Culture, Medicine, and Psychiatry

, Volume 38, Issue 1, pp 83–114 | Cite as

The Poetics of Therapeutic Practice: Motivational Interviewing and the Powers of Pause

  • E. Summerson CarrEmail author
  • Yvonne Smith
Original Paper


Motivational interviewing (MI) is an increasingly prominent behavioral therapy that draws from and claims to synthesize two American therapeutic traditions long thought to be antithetical—“client-centered” and “directive” approaches. This paper proposes that MI achieves its hallmark “client-centered directiveness” through the aesthetic management of the therapeutic encounter, and more particularly, through MI practitioners’ marked use of silence. Drawing on data collected during the ethnographic study of MI trainings and the formal analysis of video-recorded MI sessions that are commonly used as models in such trainings, we identify three patterns of pause that regularly fall at specific grammatical junctures within seasoned MI practitioners’ turns-at-talk. We demonstrate how these pauses allow MI practitioners to subtly direct the conversation while simultaneously displaying unequivocal signs of client-centeredness. In other words, we show how and explain why the poetics of pause matter to MI. In presenting this case, we more generally highlight practice poetics—that is, the aesthetic management of the style and delivery of a professional message with a particular practical aim in mind—suggesting that this is a central if under-appreciated aspect of therapeutic practices.


Poetics Pause Psychotherapy Motivational interviewing Behaviorism Client-centered therapy 



The authors acknowledge and thank Marianne Brennan, Julie Chu, Jennfier Cole, and Constantine Nakassis for their comments and contributions to this work.


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Authors and Affiliations

  1. 1.School of Social Service Administration, University of ChicagoChicagoUSA

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