).

I am driven to counter the tendency to characterize (and sometimes caricature) social workers as people who do little more than put policy solutions (shaped from above) into action. My work shows that implementation is at the very heart of both problem and policy formulation and shapes how service provisions work and for whom. Social workers are also culture workers whose everyday efforts are as intellectual and ethical as practical and bureaucratic. This is partly because these professionals are asked to make clinical evaluations about who people are and why they suffer that can profoundly affect the distribution of critical resources such as food, housing, citizenship, and employment. Furthermore, they are asked to solve ambiguous and highly complex problems that evade simple solutions and have a dearth of resources at their disposal.

I suppose, then, this is a long way of saying I am probably most vested in the idea that my research might make a critical difference in how people think about, critically (re)imagine, and hopefully revitalize social work and welfare labor in socially just and responsive ways. 

While you were researching and writing Working the Difference, what did you learn that surprised you the most?

There were quite a lot of surprises, as it turned out! The world of motivational interviewing (MI) always kept me on my toes!  Most surprising of all was learning about how MI became an “evidence-based practice” and the sheer range of actors involved—from MI proponents and clinical researchers to charitable foundations, public and private insurers, state and federal agencies, and health and human service organizations. There is a lot at stake in officially recognizing a practice as “evidence based.” Once applied, the term opens up new funding opportunities that make it easier for a method to spread across not only the various service agencies but also entire states.

Since I knew some of this already, what really surprised me was how little “evidence” the designation “evidence-based” requires. As the founder of MI himself shared with me, a method can be registered as “evidence-based” based on a single study, so long as that study plays out in what officials consider the most epistemically virtuous way—that is, by way of a randomized control trial (RCT). What is more, that single study need not show that a method is effective in the sense that it produces positive behavioral outcomes. Rather, the method need only be shown to have an “observed effect” by way of an RCT, even if that effect is a negative one.

In the end, this means that both purveyors and recipients of any “evidence-based practice” must not assume that evidence of efficacy—in the sense of producing some intended therapeutic effect—is what is necessarily promised.

What do you most hope readers take away from the book?

As an anthropologist who studies professional practice, I have long been interested in how expertise is constituted and translated. MI appealed to me because it started rather parochially (as an alternative treatment for problem drinking) but has now spread into fields as diverse as dentistry, primary health medicine, counseling psychology, corrections, and water sanitation. It, therefore, seemed like a great case to explore the question of how and why certain cultural forms and practices gain recognition as expert forms and practice.

And while many scholars (including myself) have long understood expertise to rely on differentiation and specification of objects of knowledge, MI suggests that expertise can just as easily be generated by negating and denying difference, particularly ideological differences. So as the book tracks MI’s dissemination, it also tracks how the method exploits normative distinctions in North American thought.

For instance, when faced with the question of whether the motivational interview is a directive intervention or a method that fully recognizes and accommodates client autonomy, MI says yes. To the question of whether motivational interviewers are performing an elaborate speech style or authentically presenting themselves to their clients, MI says yes. To the question of whether MI trainers are driven by a divine calling or by the promise of profits, MI says yes. And to the question of whether motivational interviewing is scientific, endowed with an authoritative evidence base, or mystical, graced with transpersonal spirit, MI says yes. In these ways and others, MI concertedly eschews partisan propositions, yet it also revives tired oppositions by recombining them, effectively assuring its growing professional audience that there is no need to take sides. It’s the secret to MI’s sauce, and I suspect that this is true of many other contemporary expert modalities.

Where will your research and writing take you next?

I’ve just come off a yearlong research sabbatical spent following service dogs. I’ve focused largely on the lives and labor of facility dogs—a category comprised of dogs who are rigorously trained for the first two years of their lives to conduct full-time human service work, typically for a contractual tenure of eight years. This form of interspecies care sheds new light on therapeutic communication given that canine-assisted therapy trades in the idea that dogs can connect with people in ways that humans—even those humans trained in the human services—cannot.

Proponents consistently point to dogs’ extraordinary, even “magical,” ability to speak to populations that are considered particularly hard-to-reach. This claim hinges on the fact that canines are not confined to or by language, which raises fascinating questions about the traditional “talking cure” and the perceived limits of human-to-human communication. What does it mean about our ability to care for one another that we are turning to dogs in these fields? How do human service workers respond to their new canine coworkers—are they demoralized or buoyed? Does it feel better to be replaced by a dog than a robot? There is also the important matter of dogs’ labor, which is—after all, unpaid—and arguably unfree. What are the ethical implications of putting dogs to work in settings where human service workers regularly experience secondary trauma, burnout, and compassion fatigue? 

What’s the best book you’ve read recently?

It’s just too brutal to select a single book, but I will happily declare a tie (while sparing readers with a long list of runners-up): Chris Kelty’s The Participant (Chicago, 2019) and Hannah Zeavin’s The Distance Cure (MIT, 2021). 

Respectively, these books speak to enduring interests of mine. Kelty’s interrogation of cultural practices that ideologically stake themselves on the ideal of participation clearly resonates with my discussion about how MI, as a behavioral therapy, frames and works to realize itself as a form of participatory democracy, writ small.  Zeavin’s text disabuses readers of the fantasy that psychotherapy is a (relatively) unmediated kind of dyadic interaction, or ever has been. That said, both books are cultural histories of an idea to which there is a surprisingly wide range of strong attachments written in such a way as to creatively and elegantly inspire a critical reappraisal of the idea in focus. They help us imagine what might be otherwise should we indeed choose to reappraise.    

E. Summerson Carr is associate professor of social work and anthropology at the University of Chicago. She is the author of Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety and co-editor of Scale: Discourse and Dimensions of Social Life.

Working the Difference is available now on our website or from your favorite bookseller.