The Spark Behind MI: Stephen Rollnick on the Origins of Motivational Interviewing Pt. 1
If you've ever wondered how Motivational Interviewing (MI) came to be and why it remains essential across so many fields today, join Dr Goodman Sibeko in a compelling four-part conversation with Professor Stephen Rollnick, clinical psychologist and co-founder of MI.
Together, they explore the personal and professional journey behind MI, from early experiences in Cape Town and the pivotal collaboration with William R. Miller, to the evolution of MI as a tool not just for behaviour change, but for personal growth. You'll hear how MI has transformed clinical practice, what keeps it relevant in healthcare, addiction support, and even elite sports, and why authentic human connection lies at its heart.
This conversation is more than a look back—it's a fresh take on where MI is headed and how it continues to inspire meaningful, respectful change. A must-listen for practitioners, trainers, and anyone passionate about evidence-based care and people-centred approaches.
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
Full 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. This is the first of a series of four podcasts focused on motivational interviewing, which is really a way of having conversations that helps people find their own reasons and internal motivation for change. It's not about pushing or persuading, but about listening, guiding and drawing out motivation from within. In this episode, we're talking about how motivational interviewing works and why it's become a go-to tool in everything from addiction support to healthcare and beyond. We're honored to welcome Professor Steve Rolnick to walk this journey with us.
Professor Steve Rolnick is a clinical psychologist and one of the co-founders of Motivational Interviewing, the really practical person-centred approach to helping people make meaningful changes in their lives. Originally from South Africa, he's now based in Cardiff University and has spent years working across healthcare, education, and even sport training people around the world. He's also written some of the go-to books on Motivational Interviewing and stays focused on how good communication can make a real difference. So today in this, our introductory podcast, we'll get to know Professor Rolnick and understand the journey that led to the development of motivational interviewing. We hope you enjoy this conversation and that you gain some new perspective and maybe even draw some inspiration. Steve, hello.
Steve Rollnick (02:11)
Greetings to you man, lovely to see you.
Goodman Sibeko (02:15)
It's wonderful to be in touch with you again. It's been a long time. Have you been well?
Steve Rollnick (02:19)
Yeah, no, no, I'm doing fine and looking forward to seeing you in person when I get out to South Africa next.
Goodman Sibeko (02:26)
I can't wait, Steve. I think just to get things going for the listeners, we're going to just let you get a piece of us and let you get to know us a little bit. So I'm going to ask Steve a few questions so that you have a better sense of who he is. And he might ask me a couple of questions. I'm a bit nervous, Steve. Please take it easy on me. Steve, Just as a background, where does Steve come from? And so what's your professional background? How do you introduce yourself?
Steve Rollnick (02:52)
I'm retired now, but I started life growing up in Cape Town, South Africa, developed an interest in addiction back then as a nurse and ended up as a clinical psychologist in the British National Health Service. Then in medical school here in Cardiff, Wales. And I guess, that's my professional background and if there's a thread that runs right through the whole thing, I can, don't know, Goodman, with the benefits of hindsight, I can say that thread was and is what makes for unhelpful and helpful conversations about, difficult conversations about change, think that's probably it.
Goodman Sibeko (03:33)
That's such an interesting segue, Steve. I'm very curious about what made you start asking that question. What happened?
Steve Rollnick (03:41)
To be honest, I was a bewildered young nursing orderly working in Cape Town in an addiction treatment setting where I say bewildered because it felt very strong-willed of the treatment staff in the way they spoke about the patients they were looking after. I was bewildered by this. They were very strong-willed and clear and very ready to label patients as unmotivated and having this or that problem.
Goodman Sibeko (04:10)
You go as far as saying paternalistic even.
Steve Rollnick (04:12)
Yeah. Definitely. And there were a couple of incidents that sort of stood out, you know, as as kind of very unfortunate and tragic consequences of I think people's lives. And these are the patients I'm talking about. And I felt in my heart they were connected to the treatment environment, not caused by but I didn't see the treatment environment as helpful in that respect. And yeah, so these were some of my early experiences that I can't say I saw very clearly what was going on until I started training as a psychologist in the UK. And then I came across a paper by William Miller called Motivation for Interviewing. It was in 1982. And I guess it turned things around for me. It took me a while to absorb and realise the implications of that paper, but I guess that's what we're going to be talking about a bit more today.
Goodman Sibeko (05:09)
Absolutely. You know, so before we get deeper into that, we first connected, you told me you just come back from being with the cricket team. Maybe it'll be really good for the audience to know what you're up to now, because I'm quite keen to hear, you know, how did you end up here? And how does this tie in with your evolving journey with with motivational interviewing?
Steve Rollnick (05:29)
Yeah, look, I've retired. So for the last 10 years, I've been doing what I enjoy, but the thread continues. other words, demanding tough conversations about change are being played out in the sporting arena. And so I'm enjoying working with elite sports people and sports coaches and doing quite a bit of work in the Premier League football world of the United Kingdom, mostly with coaches, but there they faced the same difficulty. so just a week ago, Goodman, there I was in a Premier League run course for heads of coaching in the Premier League. And guess what they had in the form of simulations with actors? Well, it was, how do I have this tough conversation about change?
For me, it's a single thread. But yes, I must say I'm enjoying retirement, working in sports at the moment. And I'm also writing a book on giving advice for the lay person. So you can see I've broadened a little bit beyond the world of addiction treatment.
Goodman Sibeko (06:32)
It's interesting, right, because the concept of change and wanting to establish where someone is on a journey of change internally and trying to figure out how exactly to assist them in stepping forward is a universal one, isn't it? It's not just in the treatment space. It's not just in the interpersonal space. You're finding it working quite easily in the sporting space as well now.
Steve Rollnick (06:53)
Yeah, know, Goodman, I don't know how to put this. In the sporting space in a microcosm, you see what's happening in society at large, particularly in deprived circumstances, you get some quite toxic environments, okay, in sport, they become toxic for quite different reasons. But nevertheless, we're not talking about an individual changes, you hear what we're talking about impacting people's wellbeing is the environment in which they're living and working. And at the front end of that are these unfortunate demands to have tough conversations. So I think we, you know, we do well to retain awareness of the environment. And I think indeed when you and I get to talk about training in our discussions here, we'll notice that.
Goodman Sibeko (07:43)
Would you say that from the get-go, you've had this appreciation that the agent of change and the individual who must undergo the change journey exists within this environmental space that determines the outcome? Or is this something that's become more and more real for you over time?
Steve Rollnick (08:01)
I know it's been there from the beginning and a source of great frustration for me because to be honest, there's a part of me that would have preferred to be a social worker or a social engineer rather than a psychologist. But that's just a personal preference of mine. But I had to, in order to survive, get a professional life and I became a psychologist. But yeah, I'm acutely aware of the impact of the environment on the way people behave. But speaking more optimistically, in the rather narrower worlds that we work in, in treatment environments and in sporting situations and in families and organisations and schools, I've seen the most incredible examples of good environments. You know, let's get that in balance. So I'm not in a state of hopelessness about this. I'm just pointing out that the way an environment is set up and the values that drive it will impact well-being and indeed the practice of motivational interviewing, which I'm sure we'll come onto.
Goodman Sibeko (09:03)
Yes. And you know, humour me here, how would you say your perspective on change, on motivational interviewing as a strategy? How has that evolved over time? Do you feel like it's evolved?
Steve Rollnick (09:18)
Yeah. Humor you. How can I humor you? It's like, I don't know. Yeah. And I don't want to sound too serious, but yeah, look, Goodman, there've been a couple of quite substantial changes for me. One is that I'm seeing motivational interviewing less as a form of therapy and more as a form of being helpful. And that's profound for me. The other more specific change, which I've been very conscious of and active in affecting, is that motivational interviewing is less focused on behaviour change and more focused on personal growth than it used to be. So it used to focus on change indeed and change in addictive behaviour when we started out, but in the most recent work that we've done, the fourth edition of our textbook, we are talking about motivational interviewing being focused on personal growth and change. Now that is aligned with the first point I made, which is that what I've realised is that motivational interviewing is a form of being helpful. And that helpfulness can be applied not just to behaviour change, to people's personal growth. And that raises a whole lot of interesting and I think very exciting possibilities that motivational interviewing can be used way outside the treatment or therapeutic environment.
Goodman Sibeko (10:45)
That's really great, Steve. I think when we speak in the next section about MI in practice, I'm really keen to get a bit deeper into that discussion. Think perhaps my nearly final question for this section for you is, where would you like to see motivational interviewing go? What's your dream for us? What's your dream for motivational interviewing?
Steve Rollnick (10:54)
It would be that in the treatment environments in which we work, people take seriously their own personal development and developing their own awareness of how they're feeling, how the person they're helping is feeling and how the relationship is going. And if they do that, my dream would be that that will lead to them being more helpful. Yeah. And then I've got another dream, is being realised in this book that I'm doing, which is that given that so much activity revolves around exchanging information, giving feedback and giving advice to people, that's been seriously neglected. So I'm writing this book to try and realise this dream that we can quite easily improve the quality of giving advice and feedback to people. Because frankly, it's being done in a very unskillful and demeaning manner worldwide across all contexts. So there you go. But maybe, yeah.
Goodman Sibeko (12:06)
So you're talking really about getting to a place where advice giving is not talking down or at people, but somehow relating to them on a deeper level where the advice actually is responsive to the exact needs and where they need to go.
Steve Rollnick (12:20)
Big difference. It's offered up, not dumped down. that offering up. It's simple. You see it being done. I'm not saying it's easy. And that's what I'm trying to write about at the moment. And there you go. I'm tempted to start asking you now, Goodman, what you've been up to. like, yeah, I feel enough about me, Goodman. Do you if switch the focus?
Goodman Sibeko (12:41)
That's great, Steve. Yeah, look, I'm not retired, not just yet. So I've, you know, I'm still heading addiction psychiatry at the University of Cape Town. Right. And I've been very lucky to join the super dynamic team at ISSUP Global. Of course, ISSUP is the International Society for Substance Use Professionals. They're doing incredible work, Steve. Bring the network of providers of care in addiction together for information sharing, for knowledge sharing, for just connecting and working together and finding new and better ways to help people in serious need with addiction.
Steve Rollnick (13:21)
And so you're a practicing psychiatrist, Goodman.
Goodman Sibeko (13:27)
Goodness me, I have not seen any patients since 2012, but I have some incredible staff that take care of that at the university. Largely my work has been around creating resources for capacity building, creating resources for technical assistance for government and non-governmental partners to be responsive to the drugs challenges that we face, not just in Africa, but globally as well. So that's been my space largely in management and largely in the development of resources and in bringing incredible minds such as yourselves together to further that mission.
Steve Rollnick (14:03)
But tell me, how does your experience of African and South African I was going to say culture, but there's so many of them. How does your experience of living and working in say somewhere like South Africa in and around the addictions field. How's that going to impact your work in ISSUP?
Goodman Sibeko (14:26)
Think, you know, when you come from a space that has a limitation of resources, we know there's a real shortage of human resource as well as treatment facilities. So when you come from an environment like that, you're already automatically oriented towards thinking about how do you maximise the impact of the little that you have? Yeah. I think that that certainly feeds into saying that the interventions and the strategies we develop need to be high impact and low resource oriented. Because then when you go to spaces where there is more, you can achieve much more. But I think importantly, Steve, a lot of the interventions that are recommended at a global level are largely proven in spaces with a much higher income bracket. So sort of higher income countries. Whereas the context that we come from is rather more low and middle income countries. So it becomes important that we test these interventions. And so what that means is that in our context, we have fertile ground for testing interventions and proving their efficacy, which is what we've done with a lot of interventions related to motivational interviewing.
Steve Rollnick (15:36)
I get you. I think I get you. And changes in your perspective?
Goodman Sibeko (15:41)
In what sense, Dave?
Steve Rollnick (15:42)
I mean, you started off as a doctor, then a psychiatrist, and now you're moving into a global sphere. Can you pinpoint changes in your perspective? I mean, since you asked me the question.
Goodman Sibeko (15:57)
That's a very interesting question, Steve. I think, you know, I see my life as a series of serendipitous moments, but at the same time, I think it's a question of acquiring the right skills to put you in the right room to take it to the next level. You know, when I studied medicine, my intention was to become a psychiatrist. And as I finished my psychiatry specialist training, I started asking questions like, why is it that we keep seeing these high readmission rates for patients with severe mental illness? That led me to start a study at the University of Cape Town with our good friend Dan Stein, which led to me asking more questions following those results, which led me to do a PhD. And when you do a PhD, you start working with policy makers and change makers at all sorts of levels. And you start realising that the impact you can have is not limited to just the clinical space, that sort of exposure started opening doors for me. And I think I've sort of fallen into it and been quite comfortable in the space. And I think that's really how it's evolved, Steve. It's just been one door after another, and I'm very happy to be at this door.
Steve Rollnick (17:07)
Yeah, and so your perspective in one sense has got wider and wider.
Goodman Sibeko (17:11)
Absolutely. And I think that maybe that's the goal of assisting someone to make change, isn't it? Allowing them to see that if they put themselves in a position to be able to see that there are additional opportunities, their perspective can also widen and give them more hope.
Steve Rollnick (17:27)
It's interesting link that.
Goodman Sibeko (17:28)
Yeah, no, Steve, it's been it's been great to catch up again. And so do you have any closing words for me?
Steve Rollnick (17:36)
Just to thank you for this really interesting conversation and I look forward to more.
Goodman Sibeko (17:42)
Wonderful, Steve.
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