The Spirit of Motivational Interviewing

Takes practice

When you want to help someone reconsider a belief or a habit, stop arguing for the change and instead draw out their own reasons for and against it, because people are persuaded by what they hear themselves say and push back against what they are told.

How to do it

  1. 1Suppress the righting reflex. The urge to correct, warn, and supply the argument for change puts the other person in the position of arguing against it, and they will talk themselves further in.
  2. 2Ask open questions and listen: "What do you like about it? What worries you about it?" Ambivalence is normal; your aim is to let both sides of it be spoken.
  3. 3Reflect back what you hear, especially any statement that leans toward change ("so part of you is not sure about him"). Reflection, not questioning, does most of the work.
  4. 4Affirm what is true and creditable (their care for their family, their wish to get it right) and say plainly that the decision is theirs. Autonomy support is not a tactic; if you cannot mean it, this approach is not available to you.
  5. 5Ask permission before offering information, give it briefly and neutrally, and ask what they make of it: "Would it help if I told you what I found? ... What do you think of that?"
  6. 6Summarize their own reasons back to them and ask what, if anything, they want to do next. Accept "nothing yet".

What to say

  • “It is your call, and I will not stop caring about you whatever you decide. Can I ask what you are getting from it?”
  • “On one hand it has given you a community; on the other you are uneasy about the money. Have I got that right?”
  • “Would you be open to hearing what I read about it? You can tell me if it does not fit.”

When to use it

  • •A friend or relative drawn into a conspiracy community, a high-control group, a multi-level marketing scheme, or a risky investment, where confrontation has only produced distance.
  • •Conversations about health choices, including vaccination, drinking, and medication, where the person is ambivalent.
  • •Civic and workplace conversations in which the other person already knows the arguments and is tired of hearing them.
  • •Any time you notice the other person defending a position more strongly the harder you push.

Counters

Reactance ExploitationBelief PerseveranceIdentity-Protective CognitionCognitive DissonanceCommitment & ConsistencySunk Cost FallacyThought-Terminating ClicheConspiracy RhetoricRecommendation Rabbit HoleMLM Recruitment PitchShame SpiralingExit-Cost EscalationIsolation TacticsMilieu ControlSemmelweis ReflexPhobia Indoctrination

Evidence and how strong it is

Motivational interviewing was developed by Miller and Rollnick for addiction counselling and is defined in Miller & Rollnick (2013) by its spirit (partnership, acceptance, compassion, evocation) more than by its techniques. It rests on reactance theory (Brehm 1966): direct pressure on a free choice provokes resistance. It is one of the most studied counselling approaches. Meta-analyses by Rubak et al. (2005) and Lundahl et al. (2010), covering many randomized trials, found small to moderate but reliable benefits over no treatment or advice-giving across alcohol, drug, and health behaviours, and rough equivalence to other active treatments in less time. Gagneur (2020) summarizes Canadian randomized trials in which a motivational-interviewing session on maternity wards increased parents' vaccination intentions and infants' vaccination coverage. Evidence strength: strong (meta-analyses of RCTs) for clinical health behaviours delivered by trained practitioners; its use by untrained relatives, and for political or conspiracy beliefs, is an extrapolation supported by clinical and practitioner consensus and not by trials.

Cautions
  • It is a way of helping someone with their own ambivalence. Used to steer a person toward an outcome that serves you and that they would not choose, the same skills become manipulation; Miller and Rollnick say so explicitly.
  • It is not suited to emergencies. If someone is in immediate danger, be direct and get help.
  • It requires patience and tolerance for hearing things you disagree with. If you cannot do that on this topic with this person, someone else may be better placed.
  • Do not use it to draw out or negotiate with a person who is abusing or controlling you. If you are in that situation, contact a domestic-violence advocate (US: 1-800-799-7233, thehotline.org; elsewhere, your national helpline) to plan safely, because confrontation and leaving can escalate danger.
  1. Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press
    The defining text: the spirit, the righting reflex, change talk, and the ethical limits of the method.
  2. Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A Meta-Analysis of Motivational Interviewing: Twenty-Five Years of Empirical Studies. Research on Social Work Practice, 20(2), 137-160
    Meta-analysis showing small to moderate, reliable benefits across behaviours relative to weak comparison conditions.
  3. Rubak, S., Sandbaek, A., Lauritzen, T., & Christensen, B. (2005). Motivational Interviewing: A Systematic Review and Meta-Analysis. British Journal of General Practice, 55(513), 305-312
    Systematic review of randomized trials finding motivational interviewing outperforms traditional advice-giving for a range of behaviours.
  4. Gagneur, A. (2020). Motivational Interviewing: A Powerful Tool to Address Vaccine Hesitancy. Canada Communicable Disease Report, 46(4), 93-97
    Summary of randomized trials in which motivational-interviewing sessions increased vaccination intention and coverage.
  5. Brehm, J. W. (1966). A Theory of Psychological Reactance. Academic Press
    The theory that threats to perceived freedom provoke resistance, the mechanism the approach is built to avoid.
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