by Adam Grant
While Tobie was still in the hospital, Marie-Hélène was shopping for diapers when she saw a headline about measles spreading in her province of Quebec. She hadn’t had Tobie vaccinated. It wasn’t even a question—he seemed too fragile. She hadn’t vaccinated her three other children, either; it wasn’t the norm in her community. Her friends and neighbors took it for granted that vaccines were dangerous and passed around horror stories about their side effects. Still, the fact remained: Quebec had already had two serious measles outbreaks that decade.
Today in the developed world, measles is on the rise for the first time in at least half a century, and its mortality rate is around one in a thousand. In the developing world, it’s closer to one in a hundred. Estimates suggest that from 2016 to 2018, measles deaths spiked worldwide by 58 percent, with over a hundred thousand casualties. These deaths could have been prevented by the vaccine, which has saved roughly 20 million lives in the past two decades. Although epidemiologists recommend two doses of the measles vaccine and a minimum immunization rate of 95 percent, around the globe only 85 percent of people get the first dose and just 67 percent continue to the second. Many of those who skip the shot simply do not believe in the science.
Government officials have tried to prosecute the problem, some warning that the unvaccinated could be fined up to a thousand dollars and sentenced to jail for up to six months. Many schools shut their doors to unvaccinated children, and one county even banned them from enclosed public places. When such measures failed to solve the problem, public officials turned to preaching. Since people held unfounded fears about vaccines, it was time to educate them with a dose of the truth.
The results were often disappointing. In a pair of experiments in Germany, introducing people to the research on vaccine safety backfired: they ended up seeing vaccines as riskier. Similarly, when Americans read accounts of the dangers of measles, saw pictures of children suffering from it, or learned of an infant who nearly died from it, their interest in vaccination didn’t rise at all. And when they were informed that there was no evidence that the measles vaccine causes autism, those who already had concerns actually became less interested in vaccinating. It seemed that no logical argument or data-driven explanation could shake their conviction that vaccines were unsafe.
This is a common problem in persuasion: what doesn’t sway us can make our beliefs stronger. Much like a vaccine inoculates our physical immune system against a virus, the act of resistance fortifies our psychological immune system. Refuting a point of view produces antibodies against future influence attempts. We become more certain of our opinions and less curious about alternative views. Counterarguments no longer surprise us or stump us—we have our rebuttals ready.
Marie-Hélène Étienne-Rousseau had been through that journey. Visits to the doctor with her older kids followed a familiar script. The doctor extolled the benefits of vaccines, warned her about the risks of refusing them, and stuck to generic messaging instead of engaging with her particular questions. The whole experience reeked of condescension. Marie-Hélène felt as if she were being attacked, “as if she were accusing me of wanting my kids to get sick. As if I were a bad mother.”
When tiny Tobie was finally cleared to leave after five months in the hospital, he was still extremely vulnerable. The nurses knew it was their last chance to have him vaccinated, so they called in a vaccine whisperer—a local doctor with a radical approach for helping young parents rethink their resistance to immunizations. He didn’t preach to parents or prosecute them. He didn’t get political. He put on his scientist hat and interviewed them.
Calvin & Hobbes © 1993 Watterson. Reprinted with permission of ANDREWS MCMEEL SYNDICATION. All rights reserved.
MOTIVATING THROUGH INTERVIEWING
In the early 1980s, a clinical psychologist named Bill Miller was troubled by his field’s attitude toward people with addictions. It was common for therapists and counselors to accuse their substance-abusing clients of being pathological liars who were living in denial. That didn’t track with what Miller was seeing up close in his own work treating people with alcohol problems, where preaching and prosecuting typically boomeranged. “People who drink too much are usually aware of it,” Miller told me. “If you try to persuade them that they do drink too much or need to make a change, you evoke resistance, and they are less likely to change.”
Instead of attacking or demeaning his clients, Miller started asking them questions and listening to their answers. Soon afterward, he published a paper on his philosophy, which found its way into the hands of Stephen Rollnick, a young nurse trainee working in addiction treatment. A few years later, the two happened to meet in Australia and realized that what they were exploring was much bigger than just a new approach to treatment. It was an entirely different way of helping people change.
Together, they developed the core principles of a practice called motivational interviewing. The central premise is that we can rarely motivate someone else to change. We’re better off helping them find their own motivation to change.
Let’s say you’re a student at Hogwarts, and you’re worried your uncle is a fan of Voldemort. A motivational interview might go like this:
You: I’d love to better understand your feelings about He Who Must Not Be Named.
Uncle: Well, he’s the most powerful wizard alive. Also, his followers promised me a fancy title.
You: Interesting. Is there anything you dislike about him?
Uncle: Hmm. I’m not crazy about all the murdering.
You: Well, nobody’s perfect.
Uncle: Yeah, but the killing is really bad.
You: Sounds like you have some reservations about Voldemort. What’s stopped you from abandoning him?
Uncle: I’m afraid he might direct the murdering toward me.
You: That’s a reasonable fear. I’ve felt it too. I’m curious: are there any principles that matter so deeply to you that you’d be willing to take that risk?
Motivational interviewing starts with an attitude of humility and curiosity. We don’t know what might motivate someone else to change, but we’re genuinely eager to find out. The goal isn’t to tell people what to do; it’s to help them break out of overconfidence cycles and see new possibilities. Our role is to hold up a mirror so they can see themselves more clearly, and then empower them to examine their beliefs and behaviors. That can activate a rethinking cycle, in which people approach their own views more scientifically. They develop more humility about their knowledge, doubt in their convictions, and curiosity about alternative points of view.
The process of motivational interviewing involves three key techniques:
Asking open-ended questions
Engaging in reflective listening
Affirming the person’s desire and ability to change
As Marie-Hélène was getting ready to take Tobie home, the vaccine whisperer the nurses called was a neonatologist and researcher named Arnaud Gagneur. His specialty was applying the techniques of motivational interviewing to vaccination discussions. When Arnaud sat down with Marie-Hélène, he didn’t judge her for not vaccinating her children, nor did he order her to change. He was like a scientist or “a less abrasive Socrates,” as journalist Eric Boodman described him in reporting on their meeting.
Arnaud told Marie-Hélène he was afraid of what might happen if Tobie got the measles, but he accepted her decision and wanted to understand it better. For over an hour, he asked her open-ended questions about how she had reached the decision not to vaccinate. He listened carefully to her answers, acknowledging that the world is full of confusing information about vaccine safety. At the end of the discussion, Arnaud reminded Marie-Hélène that she was free to choose whether or not to immunize, and he trusted her ability and intentions.
Before Marie-Hélène left the hospital, she had Tobie vaccinated. A key turning point, she recalls, was when Ar
naud “told me that whether I chose to vaccinate or not, he respected my decision as someone who wanted the best for my kids. Just that sentence—to me, it was worth all the gold in the world.”
Marie-Hélène didn’t just allow Tobie to be vaccinated—she had his older siblings vaccinated at home by a public health nurse. She even asked if Arnaud would speak with her sister-in-law about vaccinating her children. She said her decision was unusual enough in her antivaccination community that “it was like setting off a bomb.”
Marie-Hélène Étienne-Rousseau is one of many parents who have undergone a conversion like this. Vaccine whisperers don’t just help people change their beliefs; they help them change their behaviors, too. In Arnaud’s first study, with mothers in the maternity ward after birth, 72 percent said they planned to vaccinate their children; after a motivational interviewing session with a vaccine counselor, 87 percent were onboard. In Arnaud’s next experiment, if mothers attended a motivational interviewing session, children were 9 percent more likely to be fully vaccinated two years later. If this sounds like a small effect, remember that it was the result of only a single conversation in the maternity ward—and it was sufficient to change behavior as far out as twenty-four months later. Soon the government health ministry was investing millions of dollars in Arnaud’s motivational interviewing program, with a plan to send vaccine whisperers into the maternity wards of every hospital in Quebec.
Today, motivational interviewing is used around the world by tens of thousands of practitioners—there are registered trainers throughout America and in many parts of Europe, and courses to build the necessary skills are offered as widely as Argentina, Malaysia, and South Africa. Motivational interviewing has been the subject of more than a thousand controlled trials; a bibliography that simply lists them runs sixty-seven pages. It’s been used effectively by health professionals to help people stop smoking, abusing drugs and alcohol, gambling, and having unsafe sex, as well as to improve their diets and exercise habits, overcome eating disorders, and lose weight. It’s also been applied successfully by coaches to build grit in professional soccer players, teachers to nudge students to get a full night’s sleep, consultants to prepare teams for organizational change, public health workers to encourage people to disinfect water in Zambia, and environmental activists to help people do something about climate change. Similar techniques have opened the minds of prejudiced voters, and when conflict mediators help separated parents resolve disputes about their children, motivational interviewing is twice as likely to result in a full agreement as standard mediation.
Overall, motivational interviewing has a statistically and clinically meaningful effect on behavior change in roughly three out of four studies, and psychologists and physicians using it have a success rate of four in five. There aren’t many practical theories in the behavioral sciences with a body of evidence this robust.
Motivational interviewing isn’t limited to professional settings—it’s relevant to everyday decisions and interactions. One day a friend called me for advice on whether she should get back together with her ex. I was a fan of the idea, but I didn’t think it was my place to tell her what to do. Instead of offering my opinion, I asked her to walk through the pros and cons and tell me how they stacked up against what she wanted in a partner. She ended up talking herself into rekindling the relationship. The conversation felt like magic, because I hadn’t tried to persuade her or even given any advice.*
When people ignore advice, it isn’t always because they disagree with it. Sometimes they’re resisting the sense of pressure and the feeling that someone else is controlling their decision. To protect their freedom, instead of giving commands or offering recommendations, a motivational interviewer might say something along the lines of “Here are a few things that have helped me—do you think any of them might work for you?”
You’ve seen how asking questions can help with self-persuasion. Motivational interviewing goes a step further, guiding others to self-discovery. You got a glimpse of it in action when Daryl Davis asked KKK members how they could hate him when they didn’t even know him, and now I want to unpack the relevant techniques in depth. When we try to convince people to think again, our first instinct is usually to start talking. Yet the most effective way to help others open their minds is often to listen.
BEYOND THE CLINIC
Years ago I got a call asking for help from a biotechnology startup. The CEO, Jeff, was a scientist by training; he liked to have all the necessary data before making a decision. After more than a year and a half at the helm, he still hadn’t rolled out a vision for the company, and it was in danger of failing. A trio of consultants tried to convince him to offer some direction, and he fired them all. Before the head of HR threw in the towel, she threw a Hail Mary pass and contacted an academic. It was the perfect time for a motivational interview: Jeff seemed reluctant to change, and I had no idea why. When we met, I decided to see if I could help him find his motivation to change. Here are the pivotal moments from our conversation:
Me: I really enjoy being the guy who gets hired after three consultants get fired. I’d love to hear how they screwed up.
Jeff: The first consultant gave me answers instead of asking questions. That was arrogant: how could he solve a problem before he’d even taken the time to understand it? The next two did a better job learning from me, but they still ended up trying to tell me how to do my job.
Me: So why did you bother to bring in another outsider?
Jeff: I’m looking for some fresh ideas on leadership.
Me: It’s not my place to tell you how to lead. What does leadership mean to you?
Jeff: Making systemic decisions, having a well-thought-out strategy.
Me: Are there any leaders you admire for those qualities?
Jeff: Abraham Lincoln, Martin Luther King Jr., Steve Jobs.
That was a turning point. In motivational interviewing, there’s a distinction between sustain talk and change talk. Sustain talk is commentary about maintaining the status quo. Change talk is referencing a desire, ability, need, or commitment to make adjustments. When contemplating a change, many people are ambivalent—they have some reasons to consider it but also some reasons to stay the course. Miller and Rollnick suggest asking about and listening for change talk, and then posing some questions about why and how they might change.
Say you have a friend who mentions a desire to stop smoking. You might respond by asking why she’s considering quitting. If she says a doctor recommended it, you might follow up by inquiring about her own motivations: what does she think of the idea? If she offers a reason why she’s determined to stop, you might ask what her first step toward quitting could be. “Change talk is a golden thread,” clinical psychologist Theresa Moyers says. “What you need to do is you need to pick that thread up and pull it.” So that’s what I did with Jeff.
Me: What do you appreciate most about the leaders you named?
Jeff: They all had vivid visions. They inspired people to achieve extraordinary things.
Me: Interesting. If Steve Jobs were in your shoes right now, what do you think he’d do?
Jeff: He’d probably get his leadership team fired up about a bold idea and create a reality distortion field to make it seem possible. Maybe I should do that, too.
A few weeks later, Jeff stood up at an executive off-site to deliver his first-ever vision speech. When I heard about it, I was beaming with pride: I had conquered my inner logic bully and led him to find his own motivation.
Unfortunately, the board ended up shutting down the company anyway.
Jeff’s speech had fallen flat. He stumbled through notes on a napkin and didn’t stir up enthusiasm about the company’s direction. I had overlooked a key step—helping him think about how to execute the change effectively.
There’s a fourth technique of motivational interviewing, which is often recommended for the end of a conv
ersation and for transition points: summarizing. The idea is to explain your understanding of other people’s reasons for change, to check on whether you’ve missed or misrepresented anything, and to inquire about their plans and possible next steps.
The objective is not to be a leader or a follower, but a guide. Miller and Rollnick liken it to hiring a tour guide in a foreign country: we don’t want her to order us around, but we don’t want her to follow us around, either. I was so excited that Jeff had decided to share his vision that I didn’t ask any questions about what it was—or how he would present it. I had worked with him to rethink whether and when to give a speech, but not what was in it.
If I could go back, I’d ask Jeff how he was considering conveying his message and how he thought his team would receive it. A good guide doesn’t stop at helping people change their beliefs or behaviors. Our work isn’t done until we’ve helped them accomplish their goals.
Part of the beauty of motivational interviewing is that it generates more openness in both directions. Listening can encourage others to reconsider their stance toward us, but it also gives us information that can lead us to question our own views about them. If we take the practices of motivational interviewing seriously, we might become the ones who think again.
It’s not hard to grasp how motivational interviewing can be effective for consultants, doctors, therapists, teachers, and coaches. When people have sought out our assistance—or accepted that it’s our job to help—we’re in a position to earn their trust. Yet we all face situations in which we’re tempted to steer people in the direction we prefer. Parents and mentors often believe they know what’s best for their children and protégés. Salespeople, fundraisers, and entrepreneurs have a vested interest in getting to yes.
