Motivational Interviewing

Motivating through interviewing

In the early 1980s, a clinical psychologist named Bill Miller was troubled by his field’s attitude toward people with addictions. It was common for therapists and counselors to accuse their substance-abusing clients of being pathological liars who were living in denial. That didn’t track with what Miller was seeing up close in his own work treating people with alcohol problems, where preaching and prosecuting typically boomeranged. “People who drink too much are usually aware of it,” Miller told me. “If you try to persuade them that they do drink too much or need to make a change, you evoke resistance, and they are less likely to change.”

Instead of attacking or demeaning his clients, Miller started asking them questions and listening to their answers. Soon afterward, he published a paper on his philosophy, which found its way into the hands of Stephen Rollnick, a young nurse trainee working in addiction treatment. A few years later, the two happened to meet in Australia and realized that what they were exploring was much bigger than just a new approach to treatment. It was an entirely different way of helping people change.

Together, they developed the core principles of a practice called motivational interviewing. The central premise is that we can rarely motivate someone else to change. We’re better off helping them find their own motivation to change.

Let’s say you’re a student at Hogwarts, and you’re worried your uncle is a fan of Voldemort. A motivational interview might go like this:

You: I’d love to better understand your feelings about He Who Must Not Be Named.

Uncle: Well, he’s the most powerful wizard alive. Also, his followers promised me a fancy title.

You: Interesting. Is there anything you dislike about him?

Uncle: Hmm. I’m not crazy about all the murdering.

You: Well, nobody’s perfect.

Uncle: Yeah, but the killing is really bad.

You: Sounds like you have some reservations about Voldemort. What’s stopped you from abandoning him?

Uncle: I’m afraid he might direct the murdering toward me.

You: That’s a reasonable fear. I’ve felt it too. I’m curious: are there any principles that matter so deeply to you that you’d be willing to take that risk?

Motivational interviewing starts with an attitude of humility and curiosity. We don’t know what might motivate someone else to change, but we’re genuinely eager to find out. The goal isn’t to tell people what to do; it’s to help them break out of overconfidence cycles and see new possibilities. Our role is to hold up a mirror so they can see themselves more clearly, and then empower them to examine their beliefs and behaviors. That can activate a rethinking cycle, in which people approach their own views more scientifically. They develop more humility about their knowledge, doubt in their convictions, and curiosity about alternative points of view.

The process of motivational interviewing involves three key techniques:

• Asking open-ended questions
• Engaging in reflective listening
• Affirming the person’s desire and ability to change

As Marie-Hélène was getting ready to take her baby, Tobie, home, the nurses called Arnaud Gagneur, a neonatologist and researcher known for his vaccination conversations. His specialty was applying the techniques of motivational interviewing to vaccination discussions. When Arnaud sat down with Marie-Hélène, he didn’t judge her for not vaccinating her children, nor did he order her to change. He was like a scientist or “a less abrasive Socrates,” as journalist Eric Boodman described him in reporting on their meeting.

Arnaud told Marie-Hélène he was afraid of what might happen if Tobie got the measles, but he accepted her decision and wanted to understand it better. For over an hour, he asked her open-ended questions about how she had reached the decision not to vaccinate. He listened carefully to her answers, acknowledging that the world is full of confusing information about vaccine safety. At the end of the discussion, Arnaud reminded Marie-Hélène that she was free to choose whether or not to immunize, and he trusted her ability and intentions.

Before Marie-Hélène left the hospital, she had Tobie vaccinated. A key turning point, she recalls, was when Arnaud “told me that whether I chose to vaccinate or not, he respected my decision as someone who wanted the best for my kids. Just that sentence—to me, it was worth all the gold in the world.”

Marie-Hélène didn’t just allow Tobie to be vaccinated—she had his older siblings vaccinated at home by a public health nurse. She even asked if Arnaud would speak with her sister-in-law about vaccinating her children. She said her decision was unusual enough in her antivaccination community that “it was like setting off a bomb.”

Marie-Hélène Étienne-Rousseau is one of many parents who have undergone a conversion like this. Vaccine whisperers don’t just help people change their beliefs; they help them change their behaviors, too. In Arnaud’s first study, with mothers in the maternity ward after birth, 72 percent said they planned to vaccinate their children; after a motivational interviewing session with a vaccine counselor, 87 percent were onboard. In Arnaud’s next experiment, if mothers attended a motivational interviewing session, children were 9 percent more likely to be fully vaccinated two years later. If this sounds like a small effect, remember that it was the result of only a single conversation in the maternity ward—and it was sufficient to change behavior as far out as twenty-four months later. Soon the government health ministry was investing millions of dollars in Arnaud’s motivational interviewing program, with a plan to send vaccine whisperers into the maternity wards of every hospital in Quebec.

At the time of this account, motivational interviewing was used around the world by tens of thousands of practitioners—there are registered trainers throughout America and in many parts of Europe, and courses to build the necessary skills are offered as widely as Argentina, Malaysia, and South Africa. Motivational interviewing has been the subject of more than a thousand controlled trials; a bibliography that simply lists them runs sixty-seven pages. It’s been used effectively by health professionals to help people stop smoking, abusing drugs and alcohol, gambling, and having unsafe sex, as well as to improve their diets and exercise habits, overcome eating disorders, and lose weight. It’s also been applied successfully by coaches to build grit in professional soccer players, teachers to nudge students to get a full night’s sleep, consultants to prepare teams for organizational change, public health workers to encourage people to disinfect water in Zambia, and environmental activists to help people do something about climate change. Similar techniques have opened the minds of prejudiced voters, and when conflict mediators help separated parents resolve disputes about their children, motivational interviewing is twice as likely to result in a full agreement as standard mediation.

Overall, motivational interviewing has a statistically and clinically meaningful effect on behavior change in roughly three out of four studies, and psychologists and physicians using it have a success rate of four in five. These broad research summaries do not mean that the approach works equally well for every behavior, setting, or person.

Motivational interviewing isn’t limited to professional settings—it’s relevant to everyday decisions and interactions. One day a friend called me for advice on whether she should get back together with her ex. I was a fan of the idea, but I didn’t think it was my place to tell her what to do. Instead of offering my opinion, I asked her to walk through the pros and cons and tell me how they stacked up against what she wanted in a partner. She ended up talking herself into rekindling the relationship. The conversation felt like magic, because I hadn’t tried to persuade her or even given any advice.*

When people ignore advice, it isn’t always because they disagree with it. Sometimes they’re resisting the sense of pressure and the feeling that someone else is controlling their decision. To protect their freedom, instead of giving commands or offering recommendations, a motivational interviewer might say something along the lines of “Here are a few things that have helped me—do you think any of them might work for you?”

Asking questions can help people examine their own reasons. Consider Daryl Davis asking KKK members how they could hate him when they didn’t even know him: the question invites reflection rather than merely supplying a counterargument. When we try to convince people to think again, our first instinct is usually to start talking. Yet the most effective way to help others open their minds is often to listen.