ビル・ミラー基調講演 2025 – ホームカミング（帰郷）〜50年の旅　※全文和訳

ミラー先生基調講演（2025年10月23日、ミネアポリス）

2025年10月23日、米国ミネソタ州ミネアポリスで行われたミラー先生（MIの共同創始者）の基調講演を紹介します（1時間9分）。YouTubeのリンク、要約、全文和訳、英語書き起こし原文を載せておきます。ざっくりとしたものですが（AI使用）、ミラー先生の講演にご興味のある方は参考にしてみてください。修正した方がいいところなどあれば教えていただけると嬉しいです。

要約

AIによる要約です。

① 「ホームカミング」──MIが“懐かしい”理由

MINTの仲間と会うと「帰ってきた」と感じる。
MIを初めて学ぶ人も、「新しい技法」というより“もともと知っていた在り方”として受け止める。
つまりMIは、人間が本来持つ優しさとつながり方を再発見する道なのだ。

② 原点：ロジャーズ的な学びとアルコール臨床の出会い

行動療法を学んでいた頃、ロジャーズの孫弟子から「聴く・受け入れる・共感する」姿勢を学ぶ。
退役軍人病院でアルコール依存患者にただ丁寧に聴くと、彼らはよく語り、癒やされていった。
当時の「対決的で命令的な治療」とは正反対の経験。
この違和感が、のちのMIの芽となる。

③ 短い関わりの“謎”

研究で、10回の治療と自助本を渡すだけの群にほとんど差がなかった。
「治療の長さや量」ではなく、関係の質が変化を生むのではないか。
さらに分析すると、セラピストの共感スコアと成果が強く結びつき、
低共感は無治療より悪化という結果も。
「何をするか」より「どう関わるか」が決定的に重要だと気づく。

④ ノルウェーでの覚醒──MIの誕生

研修中に「なぜその質問？なぜその聞き返し？」と問われ、自分の行動を言語化。
そこから導かれた原理：

• 変化の理由はクライアント自身が語る
• 押し返さず、抵抗も受けとめて聞き返しを行う
• 希望と自己効力を育てる
  この臨床スタイルに「Motivational Interviewing」という名が与えられた。

⑤ 実証と発展：FRAMES・Project MATCH・MET

Drinker’s Check-Upなどの研究から、効果的な要素を整理（FRAMES）。
MIは1〜2回でも効果を示し、Project MATCHではMI・CBT・12ステップいずれも有効。
だが結果を分けたのは「治療法」ではなく、治療者そのもの。
MIは、共通要因を意識的に形にした臨床スタイルといえる。

⑥ 本質：人間理解と「愛」の力

研究を重ねるうち、MIの根底にあるのは**Loving-Kindness（慈愛）**であると気づく。
それはユダヤ教の「ヘセド」、キリスト教の「アガペー」、仏教の「メッター」に通じる。
ロジャーズが晩年に語った「プレゼンス」──
“ありのまま受けとめ、希望を見出す在り方”こそが、MIの魂である。

⑦ 終章：「愛を携えて現れ続ける」

人は本来、思いやりと希望を持つ存在（ロジャーズの“建設的で信頼できる人間観”）。
だからこそ、MIとは「人間本来の姿に立ち返ること」。
混乱や暴力の時代においても、
“Keep showing up in love（愛を携えて現れ続けよう）”
──それが、Millerが伝えた最後のメッセージ。

全訳

全訳（ほぼ自動翻訳）です。

00:00
世界のどこでMINTが集まっても、私はいつも「帰ってきた」ように感じます。皆さん一人ひとり、そして私たちが共有しているものの中に、私がよく知っている何かを見出すのです。個人的には互いをよく知らなくても、私たちは一体であり、似ていて、共にある――そのような感覚があります。だから私は、MINTに来ると深い帰属意識を覚えます。
00:33
私にとってMINTの集まりは本当に「ホームカミング（里帰り）」のように感じられます。皆さんにもこういう経験があるか分かりませんが、ときどき私がMIを教えると、受講者はこう言います。「これは奇妙でも、特別でも、全く新しいものでもない気がします。どこかで前から知っていたような、なじみのある感じがする」と。
01:03
「自分が何をしているのか、なぜそうするのかを理解する助けにはなるけれど、真新しい学びというより、馴染みのあるものだ。むしろ自分はそこに属している気がする。――そうだ、私は支える人たちに対して、こう在りたいのだ」と。ある意味で、それはずっと前から知っていたことなのです。
01:30
不思議なことに、私がノルウェーに行ったときには、すでにそれを知っていました。デモンストレーションを始めたとき、同僚たちが「実際はどんなふうにやるの？　どう人と関わるの？」と求めてきました。私はすでにやっていたのですが、自分が何をやっているのか、意識していなかったのです。たとえば、変化への動機をその人自身の中に探す、ということを。
02:03
それでも、なぜか私はすでにそれを“できていた”。どうやって身につけたのか――それはいまだに謎です。そして、ほかにも疑問があります。どうしてこんなに多くの職種の人たちが動機づけ面接に惹かれるのでしょうか。「そうだ、私はこのやり方で人に仕えたい」と言う。まるで“それ”を認識しているかのように。
03:00
それに、あなた方も言われるかもしれませんが、この会場でも何人もから聞いてきたことがあります。「MIを学び実践することで、自分という人間が変わった」と。これは何なのでしょう。もし私が今も研究者だったら、それを解明しようとしていたでしょう。けれど、この言葉は本当によく耳にします。
03:05
さらに、どうしてMIは文化や言語、国境をあっさりと越えていくのでしょう。インドネシアでも、アフリカでも、中国本土でも、人々はそれを認め、「うん、分かる。私も学びたい。人とこう在りたい」と言う。ここで何が起きているのでしょう。――私には、50年かけて少しずつ組み上がってきたパズルの断片のように思えるのです。
03:33
今もなお、そのピースは集まり続けています。まだ全体像は見えません。先月、サンフランシスコで、スコットランドの友人で同僚でもあったニック・ヘザーを偲ぶ講演を行いました。ニックはそのキャリアの大半を「ブリーフ・インターベンション」に魅了されて過ごしました。そこで私が投げかけた謎は、「短い介入の何が効果的なのか。なぜそれが機能するのか」ということでした。これは私の初期キャリアに端を発します。
04:15
動機づけ面接の“前史”の一部でもあります。比較的短い会話の中で、人は何年も、何十年も抱えてきた問題の“角”を曲がれる――これには何が起きているのか。これも私のパズルの一部です。私にとっての始まりは、オレゴン大学でした。
04:48
当時のオレゴンは超・行動主義的なトレーニングプログラムでした。卒業すれば行動療法家になる、というタイプのね。しかも、その頃は「自分の心理療法の学派」を選び、その学派の“良さ”と他学派の“誤り”を教え込まれる、そんな時代でした。
05:10
私は実は行動主義者ではありませんでしたが、そこで行動療法は確かに学びました。ただ、行動療法を“手にする”前、つまりクライアントを診る前に、必修の1年間のコースがあったのです――クライアントとどう話し、どう聴くか、というコースでした。
05:37
行動主義の教員たちは言いました。「実習に入る前に、うちの学生は関係性について何かを学ぶ必要がある」と。そこで彼らは学内の別キャンパスに行って、カウンセリング心理のスーザン・ギルモアという教員を雇い、私たちを訓練させたのです。2学期にわたる素晴らしい時間でした。スーザンはレオナ・タイラーの弟子で、彼女はご存じのとおりカール・ロジャーズの弟子です。
06:08
つまり私たちは、ロジャーズの“学術上の孫弟子”から訓練を受けたことになります。彼女が教えてくれたのは、本質的には来談者中心（パーソン・センタード）であるという在り方でした。そしてそれは、私がその後ずっと行動療法を実践する上で自然に結びつきました。「ああ、こうすればいいのか」と。
06:27
最初のメンターはハル・アルコウィッツでした。彼は社会心理学に強い関心を持ち、『統合的心理療法』の編集を始め、心理療法を広い視野で見ていました。ご存じの方もいますが、やがてハルはMINTの一員となり、さまざまな心理問題の治療におけるMIについて書くようになりました。
07:02
つまり、私のメンターだったハルは、やがて同僚になったのです。なお、私はオレゴン大学に戻ってブリーフ・インターベンションについて話しましたが、その聴衆の中に別のメンター、ルー・ゴールドバーグもいました。彼はちょっと偏屈者でして、「ブリーフ介入の有効成分は“短さ”そのものかもしれない」なんて言った人です。
07:44
どういうわけか、私は“禿げたメンター”を引き寄せるのかもしれませんね……私もその仲間入りをしつつありますが。ともあれ、私がミルウォーキーの退役軍人病院へ夏の実習に向かったとき、持っていたのはスー・ギルモアのもとでの1年の訓練だけ――つまり、どう話し、どう聴き、正確な共感や是認、真摯さなどをどう行うか、という訓練だけでした。
08:15
研修責任者は言いました。「夏だけの滞在だし、病院内を回って病棟やユニットを見学して、この夏に何を学ぶか決めてはどうだ？」――なんとも素敵な招待でした。私はそうしました。いくつかはすでに経験のある領域でしたが――神経心理とか、地域での実践など。
08:39
ただ、アルコール依存症の入院治療ユニットがありました。当時は珍しかったのですが、その責任者はボブ・ホールという心理学者でした。ボブが聞きます。「アルコール依存についてどれくらい知っている？」――「何も」と私。「家族歴は？」――「特にありません」
09:04
「大学院の授業でアルコール依存について覚えていることは？」――「正直、話題に上った記憶がありません」。ボブは言いました。「君が心理学者として働くなら、アルコール関連は生涯で最も一般的な診断の一つだ。学んでおいた方がいい」。
09:29
ボブも、この“在り方”――MI的な在り方――をわかっていたのです。私はその夏をそこで過ごしました。できることは“聴く”ことだけ。だから患者と座って、ひたすら耳を傾けました。彼らは私にアルコール依存について教えてくれました。私は多くを学び、それはやがて私のキャリアの主要分野になりました。
09:54
患者たちも、話をよく聴かれることを喜び、そこから利益を得ているように見えました。興味深いことです。その後、私はアルコール依存の文献を読み始めました。そこには「アルコホリックは病的な嘘つきで、否認し、現実を見られず、非常に扱いづらい」と書いてある。
10:18
私は思いました。「ん？　ミルウォーキーの人たちは、私が話した人たちと違うのかな」。やがて気づきました。当時の治療は非常に“対決的（confrontational）”で、権威主義的だったからです。「座って、黙って、君には分からない。私が君の問題とすべきことを教える」――人間はそのアプローチを好まないのです。
10:58
私は考えました。ユニットの患者たちは人生が破壊されるほど重症だった。だから私は少し“上流”にさかのぼり、滝に落ちる前に川に落ちないよう手助けできないかと。そこで私の博士論文は、「節酒（モデレーション）を学ぶ手助け」をテーマにしました。これは当時、ある意味“異端”でしたが、私は知りませんでした。
11:20
論文では、アルコール使用障害の人に対して三つの行動療法――嫌悪条件づけ、行動練習のような詳細な訓練、そして自己統制訓練（自分の行動を変える戦略を話し合う）――を比較しました。結果はどれも有効。3・6・12か月で差は出ませんでした。
11:56
治療終了時、私は全員に自助本を渡すつもりでした――少なくとも嫌悪療法群には、節酒のマネジメントをあまり教えていませんでしたから。“お詫び”の意味合いも少しあって。ちょうど『How to Control Your Drinking（飲酒をコントロールする方法）』という本を仕上げたところで、1976年に出版されたものです。
12:18
ところが指導教官のエド・リヒテンシュタインは言いました。「待ちなさい。追跡データに影響するだろう」。そこで私は提案しました。「ではランダム化しましょう。3か月時点で本を渡す群と渡さない群に無作為に分け、6か月で全員に渡すというのは？」――それで進めました。
12:58
結果、本を受け取った人たちは時間とともに飲酒量がさらに減少し、6か月時点では両群にp<.001の差が出ました。――「おや、これは予想外だ」。そこで次の研究が思い浮かびました。「では、セラピストと取り組むのは、本を渡して家で取り組むよりどれほど優れているのか？」と。
13:29
私たちは人に対して親切に一度会い、よく聴き、詳しい評価もしましたが、最後は本を渡して「指示に従って、自分でやってみて。3か月後に会いましょう」としたのです。参加者が失望するかと心配したのですが、意外にも「自分でできるんですか？　それは助かる。通わなくていいのですね」と言う人が多かった。少し申し訳ない気もしました。
14:16
そして、10回の行動療法（3種のいずれか）に無作為に割り付けるか、本を渡して家で実践するか、という比較をしました。自己記録カードをつけて郵送してもらう、という最低限のコンタクトはありましたが、それだけです。
14:40
結果は――アウトカムに差は出ませんでした。本来なら「私と過ごす時間が長いほど良くなる」はずですよね？　ところが、本を渡され自分で実践した人たちは、外来で同じ方法を受けた人たちと同等の結果を出した。12か月追跡まで、ずっと差は出なかったのです。
15:15
これは気まずい。そこで多くの人がそうするように、私も“逃亡先”のニューメキシコへ。近所とうまくいかないとか、何か恥ずかしいことが起きた人が砂漠に逃れる、そんな場所なんですよ。私は行きました。
15:40
スタッフを集め、オールドタウンで集合写真を撮りました。両脇には二人のスーパーバイザー、そして九人のセラピスト。最初の研究では問題飲酒者を無作為に――
16:07
「オレゴンでの自分の研究が何かおかしかったのだろう、あれはあり得ない」と考え、再び比較しました。1回面接＋本を渡して帰す群、10回の行動療法群、さらに手厚い行動療法群（飲酒に関連しそうな課題も扱う）、そしてグループ版の行動療法。個人と集団の両方を試しました。
16:26
結果は同じ。時間経過に伴って全群で飲酒は大きく減少し、健康上意味のあるレベルの変化が起きましたが、15か月追跡では群間差はなし。
16:59
では“用量”を増やそう。私はまだ“否認”という考えに出会っていなかったのですね。18回の行動療法、6回の行動療法、本だけ――を比較しました。ランダム割付なのでベースラインの差は偶然ですが、本群は開始時点でかなり重症でした。それでも追跡では、皆が節酒レベルにまとまっていきました。
17:47
ただし、治療法間に差はなくても、「セラピスト」によってアウトカムは違いました。私は来談者中心の訓練も受けていたので、ロジャーズの系譜であるTruex & Carkhuffの「正確な共感」評価尺度を用い、セラピストがどれだけよく聴き、理解し、聞き返しを行なっているかを測りました。
18:12
この変数で、セラピスト間にかなりの差が出ました。1から9まで並べると、1番は全員一致で最も共感的。9番は、二人が9/9、他は8/9と評価。では、クライアントの改善率はどうか――この関係は一目瞭然でした。
18:31
左が最も共感的なセラピスト、右が最も共感的でないセラピスト。同じ手引き書に沿った行動療法をしているのに、この“差”。なお、本だけ群の成功率は60％。セラピスト全体の平均は61％。平均だけ見ると「セラピストは自助本と変わらない」と言えますが、このグラフを見てください。
19:10
自助本より良い結果を出しているセラピストが5人、ちょうど同じが1人（7番）、そして、自助本の方が良さそうに見えるセラピストが3人。テリー・モイヤーズと私はこれを再現しており、「低い共感」は無治療より悪いアウトカムを生むこともあるのです。
19:37
この所見を抱えて、私はまた“逃亡”――今度はノルウェーへ。初めてのサバティカル。MIの起源の物語は多くの方がご存じでしょう。私はアルコール依存の行動療法について講義するために招かれました。
20:14
しかし病院の所長は言いました。「セラピストたちとも会ってくれませんか。あなたから学びたいし、担当症例について雑談したいようです」。私は快諾。
20:32
隔週で、ノルウェーのセラピストのグループと話し始めました。多くは卒業して間もない心理職で、ソーシャルワーカーやチャプレンも。私は“在り方”としての来談者中心――正確な共感――と、行動変容のための行動的ストラテジーの両方を教えました。
21:00
彼らは言いました。「話だけでなく、実際に見せてほしい。どうやるのか見たい」。英語が堪能なトム・バート（MINTのメンバー）らが、実際に手こずっているクライアントを英語でロールプレイしてくれて、「あなたならどう応じますか？」と。
21:30
暗黙のサブテキストはこうです。「さて賢い先生、これをどう料理します？」。訓練の場で受講者に“クライアント役”を募ると、往々にして“地獄のクライアント”が登場します。何をしても反応しない、セラピストが演じるクライアントほど扱いにくい存在はないのです。
21:54
私は自然体でやって見せました。ノルウェーの心理学者たちは非常に熟考的で、哲学的訓練も受けている。すると彼らは私を途中で止めるのです。アメリカの学生はほとんどしないのですが、ロールプレイを始めて1、2分で「ちょっと待って。今、何を考えていますか？」と。
22:34
「いま質問しましたね。なぜその質問？　ほかの質問ではなく？」――「聞き返しの傾聴を教えているんですよね？　今あなたはクライアントの発言の一部について聞き返しを行いました。どうしてそれを選ぶのですか？　他の多くではなく？」――彼らのおかげで、私は自分が無意識に用いていた“意思決定則”を言語化することになりました。
23:01
そして気づいたのです。「変化の論拠を語るのは私ではなく、クライアントであるべきだ」。会話を、その人が「なぜ変わりたいのか」「どう変えるのか」「それがなぜ大切か」を語る方向に整える。私が関心を向けるのは、その人という“人”と、その人自身の動機である。
23:30
私が主にしていたのは、正確な共感でよく聴くことでした。そして、当時「抵抗」と呼んでいたものに出会ったときでも、決して押し返さない、議論しない、否定しない。「間違っている」「現実を見なさい」とは言わない。それも聴き、聞き返しを行いました。
23:55
なぜなら、押し返すと「変化しない理由」を強めてしまうからです。私はいつも希望と楽観を育みました。重大さを説得しても、「でも自分には何もできない」と思わせてしまえば、何の助けにもなりません。だから自己効力感や希望、可能性を見るのです。
24:50
彼らはこれを「動機づけ面接（Motivational Interviewing）」と名づけました。テーマは“動機”、それもクライアントの動機。そして「インタビューイング」という語――「セラピー」ではなく――を選びました。英語の“interview”は、どちらに権力があるかが決まっていません。
25:24
採用面接なら面接官が権力側でしょう。しかし、私も学部時代、著名な来訪者にインタビューしたことがあります。そのとき権力側は明らかに相手で、私は学ばせてもらう立場です。役割は同じ“インタビュー”でも対等ではない。会話（conversation）は互いが同じ役割ですが、インタビュアーと相手は役割が異なるのです。
26:06
当時、私はこれを治療の“準備”と考えていて、それ自体を心理療法とは見なしていませんでした。だからMIの最初の2版の副題は「変化への準備（Preparing People for Change）」なのです。私はこの論文を同僚たちに送り、意見を求めました。するとウェールズのレイ・ホジソンが「出版したい」と。
26:32
私は言いました。「いや、これは今しがた考えたばかりで、数字はページ番号しかない。効果の証拠はありません」。レイは「いや、見事な論文だ。ぜひ出させてくれ」と。そこで掲載され、ノルウェー滞在の翌年、MIの最初の学術的記述になりました。
27:00
編集者がするように、彼は匿名査読に回しました。査読者は、私が出会ったことのない“南アフリカのブッシュマン”――スティーブ・ロルニックでした。私がそれを知るのは20年後のことです。
27:36
私たちは当時、嗜癖行動治療の国際会議（ICTAB）を開催していました。第3回はエディンバラで、ニック・ヘザーと私が企画をしました。そこではMI（まだ発展途上）と、プロシャスカ＆ディクレメンテの「変化の理論（トランスセオレティカル・モデル）」が二大テーマ。両者は相性がよく、整合的に見えました。
28:09
少なくとも、前熟考期・熟考期・準備期の人に対してMIはできる。私は行動療法の訓練で“行動期”の支援はできましたが、多くのクライアントはそこにいるわけではなかった。70年代の依存領域では「帰りなさい、もっと飲んで準備ができたらおいで」なんて言っていた――本当に悪い考えでした。こうして私たちは共に考え始めたのです。
28:47
カーラ（ディクレメンテ）とは既に友人で、互いの考えを豊かにし合いました。私はニューメキシコに戻り、「では実際にテストできる“治療”にするには？」と考えました。そろそろデータを集めなければ、論文も出してしまったことだし。
29:10
そこで思いついたのが“飲酒者健診（Drinker’s Check-Up）”。私は初期段階の人を捉えたかった。敷居は低く。新聞に広告を出しました――「自分は飲み過ぎではないか、害がないか気になる方に、無料チェックをします」。スコット・ウォルターズはこれをコンピュータ化するなど多くの貢献をしました。
29:41
そこで、飲酒が人生に及ぼす初期の影響を拾うアセスメントを行い、1回のフィードバック・セッションで結果を伝え、アルバカーキの治療機関一覧を渡しました。――が、ほとんど誰も治療には行かない。治療動機づけになると思ったのに、そうではなかった。人々は“自分で”飲酒を変えたのです。
30:30
飲酒は大きく、臨床的に意味のあるレベルで減少しました。これはやがて「動機づけ強化療法（MET）」へと発展します（理由は後ほど）。私たちはカウンセリング・スタイルも比較しました。フィードバックを“ロジャーズ的な共感スタイル”で与えるのと、“対決的スタイル”で与えるのと。
30:50
違いは、相手が「そんなはずない、そんなに飲んでいない」と言ったときの応じ方です。「いや、一緒に合算しましたね。あなたが言った数字です。標準値はこちらです」と対決的に示すか、「そう感じるのですね。驚きますよね」と共感的に返すか。同じセラピストが両方を行い、得手不得手はありましたが――
31:38
どちらの群でも飲酒は減少しました。待機リスト群は“丁寧に待ってくれて”――私の待機リスト研究の発見ですが、待機リストに乗せると人は変わりません。評価もして問題も語ってくれたのに、曲線は完全にフラット。私たちが「待つように」と言ったからです。クライアントは親切で、私たちが治療できる前に変わらないようにしてくれるのです。
32:00
それで気づきました。二つの条件では人の“話し方”が違う。これを今では「チェンジトーク」と呼びます。対決的な条件では、変わる理由ややり方を語る量が半分ほどで、いわゆる「抵抗（今なら維持トークや不協和）」が多い。
32:26
チェンジトークと維持トークの比率――それが行動変化を予測することは今では分かっています――が大きく違う。対決的な条件では、人々は完全に両価的（アンビバレント）なまま、変わらない理由と変わる理由が同量。さらに、セラピスト行動の単一指標――実際に何をしているか――が、その後の飲酒量を有意に予測しました。
33:27
セラピストの「対決」が多いほど、クライアントは多く飲む。――今や少なくとも40以上の統制試験で、1～2回のブリーフ介入が飲酒に有意な影響を持つことが示されています。短い会話で、人は大きく飲酒を変える。あり得ないようで、何度も繰り返し見つかる所見です。
33:58
トム・ビーン、スコット・トーニグと共に、「では実際に何をしているのか」を探りました。ゴールドバーグの言うように“短さ”が有効成分でないことを願って。論文を読み、著者に電話し、「実際には何を？」と尋ねました。そこで生まれた頭字語が“FRAMES”。私は頭字語が好きなんです。
34:23
多くの場合、個人化された飲酒のフィードバック（F）がありました。同時に、常に「選択するのはあなた（R：責任／自己選択）」というテーマがあり、変える／変えないはあなたにしかできない。とはいえ「変えることを勧める（A：助言）」も普通に含まれる。
34:44
そして「選択肢のメニュー（M）」――飲酒を変える方法はいくつもある――これは力を与えるメッセージでした。カウンセリングのスタイルが記述されている場合は「共感的（E：共感）」で、傾聴がなされ、さらに「自己効力・希望（S：自己効力/希望の支援）」が促されている。――これがブリーフ介入に含まれている要素でした。
35:08
では、時間の経過のアーティファクトか？　あるいは自己記録（セルフモニタリング）の効果か？　クライアントは言います。「本当に効いたのは記録です。一杯飲む前に毎回書くと、『本当に飲みたい？』と考えるようになった」。――そこで、待機リスト（何もしない）と、待機しつつ記録だけする群、行動的自己統制訓練（セラピスト介入）群、本を渡して家で実践する群、の4群で試しました。
35:43
セラピストと会った群は、時間とともにきれいに飲酒が減少。家で自力でやった群も、またきれいに減少――やはり差はありません。待機群はまた“待って”くれました。私は今では、待機リストは有害だと思っています。「変わるな」と伝えているのに等しいからです。
36:02
つまり、単なる時間経過ではないし、評価の効果でもないし、記録だけでもない。――何か他のことが起きている。
36:24
その後、ニックに招かれて2回目のサバティカルでオーストラリアへ。シドニーの国立薬物・アルコール研究センターで働きました。隣の部屋にはスティーブ・ロルニックがいて、MIに関連する研究をしていました。彼が言いました。「ミラー、動機づけ面接の論文を書いたのは君か？」（彼が査読者だったとは明かさず）。
36:52
「ええ、読んでくれたのですか？」――「読んだどころか、私はそれを教えている。英国で依存領域の人気の方法になっていて、私はUKを行脚して教えている。でも自分が正しくやれているのかも分からない。もっと書くべきだ」。――「では、あなたのやり方を見せて」。
37:19
私たちは一緒にリアルプレイやロールプレイを楽しみ始めました。スティーブは、あの論文で私が言おうとしたことを深いレベルで理解していました。そこで私は提案しました。「一緒に本を書こう」。2年後、MIの初版が生まれたのです。
37:39
同じ頃、Project MATCHも進行中でした。私はシドニーから米国に飛んで会議に出ました。ひどい時差ボケで会議の一部は覚えていないほどです。MATCHは「どの治療に誰が合うか」を探る計画で、三つの治療を比較する統計的検出力（サンプルサイズ）を確保していました。研究所は治療法を指定せず、私たちで選ぶ必要がありました。
38:42
テーブルにいた多くは認知行動療法家。CBTは決まり。では他に何が？――「12ステップ」が米国では人気だ。フェローシップへの参加を実際に促す12セッションの“12ステップ促進療法”を設計しました（ハゼルデンにも確認し、「共感が少なめだが概ねOK」と）。
39:33
三つ目は？　概念的にできる限り異なるものを並べたい。そこで、私はMIを説明しました。ある程度のデータもありました。「MIはどのくらいの長さ？」――「1～2回です」――「え？　12セッションの治療と比較するのに1～2回では公平ではない。伸ばせる？」――
40:12
それで、アセスメント・フィードバック（飲酒者健診でやってきたもの）とフォローアップを加え、4セッションの「動機づけ強化療法（MET）」にした――これがMETの由来です。
40:32
1,726名のクライアントを三治療にランダム割付。名目上は治療間差には関心がないことになっていましたが、内心は全員気にしていました。結果は、三者とも有効、しかも非常によく効いた。
40:57
「禁酒日割合」は、治療最初の週に大きく跳ね上がり、そのまま1年（実際は3年）持続。10年追跡したサイトもあります。平均として、その変化は持続するのです。糖尿病や高血圧でこれができたら――1～2回の介入で“問題のない日”が80～90%に保たれる――大喜びでしょう。だから私は50年も依存領域に留まっているのです。
41:49
UKはそれで満足せず、「MATCHをもう一度、もっと良い治療で」と、家族も巻き込む“ソーシャル・ビヘイビア・ネットワーク療法（8回）”とMETを比較。――同じ。アウトカムに全体差なし。
42:13
大麻では？　多施設試験で、4か月時点ではMET+CBTがやや有利。しかし9か月では差が消え、15か月ではむしろMET単独が良さそうに見える。
42:50
少なくともアルコール領域では、治療の“強度・長さ・量”はあまり差を生まない。入院vs外来でも同等、短期vs長期でも同等。これは大学院を出たばかりの私の想定とは違いました。ただし、ブリーフ介入は常に無介入より良い。
43:11
療法間の優劣は？　私は行動療法で訓練されましたが、理論間比較では、有能でその方法を信じる治療者がそれぞれの理論で行えば、アウトカムは同等――これが一貫した知見です。
43:47
しかし、どの理論内でも、同じマニュアルに従っていても、「誰が担当したか」で結果は変わる。これはブルース・ワンプルドが生涯をかけて論じてきた点で、アウトカムを説明するのは技法ではなく“治療そのものの何か”なのです。
44:16
例として、私たちも関わったCOMBINE試験（多施設、1,300名超）。MATCHを踏まえ、CBT＋12ステップ促進＋共感的MI――これらを統合した“複合行動介入”を実施。少なくとも10例担当した治療者22名のアウトカムをプロットしました。
44:40
各線が一人の治療者のクライアント群の“禁酒日割合”。1年後の右端を見ると、ほとんどのクライアントがほぼ禁酒状態の治療者もいれば、逆にほとんど飲み続けている治療者もいる。同じ“はず”の治療を受けていても、です。――どの理論でも、どのマニュアルでも、この傾向は一貫しています。
46:03
そこでテリー・モイヤーズと私は関心を持ち、2年かけて70年分の心理療法研究を読み込み、「治療者について何かを測定し、治療者ごとのアウトカムを測っている研究」を集めました。多数ありました。そこで抽出したのが8つの特性――いずれも“性格”ではなく“技能”です。
46:32
どれも測定可能で、セッションを観察・コーディングでき、その程度がクライアントのアウトカムに関係します。興味深い本になりました。――私はこのリストを見て「見覚えがある」と思いました。正確な共感は最大の効果（平均効果量0.6程度）で、理論・問題領域を超えてアウトカムに寄与。採用の条件を一つだけ選ぶなら、“共感行動を示せる人”です（感じるだけでなく、行動として示せる人）。
47:12
これはMIの根幹でした。ポジティブ・リガード（無条件の肯定的関心）もロジャーズの三本柱の一つで、是認（アファメーション）はMIの一部。受容（アセプタンス）もMIの精神に最初から含まれています。
47:32
焦点化（フォーカシング）――クライアントと共有された明確な目標――は、アウトカム改善と関連。これはMIの主要課題。希望――クライアントの希望がアウトカムを予測しますが、治療者の希望もそうです。楽観的な治療者は悲観的な治療者より良い結果を生む。
48:21
喚起（エヴォケーション）――セッション中に、アウトカムと結びつく「何か」を起こす働きかけ。来談者中心療法では“エクスペリエンシング”、すなわちクライアントが一人称・現在形・感情を伴って“いまここ”の自分を語ること。これが起きるとアウトカムは良い。MIではチェンジトークがそれに当たります。
48:46
情報提供・助言は効果が最小ですが、MIの一部です。初期の私とスティーブは、助言をMIの“反対”のように描いてしまった――それは誤りでした。大切なのは“どう行うか”。
49:39
そして真正性（ジェニュイネス）。これは私とスティーブが初期に語っていなかったが、入れるべきだった要素。第4版には入っています。
50:01
ここで私は考えました。「私たちが教え、実践してきたのは、端的に言えば“有効性の成分”そのものなのではないか」と。非特異的――と言いつつ特定可能――で、いわゆる“共通要因”――と言いつつ実はそれほど“共通”でもない――そうした治療要因を、MIは一式まとめてきたのではないか。
50:29
さらに、これらは束になって現れるのでは？　共感的な人は、おそらく是認的でもある。よく聴く人は、おそらく受容も伝えている。相互に独立というより、まとまりとして現れるのです。
50:57
そして古い概念にも同じような“束”が見られます。ユダヤ教の「ヘセド」。英訳の際、カバデールは単語に困り、“愛（意図）”と“親切（行為）”を合わせて“loving-kindness（ラヴィングカインドネス／慈愛）”という語を作りました。うまい表現です。
51:28
キリスト教には「アガペー」――無私の愛。仏教（パーリ語）には「メッター」――benevolence（慈悲）と訳されますが、やはり多要素の複雑な概念。イスラームの「ラフマ（慈しみ）」も同様。これら一神教では、神の属性であり、同時に人が互いに向けるべき在り方。
52:28
治療者も、複合的な概念を見出してきました。ロジャーズ晩年の「プレゼンス（臨在）」――クライアントとともに“在る”こと。これは共感・真正性・肯定的配慮を束ねる概念です。近年は「レスポンシブネス」――相手をよく見て、その瞬間に応ずること――も研究されています。スクリプトに従うのではなく、“いま、この人”に応じる。
53:23
MIは、他の介入を“やめて代わりにやるもの”ではありません。むしろ他の実践の“やり方”にもなり得る。ロジャーズの『A Way of Being（在り方）』を見つけたとき、私は「そうだ、これを書き、やっているのだ」と思いました。
53:50
MIは他の介入と組み合わせられるし、実際そう使われている。文献を見ると、複合介入は「MI＋〇〇＋薬物療法＋CBT……」といった形です。つまり最初から“臨床スタイル”だったのです。
54:08
FRAMESを導いた初期研究の一つ――モーリー・チャーフェッツ（アルコール研究所の初代所長）による、マサチューセッツ総合病院の救急での試み――があります。飲酒関連の外傷で来院した人に、通常はアルコールへの介入はしない。その場で何かできないか？　治療につなげられないか？
54:43
処置後、ERで平均20分ほどの会話をする群と、通常処置のみの群を比較。1961年の最初の研究では、治療に戻ってきたのは42％ vs 1％。翌年の再現でも56％ vs 0％。彼らがしたのは“聴くこと”――ロジャーズ型の正確で共感的な傾聴でした。
55:13
さて、データはこのくらいにして、ここからは“データを越えた話”です。ロジャーズは78歳、最後の著書でこう述べました――私は今78歳ですが――「私たちのセラピーやグループの経験から、超越的なもの、言葉にしづらい霊的な次元が関わっていることが明らかだ。私はその重要性を過小評価していたのかもしれない」。
56:51
ロジャーズは宗教や霊性には慎重でした。原理主義的な育ちで傷ついていたからです。しかし晩年、彼は「何かがある」と言いました。私はかつて「量子的変化（Quantum Change）」を研究しました。短く、強烈で、忘れがたい体験――人を不可逆的に変えてしまう出来事。スクルージのように、何かが起き、言葉にしがたく、説明しにくい。しかし新聞でその体験を記述したら、電話が鳴りやまず、人々は話しに来ました。
57:14
受容――それは私たちの本質で、私たちが互いに向けるべき在り方。そしてしばしば、神秘家たちが語るように、“一体性”の体験――人類、自然、宇宙との繋がり――が伴うのです。「自分だけではない。自分はより大きなものの一部だ」と。
58:14
ロジャーズの在り方――共感、無条件の肯定的関心、真正性。これを一言で言えば“愛”。ただし“愛”には多義があります。C.S.ルイスは『The Four Loves』で、ギリシャ語の4種類の愛――エロス（性愛）、フィリア（友情・家族愛）、ストルゲー（対象への愛着）、アガペー（無私の愛）――を区別しました。最初の三つは、クライアント相手にはすべきでない類。
59:19
アガペーは、見返りを求めずに与える、共感的で、そこに在り、無条件の肯定的関心を向け、自分らしくあること。ヘブライ語のヘセドも同じです。
1:00:02
では、人と人の間で、相手の幸福を第一に据える関わり――それも、ほんの少量でも影響を生む――とは何か。私は「無私の“愛”の変容力」だと考えています。2000年に『Rediscovering Fire（火の再発見）』という論文を書きました。出版にこれほど苦労したことはありません。4度リジェクトされ、修正に修正を重ね、ついにAPAの雑誌に載りました。
1:00:28
その中で私は、ブリーフ介入の謎――なぜ短い関わりが人を変え得るのか――を、古い概念、アガペー／ヘセドで説明しようとしました。査読者は難色を示しましたが、最後には通ったのです。
1:01:26
アガペーはキング牧師の指針でもありました。彼は言います――見返りなしに仕え与えること、報復を望まずに苦しみを引き受けること、支配や優位を望まずに和解を目指すこと。
1:02:00
私は「テロス」――“本来、何になるべきか”――についても書いてきました。ドングリのテロスは樫の木。節くれや歪みも含め、それがなるべき姿。ロジャーズは自己実現（actualization）を語りました。人間性運動もそこに連なる。では人間のテロスは？　説は三つ。
1:02:34
A：精神分析的見解――人の内には暗く自己本位な動機がある（『蠅の王』のように）。B：行動主義――本性はなく、経験次第。C：本性は根源的にポジティブで、善良・思いやり・向社会性を志向する――“ヒューマン”。どれも証明はできませんが、どれを信じるかは重要です。
1:03:29
ロジャーズは言います。「私は“発見”した――人には種として固有と思われる特性がある。ポジティブで、前向きで、建設的で、現実的で、信頼に足る」。彼は明らかに“理論C”の人でした。「人は恐ろしく道を誤ることがあるが、その最も深い傾向は建設的方向へ進むと信頼できる」。
1:03:53
グレッグ・ボイル神父の仕事をご存じでしょうか。彼はHomeboy Industriesを創設し、ギャングから出所した人々と働いています。彼の原則は二つ――「私たちは皆、生得的に善い。例外なし」「私たちは互いに属し合う。例外なし」。量的変化の当事者たちも、それを体験していました。
1:04:47
私は古い“ラヴィング・カインドネス（慈愛）”という概念に惹かれました。どうやってそれを体現するのか？　実際にはどんな行いになるのか？　ヘセドやアガペーを遡り、私は12の属性を抽出しました。複雑で多面的なのも道理です。そこで『Loving Kindness』という小さな本を書き、その12属性と対極（反面）を記しました。
1:05:12
私は、これこそ私たちのテロスだと信じています。ロジャーズ同様、私たちの本性はそこにある――たとえ時にひどく道を誤ることがあっても。もしそれが真なら、ラヴィング・カインドネスを目の当たりにすると、私たちは“懐かしさ”を感じ、敬意を抱くでしょう。
1:05:47
また別の禿げたメンター、リチャード・ローアは『Falling Upward』でこう述べます――「人生とは、すでに自分の中にある“本来の自己”を、十分に意識的に“なっていく”過程である」。その自己は多くの場合、私たちにはまだ見えていない。――彼も、人間の本性をポジティブに捉えます。
1:06:09
それは、こういう在り方です――自分と同じくらい、あるいはそれ以上に他者を思いやる。他者に深く意識を向け、思いやり、共感し、マインドフルである。相手に何をすべきか指示するのではなく、注意深い伴走者である。相手の知恵を尊重・協働し、自律と自己決定を敬い、自分の専門知を“許可を得て”提供し、決して押しつけない。――希望を育む。複雑ですが、こういう在り方です。
1:07:03
懐かしく聞こえませんか？　テイヤール・ド・シャルダン――科学者で哲学者、司祭で古生物学者――は、霊性・宗教・進化について著し、その著作は教会から発禁にもなりましたが、彼はテロスを信じました。個人にとどまらず、進化全体が善き方向へ向かう、と。
1:07:32
『Toward the Future』の締めくくりで彼はこう書きます――「やがて人類は、宇宙空間や風、重力を支配した後、“愛のエネルギー”を神のために束ねるだろう。その日、世界史上二度目の“火の発見”が成る」。
1:08:00
私たちの国は今、とても暗い時代に入り、すでにその渦中にあります。エリ・ヴィーゼルは問いを発しました――「どうすれば、あのような悪と同じ世界に生きられるのか」。彼の答えは、「それとは正反対の生き方をすること」。私の言い方でいえば、「愛を携えて現れ続ける」ことです。人生でも、仕事でも。
1:08:29
――ナマステ。私の中のラヴィング・カインドネスが、あなたの中のラヴィング・カインドネスを見出し、認め、敬います。

英語書き起こし

英語書き起こし（自動書き起こし）です。

00:00Wherever in the world Mint meets, I always feel like I’m coming home. There’s something I recognize in all of you and in what we have in common. Even though we don’t know each other necessarily as people, there’s a sense in which we’re one, a sense in which we’re alike, we’re together. So I have a deep sense of belonging when I come to Mint.

00:33It does feel like homecoming to me, like coming home to come to meetings of Mint. And I don’t know if you have this experience, but sometimes when I’m teaching MI to people, they say that this doesn’t feel like something strange or unusual or new. It feels like something I kind of already knew in some way. It feels familiar to me.

01:03You’re helping me understand what I do and why I do it, but it’s not like this is a brand new thing that I’m learning. It’s something familiar. It’s something, in fact, I feel like I belong with it. It’s, yes, this is the way that I want to be with the people that I serve. So in a way, it’s something that I’ve known all along.

01:30A strange thing, when I went to Norway, I already knew this. And as we began doing demonstrations, my colleagues there asked me to show, well, what does it look like? How do you actually work with people? I was already doing it, but I didn’t know what I was doing. I didn’t realize that I wasn’t conscious of what I was doing, of looking for their own motivations for change, for example.

02:03what I was doing, of looking for their own motivations for change, for example. And yet somehow I already knew how to do it. And how did I learn that? That’s still a puzzle to me. And I have some other questions. Why is it that people from so many different professions are attracted to motivational interviewing? Say, yeah, this is the way I want to serve people. And it’s like they recognize it.

03:00And why is it that maybe people tell you this too? People in this room have told me this. Learning and practicing MI has changed me as a person. What’s that about? If I were still doing research, I’d be trying to understand that. But I do hear it often.

03:05And why is it that this seems to cross cultures and languages and nations so easily that people in Indonesia and Africa and mainland China recognize it and say, yeah, no, yes, I kind of understand this and I also want to learn it. It’s how I want to be with people. What’s going on there? It’s like pieces of a puzzle that have been coming together for me for 50 years.

03:33And they’re still coming together. Still don’t see the whole picture. Last month I gave a lecture in San Francisco honoring the memory of my friend and colleague from Scotland, Nick Heather. And Nick was fascinated with brief interventions through most of his career. And so the puzzle that I posed in the talk that I gave there was what is it that is effective about brief interventions? Why does this work at all? It’s something that arose early in my career, as you’ll see.

04:15It’s part of the prehistory of motivational interviewing. And what’s going on that in a relatively brief conversation, people can turn a corner on something that’s been troubling them for years or decades? What’s going on? So that’s part of the puzzle for me, too. It started for me at the University of Oregon, as you may know.

04:48Oregon was an uber-behavioral training program. So when you graduated from the University of Oregon, you were going to be a behavior therapist. And this was back in the era when you chose your school of psychotherapy and you went to a program that told you what’s cool about your school of psychotherapy and what’s wrong with all the others.

05:10So you were kind of indoctrinated. I never was a behaviorist, actually, but I certainly learned behavior therapy while I was there. But before we were ever allowed to lay hands on behavior therapy before we could begin seeing clients, there was a year-long course in how to talk to clients and it was required by the behavioral faculty.

05:37They said, before people come into our practicum and begin working on this, our students need to know something about relationships. And so they went across campus and hired a faculty member from the Counseling Psychology program named Susan Gilmore to train us. And we spent a wonderful two semesters with her. Susan was a student of Leona Tyler, who as you may know was a student of Carl Rogers.

06:08And so we had the benefit of being trained by an academic grandchild of Carl Rogers. And essentially what she taught us was a person-centered way of being with clients. And it’s how I always have practiced behavior therapy ever since. It just fit together for me. Oh, that’s how I always have practiced behavior therapy ever since. It just fit together for me.

06:27Oh, that’s how you do it. My first mentor there was Hal Arkowitz. Hal was very interested in social psychology, began editing the journal Integrative Psychotherapy. He had a very broad view of psychotherapy. And as some of you know, Hal then eventually became a member of Mint and began writing about motivational interviewing and treating people with a whole variety of psychological problems.

07:02So Hal kind of came around from being my mentor to being my colleague. And I also want to say, I went back to the University of Oregon to talk about brief interventions. And among the people in the audience was another one of my mentors, Lou Goldberg, who was kind of a curmudgeon and allowed us how maybe the active ingredient, why brief interventions work, maybe the active ingredient is brevity of contact with psychotherapy.

07:44I don’t know why I attracted bald mentors to me, but I… And I’m joining their ranks also. Yeah. Well, all I had was a year of training with Sue Gilmore in how to talk to clients and how to listen to clients and how to do accurate empathy and affirmation and genuineness and so forth. That’s all I had when I went on a summer internship to Milwaukee, to the Veterans Hospital there.

08:15And the director of training there said, well, look, you’re just here for the summer. So why don’t you go around the hospital and visit the wards and units and kind of see what you’d like to learn this summer. What a wonderful invitation also. And so I did that. And a number of the units I had already had some experience with, neuropsychology and community practice and so forth.

08:39But there was an alcoholism treatment unit, an inpatient alcoholism treatment unit. And the director, I didn’t know how unusual this was at the time, the director was a psychologist named Bob Hall. And Bob said, oh, well, what do you know about alcoholism? I said, nothing. No family history? Well, no, not really.

09:04Not that I know of. Well, what do you remember from graduate classes about alcoholism? And I said, well, honestly, I don’t remember it ever coming up. And Bob said, well, this is either the first or second most common diagnosis you’ll see in your life as a psychologist. You might want to learn something about it.

09:29See, Bob knew something about motivational interviewing, too, or this way of being with people. So I spent the summer there. And all I knew how to do was listen. So I sat with patients and listened to them. And they taught me about alcoholism. And I learned a lot from it. In fact, I wound up with that being a major area in my career.

09:54But the patients also seemed to enjoy it. They seemed to benefit from someone really listening to them. Well, that’s interesting. And then I began reading the literature on alcoholism, which said alcoholics are pathological liars. They’re in denial. They are incapable of seeing reality. They’re very, very difficult people to work with.

10:18I said, hm, those don’t feel like the people I was talking to. Maybe they’re different in Milwaukee. I don’t know. But it posed another puzzle for me of why is it that professional opinion about people with alcohol use disorders cast them as being in denial and difficult and oppositional and always fighting against you and denying and so forth, eventually I realized it’s because of the way we were treating people at the time in a very confrontational way because alcoholism treatment in the 70s was quite authoritarian.

10:58Sit down, shut up, you don’t know anything, I’m going to tell you what’s wrong with you and what you have to do. And guess what? Human beings don’t warm up to that approach. So I decided, and the people on the inpatient unit, their lives had been destroyed. They were severe.

11:20And I decided I’d kind of like to go upstream a bit and see if we can find a way of helping people not fall into the river before they get to the waterfall. And so my dissertation was around helping people to learn how to drink moderately, which at the time actually was kind of heresy, but I didn’t know that. And from my dissertation, I compared three different behavior therapies for people with alcohol use disorders, an aversion therapy, a kind of behavioral practice therapy that was very detailed, and a self-control training of just kind of talking to people about strategies you can use

11:56to change your own behavior. They all worked. There were no differences at three, six, or 12 months. There were no differences at 3, 6, or 12 months. And I was about to give everybody a self-help book at the end of treatment because at least people in the aversion therapy condition, we hadn’t really done much for them in terms of learning how to manage their drinking.

12:18And I was just finishing up this book that we called How to Control Your Drinking. It was published in 76. So I was going to give that to we called How to Control Your Drinking. It was published in 76. So I was gonna give that to everybody at the end of treatment as a help or maybe an apology in some cases.

12:36And then my dissertation advisor, Ed Lichtenstein, said, well, no, wait a minute. This could affect your follow-up data. I don’t want this to mess up your follow-up data. Oh, well, how about if we do a randomized trial here and we just randomly assign people to get or not get the book at three months and then we’ll give it to everybody else at six months? Okay, fair enough.

12:58And so that’s what we did. When people were finishing treatment at three months, we flipped a coin again and some of them got the self-help book and some of them didn’t get the self-help book. We wanted to make sure it didn’t mess up follow-up data. Well, it did. It turns out that people who got the book continued to decrease their drinking over time, and by the time we got to six months, there was a P001 difference between the groups in how much they were drinking.

13:29I said, wow, you know, didn’t expect that. Which suggested another possible study, which is, well, then how much better do people do working with a therapist than if you just give them the book and send them home, you know? And, you know, we were nice to people in the one session they got, and we listened to them, and we had done a pretty thorough intake evaluation with them too.

13:56But then we gave them the book and said, follow the instructions and we’ll see you in three months. And I was concerned people would be disappointed because they knew they were being randomly assigned to either seeing a therapist in one of three conditions or to going home with a book. But often people said, you mean I can do this on my own? Oh, that’s great.

14:16I don’t have to come in. I felt a little bad about that. And so we randomly assigned people to get 10 sessions of various kinds of behavior therapy or to be given a copy of this self-help book and go home and we’d see them at the end of the follow-up period.

14:40We did have them keep self-monitoring cards and mail them in, so a little bit of contact like that, but that was it. What we found was no differences in outcome. Now, that’s not supposed to be. It’s supposed to be the more time you spend with me as a therapist, the better you get, you know? And yet people going home with a self-help book and working on their own following this the same methods that we were using in outpatient therapy did just as well and there were there were no differences all the way up to 12-month follow-up in the outcomes of

15:15people in these two conditions well that was embarrassing so I did what many people have done over the years, which is I fled to New Mexico. It’s where people go when they’re not getting along with their neighbors or something embarrassing happened and you just want to get away from it all and go into the desert.

15:40So I did. And I assembled a staff back then. So I did. And I assembled a staff back then. We went down to Old Town, had our photo taken down there. And there were two supervisors working with me or sitting on either side of me in this picture, and nine therapists. Well, in the first study that we did, we randomly assigned problem drinkers.

16:07So we’re kind of saying, must have been something wrong with what I did in Oregon, because that can’t be. So we randomly assigned people to one session and go home with a self-help book. Or 10 sessions of behavior therapy, following the same methods. Or kind of souped up behavior therapy.

16:26We’re also talking about other issues that might be related to drinking or a group version of behavior therapy. Let’s try individual and group and just kind of see how this will go. Same thing. No differences at all over time in how people are doing. Everybody’s drinking decreased significantly, big enough change to be health-relevant, certainly, and yet by the time you get out to 15 months follow-up, groups are the same.

16:59Well, let’s try a bigger dose of therapy. See, I hadn’t discovered about denial yet. Let’s try 18 sessions of behavior therapy and compare it with six sessions, compare it with sending people home with a self-help book. And we randomly assign people to treatment, so that difference is an accident, but a huge, very significant difference that is the people in the self-help group were like way worse off to begin with, and yet follow-up, everybody’s clustered nicely with their drinking moderated.

17:47But the outcomes, even though they weren’t different between the treatment groups, were different by therapists. And because of my training in person-centered approaches as well as behavior therapy, we were using a rating scale by Truex and Karkoff for accurate empathy developed by Rogers Group.

18:12To what extent are these therapists listening well, understanding, and reflecting back to their clients what they’re hearing? And it turns out on that variable, therapists were very different from each other. And we lined them up. Many of you have seen this graph before. We lined them up from one to nine. Number one was the most empathic therapist. All of us rated her as number one.

18:31And at the other end, number nine, two of us rated that person as nine out of nine. The other is eight out of nine. And we said, how many of their clients are doing well? And this is the relationship. You don’t even need a correlation coefficient to look at this and of their clients are doing well? And this is the relationship.

18:46You don’t even need a correlation coefficient to look at this and know there’s some kind of relationship there. So on the left is the most empathic therapist. On the right is the least empathic therapist doing the same manual guided behavior therapy. It’s a big effect. And remember, we had a self-help group? Their success rate was 60%.

19:10If you average all the therapists together, it’s 61%, which could lead you to say therapists are no different from self-help books, which on mean, on average, is true, but look at the graph. We’ve got five therapists whose clients are faring better than if they were just working on their own. Therapist number seven achieved the same success rate as a self-help book.

19:37And then we had three therapists who it looked like they might have been better off going home with a good book. And Terry Moyers and I have replicated this, that low empathy actually yields outcomes worse than no treatment. Hmm. Yeah. Well, with those findings, I fled again and went to Norway. On my first sabbatical leave, and you know the origin story, most of you, about motivational interviewing, I was hired to lecture there about behavioral treatment of alcoholism, which I was doing.

20:14But the director of the hospital said, would you also be willing to meet with our therapists? Because they’d like to learn from you and just kind of chat about cases they’re seeing and so forth. I said, sure, I can do that.

20:32And so every other week or so, I began talking to this group of Norwegian therapists, most of whom were relatively recently trained psychologists, a social worker, a chaplain, you know, a kind of variety of people, most of them pretty new, pretty green out of school recently. And I was teaching them both a person-centered way of being, so I was teaching them accurate empathy, and also behavioral strategies for helping people change.

21:00And they said, well, it’s fine for you to talk to us about it, but we want to see it. We want to actually see how you do it. How does it look? How would we do that? And I said, well, at least one of them, Tom Bart, who’s a member of Mint, was very good at English. And he was able to role play in English clients they were seeing that they were finding difficult.

21:30And just show us how you would respond to this. As you might guess, the unspoken subtext of this was, okay, smart guy, what are you going to do with this? Which is what happens if in training you ask for someone from your trainees to volunteer to be a client. It’s the client from hell, you know.

21:54It’s the client who never responds to anything that you do, you know. There are no clients as difficult as those played by therapists, I can tell you. So I began doing just what was natural for me to do. And these psychologists were very reflective, they’re kind of philosophically trained in Norway.

22:34And they would stop me, they would stop me they would interrupt me in the middle of a role play just my American students almost never did that but we’d be a minute or two into the role play and they’d say the whole wait a minute now what what are you thinking what are you thinking right now? Or you just asked a question, fair enough. Well, why that question? Why not some other question? You’re teaching us reflective listening, okay? And you just reflected something that the client said.

23:01But how do you know what to reflect? Why did you reflect that? Why did you reflect that? And not many other things the client said. And they caused me to verbalize some decision rules that I seem to be using, of which I was not aware. And so we kind of started writing these down. And one of the things seemed to be that, well, it shouldn’t be me who’s making the arguments for change.

23:30It should be the client. So I was behaving in a way to arrange the conversation so the client would be telling me why they would want to change and how they might go about it and why it would be important and so forth. And I was interested in the client as a person and in their own motivations for change and what matters to them.

23:55And listening with accurate empathy, the primary thing I was doing was listening well. And when I met what we then called resistance, never pushed against it, never argued with it, never disagreed with it, never said you’re wrong, don’t you see reality here, anything like that. Listen to that too, would reflect that as well.

24:23Because if you push against it, it strengthens the arguments against change. I was being very careful to nurture hope and optimism, because if you persuade somebody that there’s a serious problem, but they think there’s nothing they can do about it, you haven’t done them any favors. So also to see self-efficacy, to see hope, to see possibility for change as well.

24:50And they gave this the name motivational interviewing because it’s about motivation, about the client’s motivation. And interviewing, intentionally chosen word, not motivational therapy, motivational interviewing, intentionally chosen word, not motivational therapy, motivational interviewing, and interviewing in English, not necessarily when you translate it to the equivalent word in another language, but in English, you don’t know who has more power in that discussion.

25:24You don’t know who has more power in that discussion. It might be the interviewer. If you’re an employer deciding who to hire, you’re the person in the power seat. But I also had the experience as an undergraduate of interviewing famous visitors to campus. And I’m definitely not in the power seat in that case.

25:46This is a very knowledgeable person, and I’m just trying to learn from them. And it’s the same role. And interviewing rather than motivational conversation, because in a conversation, the two people have the same role, whereas an interviewer has a different role. So you’ve got a different job than the person you’re talking to.

26:06And I was thinking of that as a preparation for treatment. I wasn’t thinking of it as psychotherapy itself at the time, which is why the first two editions of Motivational Interviewing have this subtitle, Preparing People for Change. Well, I sent that paper around to colleagues to say, what do you think about it? And one of them, Ray Hodgson in Wales, said, I want to publish it.

26:32I said, Ray, I just made it up. The only numbers are the page numbers. I mean, I have no evidence that this works. This is just kind of what we discovered together. And Ray said, no, I think it’s a brilliant paper. Please let me publish it. So I did.

27:00And it became the first published description of motivational interviewing a year after I was in Norway. And he did what he, what editors do, which he sent it to anonymous reviewers to comment and say things. And the person he sent it to was this South African Bushman, whom I had never met. And I wouldn’t learn until 20 years later, actually, that Steve had been a reviewer of that paper.

27:36Well, we were doing the International Conferences on Treatment of Addictive Behaviors at the time. And the third one, Nick Heather and I worked together to plan it in Edinburgh. And two significant themes in it were motivational interviewing which was just kind of being developed and the trans-theoretical stages of change or the model of change which has meant much more than the stages and so Jim Prochaska and Carly DiClemente were also there. So here were two different things in their nascent stages just getting developed.

28:09And they seemed to fit together pretty well. You know, they made a lot of sense together. If nothing else, motivation living is something you can do with people at the pre-contemplation or contemplation or preparation stage. Because in my behavior therapy training, I knew how to help people at the action stage but if they weren’t there yet which was most of my clients now what do i do you know what we did in the addiction field in the 70s we’ll say go away drink some more come back when you’re ready you know what a bad idea that was so there was kind of the beginning of our thinking together

28:47and carla was carla was already a friend uh and we stayed in touch over the years and enrich enriched each other’s thinking well then i went back to in new mexico and thought well how could we turn this into a treatment that we can actually test? I mean, let’s better start gathering some data, because now I published a paper on it.

29:10And so I come up with the idea of a drinker’s checkup. I wanted to get people at very early stages of problem development, which is something I came out of that two-year summer internship with. I wanted to catch people early. So we wanted low thresholds to get people in. What we did was advertise in the newspaper that we have a free checkup available for anybody who’s drinking, who wonders whether they might be drinking too much or wonders whether it might harm them.

29:41And Scott Walters has done lots of wonderful things with this, including computerizing it. might harm them. And Scott Walters has done lots of wonderful things with this, including computerizing it. And so we did an assessment that was designed to pick up early effects of drinking in people’s lives.

29:59And then we had one session of giving them feedback about what we had found. And we gave them a list of treatment referrals in Albuquerque. Well, almost nobody went to treatment. We thought this would motivate people to go to treatment. Nope, it didn’t do that. They had the nerve to change their drinking on their own. Again, you know. And their drinking decreased substantially, significantly. I mean, enough to make a real difference in health.

30:30And that eventually became motivational enhancement therapy, for reasons I’ll tell you in just a moment. We even compared a couple different counseling styles. Suppose you give the feedback in a Rogerian empathic style, or suppose you give it in more of a confrontational style, which is what was being done in addiction treatment at the time.

30:50And the difference is in what you say when the client says, oh, that can’t be right, I don’t drink that much. Do you say, well, look, we added it up together and here are the data. Actually, you told us this and here are the norms. And remember you said how much you’re drinking and so forth. Or do you say, this doesn’t sound right to you.

31:13It surprises you. Empathic response. And the same therapist did both styles. And I can tell you some of them were much better at one than the other. So it was kind of a mixture of stuff happening. But both groups showed some decline in their drinking. We had a waiting list control group and they very politely waited for us.

31:38And then when we treated them, when they had the checkup, then they decreased their drinking. That’s a finding from my waiting list control studies, that if you tell people they’re on a waiting list, they don’t change. Even though you gave them a big intake and they talked about all the problems and they presented themselves for treatment, it’s just an absolutely flat curve.

32:00And then they hit me, they were just doing what we told them to do, which is wait. Clients are very nice to us. Didn’t want us to feel bad that they would change before we could treat them. All right. And I began to notice some things. People in these two conditions were behaving differently. So this is what we would now call change talk.

32:26behaving differently. So this is what we would now call change talk. And in the kind of directive or more confrontational feedback condition, we’ve got about half the level of people talking about why they ought to change and we want to change and how they would do it. And a lot less people giving what we at the time called resistance, we now might call sustained talk and discord.

32:51And when you look at the ratio between change talk and sustained talk, which we now know does predict behavior change, it is way different. And in the more directive confrontational condition, we left people perfectly ambivalent, equal amounts of sustained talk and and change talk that’s interesting and in fact we found that a single counselor behavior we were measuring what our counselors were actually doing a single counselor behavior predicted significantly how much clients would be drinking.

33:27The more the therapist confronted, the more the client drank. Well there are now 40 at least controlled trials showing that a brief intervention, a session or two, makes a significant difference in drinking. You can do something in a conversation and afterwards people substantially change their drinking. It seemed like that shouldn’t be and yet over and over and over again it’s found.

33:58And so with Tom Bean and Scott Tonig and we tried to figure out well what what are people actually doing it? I hope Goldberg isn right, that it’s brevity that is the active ingredient. So we read the articles and also called up and talked to the authors of the articles saying, what do you actually do? And that’s where we came up with this acronym FRAMES. I love acronyms, as you can tell.

34:23And usually there was some kind of feedback being given to people, personal feedback about their own alcohol use. Nevertheless, the theme was always there that it’s up to you, and you’re the person who can make the change or not make the change, and nothing else is going to do that for you. Nevertheless, there was usually some advice to change.

34:44I hope you do. And a menu of options. Lots of different ways you can make a change in your drinking. That was an empowering message. Whenever the counseling style was described, it was empathic. So it was listening well to the person. And there was encouragement for hope, for self-efficacy, that you can do it.

35:08So that’s what these things seem to be. That’s what seems to be included in these brief interventions. Was it just an artifact of time? Or maybe the self-monitoring. Clients said, you know, the thing that really worked was keep on those records because when i wrote down every drink before i had it i really got to thinking you know do i really want this drink no i thought maybe maybe that’s what it was so we did a study with two control groups one of whom got was on a waiting list the second was on a waiting list and kept

35:43self-monitoring records then a group that we saw and did behavioral self-control training, and then a group that got the book and went home. And the group that saw the therapist, nice decrease in their drinking over time. The group that worked on their own, nice decrease in their drinking again, no significant differences.

36:02And the waiting list again waited for us. I now think waiting lists are pernicious because you’re telling people, don’t change. Nothing you can do. Sorry, nothing you can do until we can treat you. So it wasn’t just the passage of time. It wasn’t all the intake assessment we did. It wasn’t keeping the records either.

36:24Actually, people who kept the record cards, they even drifted up a little bit in their drinking. It was something else. Something else. Well then Nick invited me for my second sabbatical leave to go to Australia. And I spent that year, Kathy and I went to Sydney, Australia, and I spent that year working at the National Drug and Alcohol Research Center in Sydney.

36:52And in the office next to me was this fellow named Steve Rolmec, who was there actually doing a study kind of related to motivational interviewing. And he said, Miller, did you write a paper about motivational interviewing? Not confessing that he had reviewed it, you know. And I said, yeah, did you read it? I’m grateful that you read it. He said, not only did I read it, I’m trying to teach this.

37:19And it’s become a popular way of working with people with addictions in the U.K. And I’m going up and down the UK trying to teach this. And I don’t even know if I’m doing it right. You need to write more. I said, well, show me what you do. And we began having fun together with real plays and role plays and so on.

37:39And Steve got it. I mean, he understood at a deep level what I was trying to say in that article. And so I said, well, why don’t we write a book together? And two years later was the first edition of Motivational Interview. Focused on, yeah. All this happenstance, you know. Well, Project Match was also happening at the time.

38:08In fact, I had to fly back from Sydney to the U.S. for meetings of the Project Match research group. And there are parts of those meetings I don’t even remember. You know, the jet lag is devastating. But we were designing Project Match at the time it was designed to figure out who does well and which kind of treatment and we knew we had statistical power to be able to compare three different treatments and the institute didn’t tell us what treatments so we had to decide together well what three treatments for alcohol

38:42problems are we going to compare almost everybody at the table was a cognitive behavior therapist and so that was going to be one of the treatments and it was. Well what else what else is there in the world besides behavior therapy? I don’t know. Well there’s this 12-step stuff that’s going on out there. It seems to be pretty popular in the U.S.

39:05Maybe we could design a treatment to help people understand and get engaged in the 12-step program and fellowship. And I mean, not just tell them about it, but actually begin working the steps and doing it. And so we developed a 12-session, 12-step facilitation therapy, ran it by Hazelden to make sure we were doing okay.

39:33One thing Hazelden said was, well, you’re a little short on empathy, but other than that, it looks pretty good. And then what’s the third treatment? We wanted things that were conceptually very different from each other, just as different as could be, different kind of assumptions and so forth. I said, well, tell us about this motivational interviewing stuff you’re doing.

39:55So I did. And we had reasonable data at that point. And they said, well, how long does motivational interviewing take? And I said, well, a session or two. They said, well, how long does motivational evening take? And I said, well, a session or two. He said, what? No, I mean, we’re testing this against 12-session therapies.

40:12I mean, it wouldn’t be fair to just have a session or two. Can you kind of stretch it a little bit? So we added assessment feedback, which is what we’ve been testing with the drinker’s checkup, and a couple of follow-up sessions, and made a four-session motivational enhancement therapy, and that’s where motivational enhancement therapy came from.

40:32So clients, 1,726 clients. This is the biggest randomized trial done in the alcohol field. 1,726 clients randomly assigned to these three treatments, and ostensibly we weren’t interested assigned to these three treatments. And ostensibly, we weren’t interested in differences between the treatments. Both secretly we were.

40:57And what we found was all three worked. And it worked very well. This is percent days abstinent, a big leap in the first week of treatment, and it just stays there for a year, actually for three years. We even had a 10-year follow-up with one of our sites. People make this change, and it just stays there on average over time.

41:16Now, it’s not the same people all the time who are abstaining or drinking moderately, but on average, that’s it. I’ve stayed in the addiction field 50 years because the outcomes are so good. I mean, if you could do that with diabetes, if you could do that with hypertension, have a brief intervention where 80, 90% of the days there are no problems and the severity of other problems goes way down, you would be delighted.

41:49Well, the UK wasn’t quite happy with that, and so they said, let’s do Project Match again, and let’s do the treatment better. Let’s do a social behavioral network therapy and include the family and lots of bells and whistles. And so they compared motivational enhancement therapy with eight sessions of this souped-up therapy.

42:13And same thing. No overall difference in outcomes over time. Will it work for marijuana? Multi-site trial, trial again at four months, adding CBT to MET helped some. There’s a significant difference. By nine months it’s gone. By 15 months actually the direction is opposite, that the MET group is looking better than the MET plus CBT group.

42:50And in the alcohol field, at least, I’m going to say intensity and length and amount of treatment just doesn’t seem to make a difference. You’ve seen that in the studies I’ve shown you, but inpatient versus outpatient treatment, the outcomes are about the same. Brief versus extended treatment, outcomes are about the same.

43:11You know, that’s kind of not what I expected coming out of graduate school. But brief intervention is consistently better than nothing. How about different types of psychotherapy? After all, I was trained in behavior therapy, which is better than its competing models. Well, actually when you compare different psychotherapies with each other, all of them done by people who are trained in that method and believe in that method, the outcomes are the same. That’s very consistently over time.

43:47But there are differences within any treatment according to who did the treatment, according to the therapist. Even if they’re all using the same structured manual, clients’ outcomes are very different depending on who the therapist was. This is Bruce Womple’s major point in his prolific career, that it doesn’t seem to be the techniques that are being used that account for outcomes.

44:16It’s something about therapy. An example is the combined multi-site trial, which we’re involved in, 1,300 and some patients. And we had a, having finished Project MATCH, we said, let’s put those three treatments together. So let’s do cognitive behavior therapy and encourage people to try 12 steps and be empathic and do motivational interviewing.

44:40And so everybody in the psychotherapy conditions got that. And we picked out therapists who treated at least 10 clients using that combined behavioral intervention because we to talk about their average outcomes. But 10 cases, all right, that’s fair.

45:09We had 22 therapists delivering the combined behavioral intervention with at least 10 clients. And here’s the outcome. Each line is one therapist, all of their clients, percent days abstinent. Of course, they’re all over the map. But if you look at the right-hand side of the diagram here, you can see that a year later, there’s some therapists, almost all of whose clients are abstinent almost all of the time.

45:36And there are also some therapists, almost all of whose clients are drinking almost all of the time. Having received allegedly the same treatment and everything in between. It’s very consistent. Within theories of psychotherapy, within structured behavioral intervention manuals, whatever it is, clients’ outcomes vary with the therapist who treated them.

46:03That’s what Terry Moyers and I got interested in. So interested, we spent two years reading 70 years of psychotherapy research, looking for studies that measured something about therapists and measured outcomes of each therapist’s clients. And there’s a lot out there. And we came up with this list of eight characteristics, which are not personality characteristics. These are skills.

46:32All of them are measurable skills. You can actually watch sessions. You can code it. You can see the extent to which these things are happening. And it’s related to client outcomes. So, interesting book. Yeah, I looked at that list and said, hmm, they look familiar. Accurate empathy, which it was number one in our book because it has the biggest overall effect, about a 0.6 average effect on treatment outcomes across problem areas, across theories of psychotherapy, whatever.

47:12If you have to hire therapists on one thing that’s likely to benefit clients, hire empathic therapists. And don’t mean people who feel empathy. That’s okay. I mean people who can show you the behavior of accurate empathy, who can listen well and reflect back to clients. Well, that’s been part of MI from the beginning.

47:32Positive regard, another one of Carl Rogers’ big three. Affirmation has always been part of motivational interviewing. Acceptance of people as they are. Rogers believed that when you feel unacceptable, when you feel ashamed, it’s almost impossible to change. And when you experience acceptance as you are, paradoxically, it becomes possible to change.

47:59Well, acceptance has been part of the spirit of MI from the beginning. acceptance has been part of the spirit of MI from the beginning. Focus, having clear goals shared between you and the client, that’s related to better outcomes in psychotherapy. Focusing is a key task in motivational interviewing.

48:21Hope, yes, clients’ hope predicts outcomes, but so does therapists’ hope. Optimistic therapists have better outcomes than pessimistic therapists do. Evocation, a term that Terry and I use to describe you doing something during treatment so that something happens in sessions that is related to better outcomes. In client-centered therapy, it’s called experiencing.

48:46Eugene Ginland’s work. Experiencing is a client talking about themselves first person, present tense, with feeling content, not in the abstract, not talking about the past, but here’s what I’m experiencing right now. In client-centered therapy, when that happens during sessions, the outcomes are better.

49:12In motivational interviewing, you know, change talk during sessions predicts better outcomes over time. So that’s what evocation is. Giving information and advice has the smallest effect, and yet it’s part of motivational interviewing. Steve and I made the mistake early of describing advice as the opposite of motivational interviewing. It’s not the opposite of motivational interviewing.

49:39It’s how you do it. The way in which you give information and advice makes a difference. And then genuineness. That was something that Steve and I hadn’t talked about, but we should have. It should have been there from the beginning. And so it’s there in the fourth edition.

50:01So now I’m thinking, well, what does that mean? That what we’ve been teaching and practicing is essentially these components of helpfulness. These non-specific, except they’re specifiable. These common, except they’re not all that common, attributes of therapists. Bruce Wampold calls them therapeutic factors. I think that’s a good term. And somehow we have put together all of these therapeutic factors in motivational interviewing.

50:29So I’m not sure what that means. And do these cluster together? I got curious about that. Because if you’re more empathic, chances are you’re more affirming also. If you listen well, chances are you’re conveying acceptance also. So these are not independent variables, they kind of go together.

50:57And there are ancient concepts that contain many of these same ingredients. Three thousand year old one in Judaism is chesed. Chesed. When the Bible was being translated for the first time into English, Miles Coverdale, the translator, was trying, what word do I use for chesed? I mean, it’s a complicated concept. It has a lot of moving parts to it. Chesed, I mean, it’s a complicated concept.

51:28It has a lot of moving parts to it. There isn’t any single word in English that captures this. And so he made up a word. He put together loving, the intention, and kindness, the behavior, and created the word loving kindness, which is a pretty good description of what chesed is all about in Judaism.

51:51In Christianity, a very related concept, agape, is a particular selfless kind of loving. The Pali term metta in Buddhism, which is not a theistic religion. Often it is translated as benevolence, but again, it’s one of these complicated ideas with a lot of moving parts. And in Islam, Rahmah gets translated compassion, but it also is a really complex idea with a lot of pieces to it.

52:28And in the theistic religions, in Judaism, Christianity, and Islam, these are attributes attributed to God and also how we are supposed to be with each other. Interesting. Therapists have come up with complex ideas like this, too. Toward the end of his life, Carl Rogers was interested in the idea of presence, of being present with your clients, of being there, you know.

53:00He said that in a way that kind of captures empathy and genuineness and positive regard, and, you know, it’s sort of a combination factor. Or there’s research now on responsiveness, on attending to your client and replying to and responding to what they’re doing in the moment. You’re not following a script and delivering a 12-session scripted behavior therapy.

53:23You’re really responding to the person in real time. So maybe they cluster together too. Is that what we’ve been studying all along in motivational interviewing? We really didn’t mean motivational interviewing to be done instead of anything else. Over time it’s become clearer that motivational interviewing can be a way of doing what else you do.

53:50A way of being with people. When I discovered Carl Rogers’ last book, it’s called The Way of Being. I said, yes. Yes, that’s what we’re writing about. That’s what we’re doing. And MI can be combined with other kinds of interventions. And that’s how we’re writing about. That’s what we’re doing. And MI can be combined with other kinds of interventions.

54:08And that’s how it’s being used. If you look at the literature now, complex interventions are MI plus, plus, plus, plus, plus medications or plus cognitive behavior therapy or whatever it is. So in a way, that’s how it’s been from the beginning, a clinical style. Here’s an early study, one of those brief intervention studies from which we came up with the FRAMES acronym, done by Maury Chaffetz, the first director of the Alcohol Institute.

54:43And he worked in the emergency room at Mass General. And people come in injured related to their alcohol use. And typically nothing is done about the alcohol. You patch them up, you send them out the door. And he said, I wonder if we could do something while they’re in the emergency room that could make a difference and see if we could do something while they’re in the emergency room that could make a difference and see if we could get them to come back and get some treatment for their alcohol problems.

55:13And so he compared random assignment, a single intervention in the emergency room after the persons have been patched up. They’re still intoxicated in most cases, they’re hurting, you know, they got bandages on them or whatever, like the worst conditions for psychotherapy you could imagine, you know, but let’s try it.

55:40And on average it was about 20 minutes of conversation in the ER with just emergency room treatment as usual. In the first study he did, published in 1961, 42% came back for treatment compared to 1%. And he replicated it the next year. 56% came back for treatment compared to nobody ever came back for treatment with emergency room treatment as usual. And what were they doing? They were listening.

56:11They were listening to people specifically in the style of Carl Rogers in this accurate, empathic kind of way. All right. Well, lots of data. Fasten your seatbelts. I’m going beyond the data. Carl Rogers at 78 in his last book, and I’m 78 now, said, you know, our experiences in therapy and in groups, from that it’s clear that the transcendent is involved, the indescribable, the spiritual.

56:51I’m compelled to believe that I, like many others, have underestimated the importance of this mystical, spiritual dimension. And Roger was very careful to stay away from religion and spirituality. He had a fundamentalist upbringing that wounded him. But toward the end of his life, he’s saying, you know, I think there’s something there, and I’m becoming much more of a mystic myself.

57:14I did study quantum changes long ago. These are brief, intense, highly memorable experiences that people have that change them permanently. it’s like a one-way door they can’t go back through it and just they’re better people their lives are better like ebenezer scrooge and just something something happened that’s hard to talk about it’s hard to explain it’s difficult putting it into words.

57:47And yet when I described this kind of experience in the Albuquerque newspaper, the phone rang and rang and rang, and people came and wanted to talk to us. Acceptance, that’s who we are. That’s us at our deepest level. That’s how we’re meant to be with each other. And they also often, as mystics do, had an experience of union, of connectedness with all people or all of nature or all of the universe.

58:14It’s not just about me. I’m a part of something much bigger. It’s striking how consistent that was. Carl Rogers’ way of being, empathy, unconditional positive regard. You don’t have to prove you deserve respect. Genuine being your true self. We have a word for that called love. But love can mean a lot of things C.S.

58:49Lewis wrote this wonderful little book called The Four Loves and he drew on Greek words ancient words for love that mean different things eros is passionate romantic sexual love that’s one thing we mean by love. Philia is the affection you feel for your family, for your dear friends, for the people you’re really close to, you have a bond with.

59:19Storge’s kind of sentimental attachment. I love chocolate. I love this valley. Those three meanings are attached to love. They’re all things you’re not supposed to be doing with your clients. And then there’s agape. Agape is selfless, asking nothing in return, expecting nothing in return, being empathic, being present, extending unconditional positive regard, being yourself.

1:00:02That’s chesed also in Hebrew. Well, what do we know that happens between people that is concerned with, primarily concerned with, the well-being of the other person? That what you care about in the moment is how the other person is and how they’re doing. And even a small dose of it can make a difference.

1:00:28I think it’s the transforming power of that selfless kind of loving, particular kind of love. And I wrote an article called Rediscovering Fire, got published in 2000. After a lot of effort, I never had more trouble getting an article published. It went through four rounds of critique and review, and this is wrong, you’ve got to fix that.

1:00:53I don’t get this, this doesn’t make sense to me. I stuck with it, and it finally got published in an APA journal. And what I was saying, I was puzzling about brief interventions. How come we can do something brief that has transforming effect on people i you know what’s going on and i suggest there is this ancient concept agape chesed you know that maybe what’s going on you know and reviewers had a hard time with it but but I finally got it published.

1:01:26It was a guiding principle for Martin Luther King, agape. And he said, agape is being willing to serve and give without expecting anything in return. Being willing to suffer without wanting retaliation. Being willing to reconcile without wanting the upper hand. Without wanting to dominate. Wow. I’ve written about telos, another Greek concept.

1:02:00That which we’re meant to be. The telos of an acorn is the oak tree. Knots and gnarls and twists and imperfections and all. It’s what the acorn is meant to become. Rogers wrote about actualization, becoming what you’re meant to be. And the human potential movement was related to that. Well, what is the telos of human nature? What are we supposed to be? There are very different theories about it.

1:02:34Psychoanalytic view is inside we are dark, self-serving, selfish motives. And it’s captured well in The Lord of the Flies, the novel where children left alone on an island deteriorate to the lowest level of human nature. Or there’s behaviorism, which says there is no inherent nature. It’s just whatever.

1:03:02Watson said, I could take any child and turn him into whatever I wanted to with experience. And then there’s theory C, which is human nature is fundamentally positive. At our core, people are meant to be good and loving, trustworthy, compassionate, pro-social, interested in the welfare of others, what we call humane. That’s our nature. Can’t prove any of those.

1:03:29But it does matter which one you believe. What did Rogers have to say about human nature? I have discovered, discovered is an interesting word, I have discovered that people have characteristics which seem inherent in their species. Positive, forward-moving, constructive, realistic, trustworthy.

1:03:53He’s clearly a Theory C person. A human being appears to be an awesomely complex creature who can go terribly awry, but whose deepest tendencies can be trusted to move in this constructive dimension. It’s what Rogers came out of his career believing. I don’t know if you know the work of Father Greg Boyle.

1:04:19He founded something called Homeboy Industries. He works with people who are coming out of gangs, who have been gang members. And there are only two principles, he says, to Homeboy Industries. We are all inherently good. No exceptions. We belong to each other. No exceptions. That’s what our quantum changers were experiencing too.

1:04:47So I got interested in this old concept of loving kindness. How do you do it? What does it look like? We aspire to it. We feel drawn to it. But what do you actually do to embody loving kindness? So I went back and looked at chesed and agape and came up with all of these components. No wonder it’s a complicated idea because it’s got all these elements to it.

1:05:12And so I wrote this little book, Loving Kindness, describing these 12 attributes of this ancient construct and what it looks like and what the opposite of it is also. And I hope it’s a helpful book to people who are interested in becoming more loving-kindness. I think that is our tell-us. Like Rogers, I believe that’s who we are and our nature, even though it can go terribly awry.

1:05:47nature, even though it can go terribly awry. And if that’s true, when you witness loving kindness, it would feel familiar. You would admire it. Another of my mentors, another bald mentor, Richard Rohr, in my favorite book of his, Falling Upward, says, life is a matter of becoming fully and consciously who we already are.

1:06:09But it’s a self we mostly don’t know. It’s buried inside us somewhere. But he has that same positive view of what is our inherent nature, that it’s love and kindness. It’s a particular way of being. Being more concerned for, or at least as concerned for, other people as for yourself. Being very other-conscious, being compassionate and empathic and mindful.

1:06:37Being an attentive companion with people rather than telling them what to do. Respecting and collaborating with other people’s wisdom, honoring their autonomy and their self-direction, offering your own expertise but with experience, with permission, never imposing it on people, and fostering hope to the complicated idea.

1:07:03Does that sound familiar? Pierre de Chardin, a French scientist, philosopher, another wonderful, prolific writer, a priest, also a paleontologist, who went on digs and was interested in evolution, wrote about spirituality, religion, and evolution, too. And his writings were banned by his church. 1957, the Catholic Church said, you cannot teach this.

1:07:32These are not acceptable books to be used. But he believed in telos. And not just for an individual. He believed that in evolution, we are moving in a positive direction. There’s a beacon out there that evolution is moving toward, and it’s very good. And in his book, Toward the Future, he concluded with these words that I used in my Rediscovering Fire article.

1:08:00The day will come when after harnessing space and the winds, gravitation, we will harness for God the energies of love. And on that day, the second time in the history of the world, we will have discovered fire. We are heading into and are already in a very dark time in our nation. And how can we be? It’s a question Elie Wiesel asked.

1:08:29How can we live in a world with that kind of evil there? And he found us an answer to it. It is to live in a way opposite to what you’re seeing. And my simple way of putting it is keep showing up in love. Keep showing up in love in your life, in your work. And so with that I say namaste. The loving kindness in me sees, recognizes, honors the loving kindness in you.