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Decades of social science data have illuminated how oppression and inequality on the macro levels of society can manifest as trauma and deprivation on the individual or micro level. However, clinical pedagogies within human services fields (social work, substance use disorder treatment, psychology, psychiatry) do not adequately reflect these advances. This creates barriers for service providers seeking to address socially-engineered trauma, i.e., trauma occurring in the context of oppressive macro structures such as white supremacist racism, neoliberal economic policies and cisgender-heteropatriarchy. Service provision that is structurally competent, on the other hand, exists at the intersection of macro and micro and offers both ethical and clinical advantages. Given its traditional focus on eliciting behavior change on the micro level, the therapeutic modality of motivational interviewing (MI) may not attract attention as a tool for addressing systemic social injustice. However, by integrating key elements of MI with SHARP – a framework for addressing oppression and inequality – new options for structural competence emerge. The resulting hybrid, Macro MI, offers tools to join with clients to assess the impact of structural oppression on individual problems, as well as to envision solutions that include macro systems change. Underpinning this approach is a belief that the collective work of tearing down and replacing the systems that create trauma is central to healing the wounds inflicted by oppression. Within Macro MI, activism, organizing and consciousness-raising are interventions to treat PTSD as well as tools for preventing trauma from occurring to other members of the community.

Macro MI: Using Motivational Interviewing to Address Socially-engineered Trauma