Most therapists enter the helping professions with a genuine desire to help others and effectively support their patients to make healthy changes. These types of personal motivations can foster resilience against the challenges characteristic of helping professions, and can underpin an individual therapist’s clinical strengths. But as Stephen Rollnick (co-developer of Motivational Interviewing [MI] alongside founder William Miller) explains in this short video, that same impulse can work against the very change it’s trying to bring about.
The term Miller and Rollnick coined for this phenomenon is the righting reflex: the automatic, well-intentioned urge to identify a problem and solve it for someone else. While it can be an innocent, or even useful underlying motivation for the clinician, Motivational Interviewing offers unique insights into when the righting reflex can interfere with interventions that actually support patients to change.
The Righting Reflex in Practice
To illustrate the righting reflex, Dr. Rollnick uses the example of a mother watching her child struggle with a puzzle. Rather than bearing witness and allowing the child to figure out the solution for themselves, the mother intervenes. As Dr. Rollnick points out, the problem with this strategy is that it prevents the child from learning how to solve the puzzle.
The equivalent action in a psychotherapeutic context might be the therapist moving straight to offering a solution when the client shares what the therapist perceives to be a problem that needs fixing. Say the client mentions that they’ve noticed an increase in the number of drinks they have in the evenings after they finish work. A clinician operating from their righting reflex might move straight to suggestions of other ways the client can relax when they get home, or suggest some kind of monitoring exercise to get on top of their drinking.
When we offer our patients solutions in this way in therapy, it not only prevents them from finding their own ways to solve the puzzles of their lives, but it can also have negative consequences for the therapeutic relationship, and perpetuate ambivalence that the client may be feeling about change. The therapist jumping straight to solutions for their client’s increased alcohol consumption is assuming that the client actually sees the drinking as a problem, and is ready enough to take motivated action for change.
In MI terms, they’ve also skipped the first three stages of motivational interviewing - engaging, focusing, and evoking - and moved straight to the final stage of planning. (See the Four Processes of Motivational Interviewing for more detail.)
The Pressure to Be (Seen As) Helpful
The righting reflex has its origins in a number of aspects of the therapist’s experience. Beneath the explanation that the therapist simply wishes to be helpful, their role by nature also includes an ongoing pressure to offer something: to demonstrate effectiveness actively so as to be seen as effective by the patient. This pressure can often sponsor the therapist to favour interventions that involve more action on their part, including offering corrections, warnings, and solutions to the patient, regardless of their state of readiness.
This is also a matter of clinical training. Many clinicians enter their field having been taught, implicitly or explicitly, that skill and expertise are signaled by a directive, coaching stance where the therapist has all the answers. Acknowledging the righting reflex invites clinicians to reframe what it means to be helpful, and to locate their own skills in the ability to create conditions for the client to find their own motivation to change, rather than how they can demonstrate their own expertise.
The Spirit of MI: A Remedy to the Righting Reflex
Motivational interviewing offers clinicians an alternative to the more directive, ‘righting’ orientation by making special provision for clients who are ambivalent, resistant, or simply not quite ready for change. What Miller and Rollnick refer to as ‘the spirit of MI’ is characterized by a stance that honours the client’s autonomy first, and recognizes that lasting change is almost always self-generated rather than externally prescribed.
In this context, MI provides a framework focused on empathy, attuned listening, and aligning with the client’s own pace. The therapist can then be helpful in a way that might appear less active on the surface, but that is ultimately associated with high rates of client change. Studies on therapist behaviour and client outcomes have consistently found that high-empathy counsellors have higher success rates, while a more directive, confrontational style is associated with higher drop-out and relapse rates, weaker therapeutic alliance, and poorer outcomes (Moyers & Miller, 2013).
Benefits of Using MI For Clinicians
Using MI principles to bring awareness to the righting reflex not only improves outcomes for clients, but it can also take the pressure off therapists. The invitation to reconceptualize success and skill in terms of facilitation rather than teaching or coaching creates a therapeutic environment that both clinicians and clients find more comfortable. This finding is supported by an emerging body of research. A study of medical residents who described themselves as having integrated MI into their practice reported a greater sense of personal accomplishment in their work - one of the key protective factors against burnout (Hershberger et al., 2024). Another study of practitioners indicated that MI training was associated with reduced rates of disengagement associated with burnout. Practical application of motivational interviewing techniques was also associated with increased resilience (Endrejat & Kauffeld, 2021).
For therapists interested in integrating MI into their practice, Psychwire has collaborated with MI founder William Miller, co-developer Stephen Rollnick, and expert MI researcher and teacher Theresa Moyers to create a Motivational Interviewing Courses, which include teachings on the righting reflex, the four processes of MI, teaching demonstrations, and direct access to the trainers via a discussion forum.
