”Even after all this time, I still find myself surprised with how well MI works”

What do you see as the most important developments in MI over the years?
To me, the most important developments in MI have been in willingness to change in response to new evidence. “Believe your data” is one of the few things on which Carl Rogers and B. F. Skinner agreed. There is an astonishing amount of published research on MI. Let me mention just a few of the findings that have changed practice. Through psycholinguistic research we know much more about how to recognize change talk when we hear it. It wasn’t until our third edition that Paul Amrhein’s work led us to the categories of desire, ability, reasons, need, activation, taking steps, and commitment language.

From the publications of Molly Magill and others we now know that sustain talk can be at least as important as change talk in predicting clients’ outcomes. A recent “aha” has been the substantial overlap between MI and the interpersonal skills that distinguish more effective helpers as represented in my book with Terri Moyers, Effective Psychotherapists. This led us to include genuineness in the fourth edition. We know much more about how to help people learn MI skills. It’s not just through reading, watching videos, or attending didactic training. Feedback and coaching based on observed practice really help. This has changed the way we teach MI.

Is there a common misconception about MI that you would like to take the opportunity to correct?
There have been several. One is that MI is just about being nice to your clients. Yes, empathic listening is important, and there are also some technical skills for cultivating change talk and softening sustain talk that influence whether people will change. Another is that MI is a subtype of cognitive-behavior therapy, when actually MI is a person-centered approach that is rooted in the writing and research of Carl Rogers. Maybe the most common misconception, though, is that “I already do that.” Like good listening, there’s a big difference between believing you’re good at MI and actually doing it well.

When working with MI, is there something that has surprised you about the process of how people change?
Even after all this time, I still find myself surprised with how well MI works. Many of us in helping professionals believe that clients need us much more than they actually do in order to change. We are providing conditions that make it more possible, more likely that people will change in a positive direction. It is clients themselves who actually make change happen. What we do does matter, but we’re more like privileged witnesses to the human capacity for change.

MI can be applied in a wide range of sectors. Where is it most widely used and with most success?
Well, it’s still used widely in the addiction field where MI began, in helping people change substance use and compulsive behaviors. That’s one of the largest areas of research on MI along with health care, helping people change behavior in order to be and stay healthy. MI has also become popular in working with people in correctional facilities or jails – a field where the language is still fairly pejorative as it was in addiction treatment. Newer applications are in social work, education, coaching, and leadership.

Intervjun genomfördes i april 2024.