What does the evidence tell us about Motivational Interviewing (MI), and what might the future of research hold?

In the final episode of the ISSUP Exchange series, Dr. Goodman Sibeko and Professor Stephen Rollnick explore the research behind MI, discussing why it remains effective across so many settings. With over 2,500 randomised trials, MI is one of the most studied approaches in behavioural health, but some of the most valuable insights come from understanding how and why it works.

They look at the importance of process research, the impact of brief interventions in emergency settings, and how MI principles are now used beyond clinical practice, including in staff development, leadership, and team culture. The episode also touches on professionalisation in addiction services, AI's potential in MI training, and how embedding empathy and autonomy into systems can support both clients and practitioners.

Whether you're a researcher, trainer, or frontline practitioner, this episode offers a thoughtful look at where MI is making a difference and how it can continue to shape people-centred care.

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

Time Stamps

[00:00] – Introduction

[00:54] – Defining Competence in Motivational Interviewing

[03:10] – The Role of Leadership in Effective Training

[05:04] – Organisational Culture and Change

[09:59] – The Importance of Helpfulness Skills

[12:44] – Training Models and Their Effectiveness

[16:02] – What Strengthens MI Competence in the Real World

About the ISSUP Exchange 

The ISSUP Exchange podcast series explores the evolution of responses to the challenges of substance use—from research and training to ethics, quality standards and evidence-based practice. We connect the dots so you can see the big picture. 

Explore more episodes and join the ISSUP podcast community here>>>

About ISSUP 

ISSUP is a global network that unites, connects, and shares knowledge across the substance use prevention, treatment, and recovery support workforce. Our mission is to make our members’ work as effective as possible—by providing access to training, resources, and a vibrant professional community. 

A warm welcome to you and thank you for joining us for this ISSUP podcast. I'm Goodman Sibeko the ISSUP Global Scientific Advisor and your host. You can find me on LinkedIn and all the socials at the handle of Prof. G. 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, connects professionals worldwide, sharing evidence-based resources, training, and networking opportunities. Membership is free, so visit us at isap.net to join and access webinars, events, and a world of useful training and knowledge share materials. On today's follow-up podcast on Motivational Interviewing, we'll turn our attention to the evidence for motivational interviewing and maybe consider some ideas

for where research in motivational interviewing might best go to take the conversation forward. As always, we hope you enjoy this conversation and that you're inspired to engage in some research on motivational interviewing as might be relevant to your own practice. Steve, thank you for joining me again. Welcome back. Thank you. So today we're gonna talk a little bit about some of the research that's been done for motivational interviewing. And if we've got time later, we might talk a little bit about.

A pleasure, Pleasure, Goodman.

Motivational interviewing for staff development and staff management, which is something that my team has delved into a little bit. So what we know is that motivational interviewing has been evaluated across many, many hundreds of clinical trials and analyses, and that it's considered to be well supported and evidence-based. And I think what's really great is that its utility has been demonstrated not just for substance use, but also for dietary.

considerations for physical activity, for medication adherence, and the fact that it, because it's so client-centric, client-focused and change-focused, it's really well-placed for folks or populations who are not actively necessarily seeking treatment. So patients who are seen as ambivalent or patients who are seen or considered to be mandated. How do you feel about what you've seen in terms of the research around motivational interviewing in general?

What inspires you? Where do you wish it would go?

Yeah, it's a great question. What inspires me is the research on the process. That inspires me more than the research on the outcomes, okay? There've been over two and a half thousand randomised trials on motivational interviewing. I mean, I feel at a loss to summarise that body of research. Two and a half thousand. I don't know why it... I mean, you could ask the question, why is there such a huge volume of studies?

because there can't be many other interventions in healthcare or mental health that have been so submitted to research. And I think it's because of this yearning to find a way of understanding behaviour change, I think. I don't know what, but there's a lot of it. The stuff that inspires me is the research on looking at the question, well, why is this working when it does work?

And there must be in the hundreds studies of what you might call the process of motivational interviewing. So that stuff inspires me as well as research on implementation, if you like, and the research on training and the research on stock development. And there's not enough of that last one in my view.

So I think you're right, Steve, that a lot of the research looks at what are the components of interventions that are effective and that cause change, that result in change. And then, and then it therefore focuses on the design of these, these interventions. So very often combined with problem solving therapy, with cognitive behaviour therapy, solutions oriented therapy. So it's really about looking at comparing these in contexts where

folks might have just had access, say, to problem solving. If you add this component of empowering the individual through motivational interviewing, does it have an improved outcome? I think what's been noticed is that the gains do seem to hold up over time.

encouraging you've noticed that

Indeed. So that's what the literature shows. I think overwhelmingly, particularly in the short and medium term, I think over time we'll see whether longer term gains are also maintained.

Yeah, yeah, yeah.

But I think Steve, for me, what's really exciting is when you initially started testing motivation, interviewing was really largely in the alcohol and drug space, wasn't it? But we seeing an increase in literature, especially in the HIV diabetes space that's focused on making sure that the behaviour change is oriented towards medication adherence. What are your thoughts about how successful that's been?

What I take a lot of hope in from is the thought that what they've evaluated, they have improved adherence rates because they've got this method called motivational interviewing. they have found that if you stop fixing problems for people and telling them why they should adhere and you come alongside them and you have a reasonable discussion with them about the benefits of adherence in which you listen to their sense of what the benefits are, this produces better outcomes. Now,

If that's the case, I'm truly delighted and I have trained practitioners working on research projects that address exactly that and, you know, diabetes self-care and cardiac rehab self-care, all sorts. And I'm hoping that if we ask the question, where's the magic in this research? Where is the magic? That it's that, that practitioners were able to move from fixes to quality guides and that that's what they were taught to do.

And that's why I'm excited by what I call the process research book, because I think it's bearing it out in that the more you confront people and instruct them and behave in a patronising manner to them, the poorer are your outcomes.

I'm very interested, Steve, to see down the line because, you know, right now we're grappling with considerations around the professionalisation of the field. So when it comes to addiction, we want to say, we want to make sure that the folks who are out there treating folks with addiction have core competence. And so when it comes to finding ways to standardise certain competencies is, you know, you and I have to, you know, over the course of the series have spoken about that, you know, motivational interviewing isn't just the theory isn't just the, all of the elements of practice. It's also a way of being. It's also a culture. It's an institutional culture. It's a personal culture. It's a relational culture is how do you make sure that, you know, one balances the soft parts, which are those with the hard parts, with the core competencies that one needs to check all the boxes for, for credentialing. So that would be an interesting area for me as a researcher and as someone who,

Searcher.

wants to support the professionalisation of the workforce and make sure that clients are getting safe and replicable care.

That's a brilliant question. you know, as we know, a lot of the trials that have been done, many of them haven't used any measure of competence. So we don't really know. And when they have, they've tended to use measures that are very specialist. That really, you know. And so I'm not sure, but I imagine people will have developed brief competency measures that captured just a few of the core competencies. And these things are measurable.

Good relationship building skills, how's that? That I'd say is number one. Number two, useful open questions that encourage the person to say why and how they might change, and so on. I imagine, I don't know, I've been out of the research world. I'm hoping that people have established what those core competencies are, and I've mentioned just a couple. And then there's maybe two or three more. And I think those things are measurable.

But whether people have developed them or not good men, I don't know. Have you come across it?

Yeah, I know that the colleagues at Stellenbosch, our good friends, Bob Mesh and friends have used the Mitty, so the motivational interviewing treatment integrity tool. There's also the motivational interviewing skills code and there's various other ones that you can use video and sort of coaching measures to sort of establish. So there are a few that are available out there. Some of them are check-in and some of them are live rating.

And where we should be investing energy is in using AI for this purpose. And that's happening already, but I would really hope that some of the energy and resources are channeled into the use of AI to analyse people's conversations, counselling sessions, consultations, whatever you call them, using AI to analyse them and give someone feedback and assess their competence. And that's well within reach and people, think, are working on this.

Absolutely. You know, we've got colleagues down in South Africa who've used motivational interviewing as a core element for managing and developing their staff. You know, I doubt that they've written this up, but it would be really interesting. I know there are a couple of publications out there. Most of them are a little bit older. It would be nice to have some newer ones. The principles of motivational interviewing have essentially been pulled away from just the clinical space, but into designing frameworks for supervision team management. And it links back to what we discussed earlier, which is driving organisational change, creating spaces that are safe or where people can start engaging with how do I become a different type of practitioner who's more compassionate. It's all about modelling, isn't it? If you experience an environment which enables you to feel valued, to feel recognised, to feel that there's compassion, you're more likely to be that kind of practitioner.

Exactly. I couldn't have put it better.

Yeah. And I think when we spoke about, you know, the approach in terms of motivational interviewing in practice, my main, you know, driver for wanting to make sure that we expose practitioners to this is that because you're sharing the burden with the client, there is some impact in reducing burnout for the practitioner, you know. So if it's used to coach staff and used to create an environment that is collaborative, it has been noted to reduce burnout.

And that of course, if a leader, so we spoke about leadership earlier as well, Steve, is that if a leader really embraces MI principles, they're more likely to exercise reflective listening, to allow folks in the workspace to be autonomous while providing them support, and to make sure that the supervision they provide is, you know, respectful and recognises the person's value. Correct.

Correct. And I'm sure you and I share a dream that research could be conducted that is systemic research, not just research on an individual clinical method. And that's an area for development.

If it sounds to me like what we're saying is, we know that there's a lot of evidence that at the clinical level, this is effective. We're saying we know that there's been demonstrated impact when it's combined with other interventions such as problem solving and cognitive behaviour therapy. We're saying we know that there is early evidence that there is some good impact when this is adopted in the workspace as well. But I think we agree that we'd love to see more system-wide sort of research and to look at ways to measure both the soft and the hard competencies for

We're spot on, but I would just add one thing on that journey that you just took me through, which we haven't touched on, which is that there's very good quality research on very brief conversations and consultations in emergency settings and tough hospital environments. And I think that research is really very impressive. In other words, a super brief conversation, like for a minute or two, can have a very powerful impact.

on people if you get the conversation right. In my world of working in sport now and working in the Premier League football, that's what I see the really quality coaches doing. They can have a brief conversation with somebody that has a major impact. And we found that in healthcare, that in A &E settings, for example, motivational interviewing can inspire a brief conversation that impacts people's lives. So believe me, what you say matters.

Absolutely. You know, we've got colleagues at the Medical Research Council in South Africa who've done a lot of work in the emergency space using motivational interviewing as a core element for screening, brief intervention and referral to treatment for substance use disorders. And for colleagues listening, I'm sure you'll be familiar with this, but it's really about taking, being opportunistic about finding folks who might be using substances at risky levels and allowing them to understand the need to change their behaviour so that they improve that or reduce the likelihood of developing worsening substance use disorder.

That's right. And if you do that by not wagging a finger at them, but coming alongside and having a brief conversation, there is evidence that it works. And I think the pioneer of this, and I feel I want to acknowledge it, is Nick Heather. And I'm very sad to report his passing and death recently. And he was a pioneer in this field for decades and was a personal friend and inspired me to work in this field of brief intervention. And it's proven to be incredibly useful where it's been used thoughtfully.

Steve, I appreciate you so much. Thank you for joining us for this episode. I think we've spent some time really getting into what's been interesting about the research and where we'd like it to go. And again, if the listeners want to share some ideas with us, please reach out to ISUP and tell us what you found, what you're interested in learning about in terms of research for motivational interviewing. And we'll see you on the next episode of an ISUP podcast. Steve, thank you so much. We appreciate you.

A huge pleasure, Goodman, and best wishes to everybody.

Thank you for spending this time with us. We hope you enjoy that as much as we did. We really want to express our heartfelt thanks to Professor Rolnik for sharing your time and your thoughts with us. It's always a pleasure to talk to you and always wonderfully challenging and enlightening. We look forward to continuing to learn with and from you and to continue experiencing the growth of motivational interviewing. 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.