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Motivational interviewing (MI) is a powerful technique used by psychiatrists and other healthcare professionals, often in the context of encouraging a person to recognise his alcohol or drug problem and of ‘motivating’ him to reduce his substance use. However, the technique has very broad applications. In our private life, we often feel compelled to offer advice to our near and dear, but the better the advice, the more likely it is to be ignored, resisted, or opposed. This can have unfortunate consequences, not only for the problem in hand but also for the warmth or quality of the relationship. Such problems can be avoided by using the principles and techniques of MI. In short, MI involves a sort of empathetic Socratic questioning aimed at determining a person’s readiness for change and, if possible, at encouraging him to recognise the full import of the problem and then at guiding his reasoning so that he appears to come to a solution all by himself. This not only lends him a sense of ownership and empowerment, but also strengthens the relationship or, in the professional setting, the ‘therapeutic alliance’ – as illustrated below.

Scenario A (without using motivational interviewing)
Doctor: According to your blood tests, you’re drinking too much alcohol.
Patient: I suppose I do enjoy the odd drink.
Doctor: You’re probably having far more than just the odd drink. Alcohol is very bad for you, you need to stop drinking.
Patient: You sound like my wife.
Doctor: Well, she’s right you know. Alcohol can cause liver and heart problems and many other things besides. So you really need to stop drinking, OK?
Patient: Yes, doctor, thank you. (Patient never returns.)

Scenario B (using motivational interviewing)
Doctor: We all enjoy a drink now and then, but sometimes alcohol can do us a lot of harm. What do you know about the harmful effects of alcohol?
Patient: Quite a bit, I’m afraid. My best friend, well he used to drink a lot. Last year he spent three months in hospital. I visited him often, but most of the time he wasn’t with it. Then he died from internal bleeding.
Doctor: I’m sorry to hear that, alcohol can really do us a lot of damage.
Patient: It does a lot of damage to the liver, doesn’t it?
Doctor: That’s right, but it doesn’t just do harm to our body, it also does harm to our lives: our work, our finances, our relationships.
Patient: Funny you should say that. My wife’s been at my neck…
(…)
Doctor: So, you’ve told me that you’re currently drinking about 16 units of alcohol a day. This has placed severe strain on your marriage and on your relationship with your daughter Emma, not to mention that you haven’t been to work since last Tuesday and have started to fear for your job. But what you fear most is ending up lying on a hospital bed like your friend Tom. Is that a fair of summary of things as they stand?
Patient: Things are completely out of hand, aren’t they? If I don’t stop drinking now, I might lose everything I’ve built over the past 20 years: my job, my marriage, even my daughter.
Doctor: I’m afraid you might be right.
Patient: I really need to quit drinking.
Doctor: You sound very motivated to stop drinking. Why don’t we make another appointment to talk about about the ways in which we might support you? (…)

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Groupthink arises when the members of a group seek to minimise conflict by failing to critically test, analyse, and evaluate the ideas that are put to them as a group. As a result, the decisions reached by the group are hasty and irrational, and more unsound than if they had been taken by either member of the group alone. Even married couples can fall into groupthink, for example, when they decide to take their holidays in places that neither spouse wanted, but thought that the other wanted.

Groupthink principally arises from the fear of being criticised, the fear of upsetting the group, and the hubristic sense of invulnerability that comes from being in a group. The 20th century philosopher Ludwig Wittgenstein once remarked that ‘it is a good thing that I did not let myself be influenced’. In a similar vein, the 18th century historian Edward Gibbon wrote that ‘…solitude is the school of genius … and the uniformity of a work denotes the hand of a single artist’.

In contrast to Wittgenstein or Gibbon, modern society constantly reinforces the notions that man is a social animal, that he needs the companionship and affection of other human beings from cradle to grave, and that the chief source of his happiness should come mostly if not exclusively from intimate relationships with other similarly gregarious human beings. In the realm of the nine to five or eight to eight, large corporations glorify and reinforce conformism, decisions are taken by committees dominated by groupthink, people are evaluated according to their ‘team playing skills’, and any measly time out is seen as an opportunity for ‘team building’, ‘group bonding’, ‘networking’, or, at best, ‘family time’.

Yet solitude also has an important role to play in any human life, and the capacity and ability for solitude are a pre-requisite for individuation and self-realisation. In his book of 1988, Solitude – A Return to the Self, the psychiatrist Anthony Storr convincingly argues that ‘the happiest lives are probably those in which neither interpersonal relationships nor impersonal interests are idealised as the only way to salvation. The desire and pursuit of the whole must comprehend both aspects of human nature.’

[See also my post on the manic defence]

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As far as men go, it is not what they are that interests me, but what they can become. – Sartre

The 20th century philosopher Jean-Paul Sartre called it ‘bad faith’ (mauvaise foi), the habit that people have of deceiving themselves into thinking that they do not have the freedom to make choices for fear of the potential consequences of making a choice. By sticking with the safe, easy, default ‘choice’ and failing to recognise the multitude of other choices that are available to him, a person places himself at the mercy of the circumstances in which he happens to find himself. Thus, the person is more akin to an object than to a conscious human being, or, in Sartrean terminology, more akin to a ‘being–in–itself’ than to a ‘being–for–itself’. People may pretend to themselves that they do not have the freedom to make choices by pursuing pragmatic concerns and adopting social roles and value systems that are alien to their nature as conscious human beings. However, to do so is in itself to make a choice, and thereby to acknowledge their freedom as conscious human beings.

Examples

One example of bad faith that Sartre gives is that of a waiter who does his best to conform to everything that a waiter should be. For Sartre, the waiter’s exaggerated behaviour is evidence that he is play-acting at being a waiter, an automaton whose essence is to be a waiter. However, in order to play-act at being a waiter, the waiter must at some level be aware that he is not in fact a waiter, but a conscious human being who is deceiving himself that he is a waiter. Another example of bad faith that Sartre gives is that of a young woman on a first date. The young woman’s date compliments her on her physical appearance, but she ignores the obvious sexual connotations of his compliment and chooses instead to direct the compliment at herself as a conscious human being. He then takes her hand, but she neither takes it nor rejects it. Instead, she lets her hand rest indifferently in his so as to buy time and delay having to make a choice about accepting or rejecting his advances. Whereas she chooses to treat his compliment as being unrelated to her body, she chooses to treat her hand (which is a part of her body) as an object, thereby acknowledging her freedom to make choices.

Implications

For Sartre, people may pretend to themselves that they do not have the freedom to make choices, but they cannot pretend to themselves that they are not themselves, that is, conscious human beings who actually have little or nothing to do with their pragmatic concerns, social roles, and value systems. In pursuing such and such pragmatic concerns or adopting such and such social roles and such and such value systems, a person may pretend to himself that he does not have the freedom to make choices, but to do so is in itself to make a choice, namely, the choice of pretending to himself that he does not have the freedom to make choices. Man, Sartre concludes, is condemned to be free.

Inauthenticity