TIRCIA · Professionals
What is motivational interviewing?
Helping someone change without forcing them: principles, tools and scientific evidence
By Marie-Agnès Thulliez · Author · Publishing Director14-minute read
You have tried everything: kindly advice, logical arguments, repeated encouragement… and the person you want to help, whether a patient, a loved one or a colleague, is not budging. The more you insist, the more they resist. Motivational interviewing, developed by William Miller and Stephen Rollnick, offers another way: helping the person find their own reasons to change. It is now one of the most widely studied approaches in the helping professions.
In brief
- Motivational interviewing is a way of guiding a conversation so as to strengthen a person’s own motivation for change.
- It rests on a “spirit” (partnership, acceptance, compassion, evocation) and four processes: engaging, focusing, evoking, planning.
- Its effects are modest but robust and lasting, with, according to its authors, more than 2,000 controlled trials, mainly in addictions and health.
- It is learned through supervised practice; reading provides the foundations, and practice with feedback on one’s own sessions brings mastery.
1. Where does motivational interviewing come from?
In the early 1980s, the American psychologist William Miller was working with people who had alcohol problems. He observed that confrontation, then very widespread, often strengthened resistance. In 1983 he described a different approach, which he went on to develop with the British psychologist Stephen Rollnick (Miller, 1983; Miller and Rollnick, 2013). They define it as a collaborative conversation style for strengthening a person’s own motivation and commitment to change.
The starting point is ambivalence: most people who do not change are torn rather than “resistant”. They have both reasons to change and reasons to stay as they are. Motivational interviewing helps to explore this ambivalence, without forcing it.
2. The trap of the “righting reflex”
Faced with someone who is struggling, our first impulse is often to want to put things right: to explain, advise, warn. Miller and Rollnick call this the righting reflex, renamed the fixing reflex in the 4th edition of Motivational Interviewing. The problem is that, with an ambivalent person, every argument in favour of change invites them to defend the other side. The more we argue “for”, the more they argue “against”, and the more they convince themselves.
Motivational interviewing suggests resisting this reflex and replacing arguments with curiosity: “I don’t yet know what matters to this person, and I am going to discover it with them.”
3. A spirit before techniques
For its founders, motivational interviewing is first and foremost a stance, which they describe in four elements (Miller and Rollnick, 2013):
| Element | What it means |
|---|---|
| Partnership | We work alongside the person, as equals. They are the expert on their own life. |
| Acceptance | Respecting their worth, their autonomy and their right to choose, even when we disagree. |
| Compassion | Acting in the person’s best interest, rather than to obtain a result that reassures us. |
| Evocation | The reasons and resources for change already lie within them: we draw them out rather than supplying them. |
In the 4th edition (2023), the fourth element, evocation, is broadened into empowerment: helping the person to recognise and mobilise their own strengths and their capacity to decide (Miller and Rollnick, 2023). It is this spirit that gives the techniques their meaning: the authors have stressed this from the very beginning.
4. Four processes
Miller and Rollnick describe four processes that overlap and recur throughout the helping relationship. In the 4th edition of their reference work, they call them “tasks”, to emphasise that one can return to them at any time (Miller and Rollnick, 2013, 2023):
- Engaging: building a relationship of trust and collaboration.
- Focusing: agreeing together on a direction, a shared goal for change.
- Evoking: drawing out the person’s own reasons for change.
- Planning: when the person is ready, helping them build a realistic plan.
5. The core tools
The core skills are often summed up as four tools, found in any good helping relationship:
| Tool | Example |
|---|---|
| Open questions | “What concerns you most about your drinking?” |
| Affirmations | “You managed three weeks; that takes a lot of determination.” |
| Reflections | “You’d like to be fitter, and at the same time exercise feels like a mountain to climb.” |
| Summaries | “If I’ve understood correctly, on the one hand… and on the other…” |
Reflection is the central tool: restating what the person says, sometimes going a little beyond their words, shows that we have understood them and helps them to hear their own thoughts.
6. Drawing out “change talk”
Motivational interviewing distinguishes between change talk (what the person says in favour of change: desire, ability, reasons, need, commitment) and sustain talk (what they say in favour of the status quo). The idea is that we are persuaded more by what we say ourselves than by what others tell us.
The importance ruler is a simple tool for this: “On a scale of 0 to 10, how important is it for you to change?” If the person answers 6, we avoid asking “why not 10?”, which would lead them to justify staying put. Instead, we ask: “Why 6 and not 3?” To answer, they have to put their own reasons for change into words.
Research does, however, temper the idea of a “magic question”. A meta-analysis of client language in addictions shows that sustain talk is fairly clearly associated with poorer outcomes, but that the different forms of change talk do not all predict progress equally well (Magill et al., 2019). Reducing sustain talk, particularly by avoiding provoking confrontation, matters at least as much as eliciting change talk.
7. When faced with “resistance”: discord
In the early versions of the approach, people spoke of the patient’s “resistance”. Miller and Rollnick dropped this term, which they felt was blaming, in favour of two notions: sustain talk, which is a normal part of ambivalence, and discord, which signals a problem in the relationship (Miller and Rollnick, 2013). If the person digs their heels in, the question becomes “what in our exchange has created this tension?” rather than “why are they being so difficult?”
Repairing the relationship
- Stop arguing immediately.
- Reflect what the person is feeling: “You feel I’m putting pressure on you.”
- Apologise if need be: “I went too fast; that wasn’t my intention.”
- Reaffirm their autonomy: “You’re the one who decides; nobody can do that for you.”
8. What does the research say?
Motivational interviewing is one of the most extensively evaluated approaches in the helping professions:
- A meta-analysis of 72 controlled trials found a favourable effect in around three quarters of the studies, on outcomes as varied as alcohol consumption, weight and blood pressure (Rubak et al., 2005).
- A meta-analysis of 119 studies showed a small but lasting effect compared with no intervention or minimal interventions, and effectiveness comparable to that of other recognised treatments, often in fewer sessions (Lundahl et al., 2010).
- For substance use, a Cochrane review concludes that there is a short-term benefit compared with no intervention, with moderate- to low-quality evidence (Smedslund et al., 2011).
The effects depend greatly on how the approach is practised: the quality of the relationship and fidelity to the spirit of motivational interviewing both matter. This is why the authors insist on learning through practice, with feedback on one’s own sessions. Reading a book or an article, such as this one, is a way to discover the approach; mastery comes with supported practice (Miller et al., 2004).
9. An example
A fictional case, drawn from common clinical situations.
Karim, 52, has diabetes. For months his doctor has been encouraging him to take up physical activity again. At every appointment, Karim promises, then nothing changes. One day, the doctor changes approach: “What matters most to you at the moment?” Karim talks about his grandson, whom he would love to take to football. “On a scale of 0 to 10, how important is it for you to be able to keep up with him?” — “8.” — “Why 8 and not 4?” — “Because my father never got to know his grandchildren.” For the first time, the reason to change comes from Karim. Together they decide on a first step: walking to the football ground on Saturdays.
What is established, and what is still uncertain
- Established: motivational interviewing has a favourable effect, modest but lasting, on many health behaviours, and effectiveness comparable to other recognised treatments (Rubak et al., 2005; Lundahl et al., 2010).
- Nuanced: for substance use, the benefit has been shown mainly in the short term, with moderate- to low-quality evidence (Smedslund et al., 2011).
- Promising: sustain talk is associated with poorer outcomes; the link with change talk varies according to its form. These data remain preliminary (Magill et al., 2019).
- Demonstrated: skill improves markedly when training is followed up with feedback on one’s practice (Miller et al., 2004).
- Variable: the effects depend greatly on the practitioner and their fidelity to the spirit of the approach, beyond the techniques alone.
Frequently asked questions
Is motivational interviewing a form of manipulation?
No, provided its spirit is respected: the aim is to draw out the person’s own reasons, in their interest, while respecting their right not to change. Used to obtain an outcome against their interest, it would no longer be motivational interviewing.
Can it be used with a loved one?
Its principles, listening, reflecting, steering clear of the righting reflex, respecting autonomy, can improve many difficult conversations. The approach was, however, designed and evaluated in a professional setting.
How can I learn it?
Step by step. The first step is to understand the spirit of the approach and its tools, and to start using them in your sessions. Mastery is then refined through practice, particularly through feedback on your own sessions (Miller et al., 2004). For this first step, TIRCIA offers the programme Introduction à l’entretien motivationnel (Introduction to motivational interviewing, in French): understanding what it is, and how to use it.
In a nutshell
Motivational interviewing helps people hear their own reasons for change, and move forward at their own pace.
A stance of partnership, simple tools and plenty of practice: this is what underpins its effectiveness, modest but solidly demonstrated.
References
- Lundahl, B., 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. Link
- Magill, M., Bernstein, M. H., Hoadley, A., et al. (2019). Do what you say and say what you are going to do: A preliminary meta-analysis of client change and sustain talk subtypes in motivational interviewing. Psychotherapy Research, 29(7), 860-869. Link
- Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11(2), 147-172. Link
- Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd ed.). New York: Guilford Press. French translation: L’entretien motivationnel : aider la personne à engager le changement, InterÉditions.
- Miller, W. R., & Rollnick, S. (2023). Motivational Interviewing: Helping People Change and Grow (4th ed.). New York: Guilford Press.
- Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050-1062. Link
- Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55(513), 305-312. Link
- Smedslund, G., Berg, R. C., Hammerstrøm, K. T., et al. (2011). Motivational interviewing for substance abuse. Cochrane Database of Systematic Reviews, (5), CD008063. Link
This article summarises the scientific evidence available at the date of publication. It is no substitute for clinical training, supervision, or the advice of a health professional.
