Say you’re a student at Hogwarts, and you want to help your uncle reject Voldemort. You might start 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. 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. Are there any principles that matter so deeply to you that you’d be willing to take that risk?
In controlled trials, motivational interviewing has helped people to stop smoking, abusing drugs and alcohol, and gambling; to improve their diets and exercise; to overcome eating disorders; and to lose weight. The approach has also motivated students to get a good night’s sleep; voters to reconsider their prejudices; and divorcing parents to reach settlements.
Recently, thanks to a vaccine whisperer, it has been applied to immunization. Arnaud Gagneur is a pediatrician in Quebec who encourages reluctant parents to immunize their children. In his experiments, a motivational interview in the maternity ward after birth increased the number of mothers willing to vaccinate their children from 72 percent to 87 percent; the number of children who were fully vaccinated two years later rose by 9 percent. A single conversation was enough to change behavior over the next 24 months.
I set up a conversation between Dr. Gagneur and my friend. After 90 minutes, it was clear to me that R.’s vaccination stance had not changed.
“I have tried to apply all the principles of motivational interviewing, but I have had the unpleasant feeling of not doing so well,” Dr. Gagneur wrote to me in email. “R. is very knowledgeable and always ends up finding arguments that support his decision.”
Strangely, I didn’t feel defeated or irritated. I wanted to learn how my friend’s views could evolve.
The pioneers of motivational interviewing, William Miller and Stephen Rollnick, have long warned against using the technique to manipulate people. It requires a genuine desire to understand people’s motivations and help them reach their goals. Although R. and I both want to keep his children healthy, I realized I had never tried to understand his perspective on vaccines before. So the next morning, I called him.
In our past debates, R. had focused only on the potential downsides of vaccinations. With Dr. Gagneur, though, he acknowledged that vaccines could be good for some but not necessarily for others. If he lived in a country experiencing an outbreak of, say, malaria, would he consider immunization? “You weigh the pros and cons,” he said.