MI in Action: Turning Conversations into Change Pt. 2
What does it really mean to “step back” in a helping conversation? And how can practitioners cultivate genuine curiosity and empathy while still focusing on change?
In this second episode of our four-part ISSUP Exchange series, Dr. Goodman Sibeko continues his conversation with Professor Stephen Rollnick, clinical psychologist and co-founder of Motivational Interviewing (MI). Together, they unpack what MI looks like in real-world practice and what it takes to truly empower clients, without trying to "fix" them.
This episode explores the importance of self-awareness, the common traps practitioners fall into, and how stepping back can actually lead to more effective and respectful behaviour change conversations. Professor Rollnick introduces his “6 Cs” for personal guidance in practice and training—calm, curious, compassionate, and more; and explains how these qualities underpin both effective MI and sustainable, rewarding work in the helping professions.
If you’re a practitioner, trainer, or someone who works with people in any kind of support capacity, this episode offers essential insights into how to be present, collaborative, and truly helpful.
Featured Voices
Host – Dr. Goodman Sibeko
ISSUP Global Scientific Advisor.
Head of Addiction Psychiatry, University of Cape Town.
LinkedIn: goodmansibeko
Twitter/X: @profgsibeko
Guest – Professor Steve Rollnick
Clinical Psychologist.
Co-founder of Motivational Interviewing.
Visit: www.stephenrollnick.com
Transcript
Goodman Sibeko (00:01)
A warm welcome to you and thank you for joining us for this ISSUP podcast. I am Goodman Sibeko the ISSUP Global Scientific Advisor and your host. You can find me on LinkedIn and all the socials at the handle profg.sibeko. You can find ISSUP on LinkedIn, X and Blue Sky. Just type in ISSUP and you'll find us easily. ISSUP the International Society for Substance Use Professionals is a global membership organisation supporting the substance use prevention, treatment, recovery, and harm reduction workforce. With over 42,000 members, ISSUP connects professionals worldwide, sharing evidence-based resources, training, and networking opportunities. Membership is free, so visit us at issup.net to join and access webinars, events, and a wealth of useful training and knowledge share materials.
On today's follow-up podcast on motivational interviewing, we will look at some of the considerations for motivational interviewing in training and in practice, and consider the value add for those engaged in capacity building and service provision in addiction and in other areas. As always, we hope you enjoy this conversation and that you gain some new insights into this essential area for motivational interviewing.
Steve, thanks for being back with us. In this section, we're gonna delve into some of the things to think about when it comes to motivational interviewing in practice. And then we'll also talk a little bit about some considerations for conducting training to increase people's competence in motivational interviewing. So in terms of just reflecting on the role of the client in this change conversation, it's a question I was asked in a podcast before Steve about when I was talking about MI about how do you ensure or how do you support the client's power? How do you ensure that they are in a position to see and accept their own resources that they bring to the conversation.
Steve Rollnick (01:59)
Yeah, it's a brilliant question. It's really brilliant. Goodman, I reckon there's some fundamentals here and my every experience is that if one wants to use motivational interviewing or in fact, if one wants to be helpful, there's a whole load of things that we need to not do to enhance the power of the client. And that includes labelling them, blaming them. It includes looking at them through what I call deficit lenses. What's your problem? Okay, that this is a, if you like, my worst fantasy is that this is a referral, you might not even say a person, this is a referral with an addiction problem who's got X, Y, and Z wrong with them. And I think you're not going to be helpful and you're not going to empower the clients if that's your attitude. So my sense of it is that to be helpful and to use MI, absolutely foundational is not to do a whole lot of things or put another way, to put a different set of lenses on before you open your mouth and I can clarify what that lens is like if you want me to.
Goodman Sibeko (03:07)
It sounds to me, Steve, that we're also talking about self-awareness.
Steve Rollnick (03:10)
You can't let go the labelling of people, the blaming of them, the judging of them, the focus on problems unless you're self-aware because we are so conditioned to wear these lenses that are not helpful.
Goodman Sibeko (03:24)
One of the issues that I've found quite a lot in our space, Steve, is that a lot of folks who work in addiction, work in addiction because they care and they're very concerned about people who are suffering with addiction, but largely because they had some sort of personal experience, whether it's a family member or they have themselves, you know, gone through something similar. And so that position of eternallistic directive, you know, sort of lacking in self-awareness sometimes stems from that. What are your thoughts about that?
Steve Rollnick (03:55)
People's hearts are in the right places, okay? But caring is a little bit more than just having your heart in the right place. And I would also say that you want to be both caring and skilful, okay? And to be caring and skilful with another human being struggling with, an addiction issue, in my view, involves putting on a different set of lenses. And I can clarify what I mean by that.
Which is that sitting in front of me is a person first, client second. This person appreciates being heard. This person appreciates choice and will respond best to finding out for themselves why and how they might change. In other words, this person's got most of the good reasons for change in them and much of the wisdom about how to do it. And so the task of the helper is to basically create an environment conversational environments in which you get out of their way, don't project a whole lot of stuff onto them, show respect for these things I've talked about, and then give them a space to be brave enough to tell you why and how they might change. And frankly, when I look at the world of elite sports coaching, that is exactly what the good coaches do.
Goodman Sibeko (05:12)
It sounds as well to me, Steve, that part of the complexity of the skill is giving way to saying, you know, I've studied all these years and I know all this theory and I can theorise about where you're at and I can identify the best resources to move you forward. Taking all of that and then being able to step back and say, I may know all of that, but at the end of the day, you are the actual expert here. In your life, you're the expert in your social capital.
Steve Rollnick (05:44)
You know, I could not agree more. Yeah, I could not agree more, Goodman. That stepping back is quite difficult for people who've had an addiction problem themselves because they develop quite strong feelings about how they changed and therefore how other people might change. And that I think can be as limiting as all the professional qualifications can be limiting because in truth, most of the answers sit inside the person you're speaking to.
Goodman Sibeko (06:15)
What does that look like, Steve? What does stepping back look like? You know, if a lot of us bring into a space, into an interaction, into a professional role, not just the skills we've acquired, you know, professionally or in higher education and what have you, we bring ourselves and we've been cultured by our society and by our communities to receive guidance in a certain way, to receive and give instruction in a certain way. How do we get practitioners to unlock that? How do we get them to step back? Because this for me links to the next thing we're going to talk about, which is training. So for me, it's a question of what do we need to actively do in providing guidance and capacity to enable people to step back.
Steve Rollnick (06:59)
Just before we move on to training, I've got my own personal self-awareness guidelines. Now, I don't want to say they're useful to you, but I've worked a bit on myself and noticed that I need to be more emotionally regulated. But I've got my, if you like, I've worked it out. They're six C's for me, right? I've got to let go of being clever. I've got to let go of being cluttered and I've got to let go of complexity in my head. I've got to let those things go. Particularly cleverness because that's not my cleverness isn't going to solve someone's problem. And then I've got to hold on to a few other C's like be calm. That's the emotional regulation part. Be curious. That's in all of us. And it's the fuel that drives empathy, curiosity. And we could talk a bit more about that if you want to. And compassionate. So for me, the combination of calm, curious, and compassionate captures the essence of what it is to be helpful and then I can practice motivational interviewing or whatever other form of helpfulness I like if I can achieve that and let go of cleverness and complexity and clutter out of my mind and just be with somebody calm curious and compassionate I reckon that's probably 50 % of the job done the rest is skilful it is skilful but those are the fundamentals and I think sadly all too often they neglected. And indeed, if you've got seven degrees, it doesn't mean you're to be able to achieve that state of awareness. And the good news is that it doesn't matter the setting or the level of economic deprivation of the practitioners. They get this. They get this. And the wonderful contribution of motivational interviewing, I think, has been people's realisation that if your mindset is I'm solving problems for you, I'm solving your problems, It gets you into trouble. It's like falling down stairs together and landing with a bump. And it causes no end of stress, distress and burnout. Having to carry that weight on one's shoulders. And what we're talking about now is, is releasing ourselves from the weight of solving problems for people by being calm, curious and compassionate. Then there's a different challenge, which has got to do with empathising with people too much and feeling the way to that. But that's a different discussion.
Goodman Sibeko (09:24)
I really like the idea that what we're trying to do with MI is to relieve practitioners of the burden of having to be the fixers. It's a theme that we've focused on quite a lot as a team at University of Cape Town. For me, the question, I hope certainly that we are modelling curiosity in this webinar. Hopefully people get a sense that we're curious about each other's opinions and thoughts as we discuss.
How do you teach someone to be curious? Can anybody, can everybody learn? Or just some people just not cut out to, be compassionate, to be curious, to be calm, to be caring.
Steve Rollnick (10:03)
I mean, it's a hell of a question. I have had lots of experience of working with groups of people where we exchange stories and ask questions and people about curiosity and about empathy. Like I could say to you, where does empathy come from? And I've noticed a few things and I tell people stories about when an infant is newly born, they are searching. If you look at their eyes, they are searching all the time. What the hell's going on here? If you look at an infant crawling across the room, why isn't, why they're crawling across the room? They want to get to the other side. They want to see what's happening. That's curiosity. Okay. And when it puts a puzzle together, it's curious. So these are qualities we've all got. Okay. And our lives have been full of experiences of the incredible power of, of curiosity in promoting learning.
That's, you know, fundamental human quality. The question then becomes, do you, if you're sitting in front of another human being with an addiction problem, okay, let's put it that way, how do you channel this curiosity in a constructive way with him? And that's where empathy comes in, because empathy is a personal, internal experience of putting yourself in someone else's shoes, okay? Because you're wondering what's on the other side in them. And then there's a highly skilful aspect of this, which is what I think Motivational Interviewing's main contribution is. Which is conveying this empathy to them. That's where the skill comes in. So you convey to them your understanding of their experience and that creates a connection between two human beings. That's a powerful force for healing.
Here you go, I've ranted a bit there, Goodman. I don't know if that's making any sense.
Goodman Sibeko (11:55)
So is empathy the bridge?
Steve Rollnick (12:16)
Yeah, expressing it is, expressing it is. And that's where the technical skill of motivational interviewing comes in, which is not easy to learn. But I think these fundamentals that we've been talking take you way past 50 % of the way there. Then get out of people's way and ask them simple questions like... Why do you think you need to make a change in your use of the substance? How do you think that might pan out? What sort of support do you need? So the use of simple open questions is accessible to all practitioners in all settings. And in asking those questions, you are genuinely expressing curiosity. Okay, so you don't need to have a high level of technical communication skill to ask someone how they think they might make their way through a serious addiction.
Goodman Sibeko (12:45)
So it sounds to me, Steve, you're really reinforcing the idea that motivational interviewing at its core is ⁓ a relational approach to behaviour change. It's about how you relate to this person. It's about being able to give them room to be autonomous, to demonstrate that you are genuinely concerned and empathetic towards them. And in that way, it actually enables you to be more easily able to evoke the information you need to help them on their journey.
Steve Rollnick (13:14)
And you are focused on change. So this is not just client-centred counselling, okay? You are focused on change. So your questions will be about change in exactly the same way as I sat with the international famous level cricketer this morning and asked him about improvement in his batting.
Goodman Sibeko (13:34)
Steve, think what, you know, I, you know, my team and I have been working with Motivational Interviewing for years, but what you've just said now has possibly unlocked something for me. The idea that you have to be consistently focused on change.
Steve Rollnick (13.36)
Correct.
Goodman Sibeko (13.37)
Because if you're consciously and mindfully focused on change, your language will be oriented towards change.
Steve Rollnick (13:55)
Correct. And it'll be conveying a belief in this person's ability to change. Don't ask question about change unless you kind of believe that the person has got wonderful qualities in them.
Goodman Sibeko (14:07)
Yeah, that's beautiful. That's my main gem for today is for motivational interviewing practice. First of all, it's really important to step back, allow the client to be the focus, make sure that one is engaging in a way that is empathetic, that is demonstrating curiosity and genuine interest. And that is focused on change because that really does direct the style of the language that you're using and how you're able to identify ways to support them.
Steve, that's really incredible. Before we tie it up, in talking about MI in practice, it's always been for me about not just the intervention of this relational approach to behaviour change as a benefit to the client, but also as a benefit to the provider. You know, we were talking earlier about the paternalistic way in which we're all trained as practitioners. What MI does is it takes away some of that burden. And this is why this is what makes me love MI so much is it says you don't have to fix this person. All you need to do is believe enough that change is possible and allow them to identify how they'd like to change and then walk with them down the path. So you're not there to fix them. You're here to walk with them. You're here to collaborate with them. And my hope is that, you know, this is what motivational interviewing does for folks who practice it.
Steve Rollnick (15:32)
Yes, and I think there's a lovely quality that I've learned in sports actually, which is this phrase, I've got your back. Yeah. And I use it many times a week with these guys and okay, while they might be struggling, I actually use a phrase, hey, listen, until I see you next time, I've got your back. Hey, and they know what I mean and they know I'm there for them. And I think that gives them courage.
Goodman Sibeko (15:54)
Awesome, Steve. Steve, I feel like you've got my back in this session. So I really appreciate all of these gems and I've learned something new today already. So that's where we're gonna close this discussion about motivation of the interviewing in practice. We really could go on forever, but we'll tie it up here for today. And when we come back, I will talk about some of the things to think about when one is considering either giving or receiving training in motivation of the interviewing. Steve, thanks for joining us here and we'll see you in the next one.
Steve Rollnick (16:24)
Honestly a pleasure, I'm enjoying it.
Goodman Sibeko (16:26)
Thank you, Steve.
Thank you for spending this time with us. We hope you enjoy that as much as we did. Be sure to hop on over to our website, issup.net, where you'll find information on how to sign up for free membership. Our website also has a wealth of resources and publications for you to browse and engage with, and hopefully be enriched by. You can also watch a recording of past webinars and podcasts and see future event listings. Take care and catch you on the next one.
