Social Theory & Health

, Volume 17, Issue 4, pp 443–462 | Cite as

When no is not an option: the immunization against silence in a motivational interview about marijuana use

  • Niels Åkerstrøm AndersenEmail author
  • Justine Grønbæk Pors
Original Article


Many studies have documented how welfare service and professional practices increasingly depend upon the willingness of the citizen to engage actively in dialogues with professionals. This, however, produces the problem of how to deal with citizens who are silent. The framework of Motivational Interviewing presents itself as one solution to this problem. This article explores how Motivational Interviewing operates with a set of strategies to avoid the silence of citizens. We draw on theoretical concepts developed by Niklas Luhmann to analyse a particular instantiation of Motivational Interviewing produced by the Danish National Board of Health, namely a conversation concept entitled, the Marijuana Conversation. We ask thus: what is put at stake when health communication is designed to anticipate and make itself immune to the citizens’ refusal to have a dialogue. Our analysis identifies the different strategies of the conversation concept to make it difficult for the citizen to refuse continued communication. We conclude that by trying to make itself immune to the citizen’s ‘no’, the conversation undermines the possibilities of reaching its objective of empowering the citizen.


Motivational interviewing Health prevention Silence Niklas Luhmann Social immune mechanisms 



  1. Andersen, Niels Åkerstrøm. 2017. Potentialiseringsteknologier som immunmekanismer. In Når velfærdsteknologier holder mere end de lover, ed. Anders la Cour et al. Frederiksberg: Samfundslitteratur.Google Scholar
  2. Andersen, Niels Åkerstrøm, and Paul Stenner. 2019. Social immune mechanisms: Luhmann and potentialisation technologies. Theory, Culture & Society, forthcoming.Google Scholar
  3. Andersen, Niels Åkerstrøm, and Justine Grønbæk Pors. 2016. Public management in transition. The orchestration of potentiality. Bristol: Policy Press.CrossRefGoogle Scholar
  4. Barth, Tom, and Christina Näsholm. 2006. Motiverande samtal. Stockholm: Studentlitteratur.Google Scholar
  5. Burr, Jennifer, and Barry Gibson. 2018. Informed consent in research ethics: An analysis from the perpective of Luhmann’s social systems theory. Social Theory and Health 16 (3): 241–255.CrossRefGoogle Scholar
  6. Callon, Michel, and Vololona Rabeharisoa. 2004. Gino’s lesson on humanity: Genetics, mutual entanglements and the sociologist’s role. Economy and Society. Scholar
  7. Carr, Summerson. 2011. Scripting addiction. The politics of therapeutic talk and American sobriety. Princeton: Princeton University Press.Google Scholar
  8. Carr, E.Summerson, and Yvonne Smith. 2013. The poetics of therapeutic practice: Motivational interviewing and the powers of pause. Culture, Medicine and Psychiatry 38 (1): 83–114.CrossRefGoogle Scholar
  9. Carton, Tony. 2014. The spirit of motivational interviewing as an apparatus of governmentality. An analysis of reading materials used in the training of substance abuse clinicians. Sociology Mind 4 (02): 192–205.CrossRefGoogle Scholar
  10. Dean, Mitchel. 1995. Governing the unemployed self in an active society. Economy and Society 24 (4): 559–583.CrossRefGoogle Scholar
  11. Dean, Mitchel. 2010. Governmentality: Power and rule in modern society, 2nd ed. London: Sage.Google Scholar
  12. Deleuze, Gilles. 1997. Mediators, in Deleuze, Negotiations 1972–1990. New York: University of Columbia Press.Google Scholar
  13. Esposito, Roberto. 2011. Immunitas: The protection and negation of life. Cambridge: Polity Press.Google Scholar
  14. Gray, Sean W.D. 2015. Mapping silent citizenship: How demoractic theory hears citizens’ silence and why it matters. Citizenship Studies 19 (5): 474–491.CrossRefGoogle Scholar
  15. Hoffman Pii, K., and K. Villadsen. 2013. Protect the patient from whom? When patients contest governmentality and seek expert guidance. Social Theory and Health 11 (1): 19–39.CrossRefGoogle Scholar
  16. Karlsen, Mads Peter, and Kaspar Villadsen. 2008. Who should do the talking? The profilation of dialogue as governmental technology. Culture and Organization 14 (4): 345–363.CrossRefGoogle Scholar
  17. Knudsen, Hanne. 2011. The game of hospitality. Ephemera, Theory & politics in organization 11 (4): 433–449.Google Scholar
  18. Knudsen, Hanne, and Niels Åkerstrøm Andersen. 2014. Playful hyper responsibility: Toward a dislocation of parents’ responsibility. Journal of Education Policy 29 (1): 105–129.CrossRefGoogle Scholar
  19. Lister, R. 2001. Towards a citizens’ welfare state. Theory, Culture & Society 18 (2–3): 91–111.CrossRefGoogle Scholar
  20. Luhmann, Niklas. 1994. Speaking and silence. New German Critique 61: 25–37.CrossRefGoogle Scholar
  21. Luhmann, Niklas. 1995. Sociale systems. Stanford, CA: Stanford University Press.Google Scholar
  22. Luhmann, Niklas. 2002. Inklusion og eksklusion. Distinktion: Scandinavian Journal of Social Theory 3 (1): 121–139.CrossRefGoogle Scholar
  23. Luhmann, Niklas. 2013a. Theory of society, vol. 1. Stanford, CA: Stanford University Press.Google Scholar
  24. Luhmann, Niklas. 2013b. Theory of society, vol. 2. Stanford, CA: Stanford University Press.Google Scholar
  25. Matthiesen, Noomi Christine Linde. 2016. Understanding silence: An investigation of the processes of silencing in parent–teacher conferences with Somali diaspora parents in Danish public schools. International Journal of Qualitative Studies in Education 29 (3): 320–337.CrossRefGoogle Scholar
  26. McBrien, J.L. 2011. The importance of context: Vietnamese, Somali, and Iranian refugee mothers discuss their resettled lives and involvement in their children’s schools. Compare 41: 75–90.CrossRefGoogle Scholar
  27. Miller, W.R. 1983. Motivational interviewing with problem drinkers. Behavioural Psychotherapy 11: 147–172.CrossRefGoogle Scholar
  28. Miller, W.R., and S. Rollnick. 1991. Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.Google Scholar
  29. Miller, William R., and Stephen Rollnick. 1995. What is motivational interviewing? Behavioural and Cognitive Psychotherapy 23 (04): 325–334.CrossRefGoogle Scholar
  30. Miller, William R., and Stephen Rollnick. 2013. Motivational interviewing: Helping people change. New York: Guilford Press.Google Scholar
  31. Montoya, Margaret E. 2000. Silence and silencing: Their centripetal and centrifugal forces in legal communication, pedagogy and discourse. Michigan Journal of Race & Law 5: 847–911.Google Scholar
  32. National Board of Health. 2005. Hash-samtalen. København: National Board of Health.Google Scholar
  33. Nielsen, Anette Søgaard. 2006. Kommunikation og samtale om adfærdsændringer. Månedsskrift for praktisk lægegerning November: 1331–1340.Google Scholar
  34. Peter, Marianne and Lilliendal, and Dorthe Brænder. 2015. Evalueringsrapport midtvejs, Projekt MI-implementering. Faaborg Midtfyn Kommune.Google Scholar
  35. Peterson, Shelley S., and Mary Ladky. 2007. A survey of teachers’ and principals’ practices and challenges in fostering new immigrant parent involvement. Canadian Journal of Education/Revue canadienne de l’éducation 30 (2): 881–910.CrossRefGoogle Scholar
  36. Rah, Yeonjai, Shangmin Choi, and Thu Suyong Thi Nguyễn. 2009. Building bridges between refugee parents and schools. International Journal of Leadership in Education 12 (4): 347–365.CrossRefGoogle Scholar
  37. Rolfe, Gary. 2004. Motivational interviewing: A hammer looking for a nail? Journal of Psychiatric and Mental Health Nursing 11 (4): 494–501.CrossRefGoogle Scholar
  38. Rosdahl, Gregers. 2013. Den motiverende samtale i teori og praksis. Copenhagen: Munksgaard.Google Scholar
  39. Rubak, Sune. 2001. Den motiverende samtale. Systematisk oversigtsartikel og metaanalyse. Månedsskrift for praktisk lægegerning November: 81–97.Google Scholar
  40. Sonne, Torsten. 2002. Den motiverende samtale. In Rygning og rygestop, ed. Irene Christiansen, Henning Damkjær, and Torsten Sonne, 204–230. København: Munksgaard.Google Scholar
  41. Stäheli, Urs. 2016. Das Recht zu schweigen: Von einer Politik der Konnektivität zu einer Politik der Diskonnektivität? Soziale Welt 67: 299–311 (exist also as a working paper in English: “Rights to remain silent: From a politic of connectivity to a policy of non-connectivity”).Google Scholar
  42. Stevenson, N. 2003. Cultural citizenship in the cultural society: A cosmopolitan approach. Citizenship Studies 7 (3): 331–348.Google Scholar
  43. Suoninen, Eero, and Arja Jokinen. 2005. Pursuasion in social work interviewing. Qualitative social work 4 (4): 469–487.CrossRefGoogle Scholar
  44. Turner, Bryan S. 2015. Silent citizens: Reflections in community, habit, and the silent majority in political life. Citizenship Studies 19 (5): 507–519.CrossRefGoogle Scholar
  45. Ussher, Jane. 2004. Premenstrual syndrome and self-policing: Ruptures in self-silencing leading to increased self-surveillance and blaming of the body. Social Theory & Health 2 (3): 254–272.CrossRefGoogle Scholar
  46. Vera, Elizabeth M., et al. 2012. Exploring the educational involvement of parents of English learners. School Community Journal 22 (2): 183–202.Google Scholar
  47. White, Melanie, and Alan Hunt. 2000. Citizenship: Care of the self, character and personality. Citizenship Studies 4 (2): 93–116.CrossRefGoogle Scholar

Copyright information

© Springer Nature Limited 2019

Authors and Affiliations

  • Niels Åkerstrøm Andersen
    • 1
    Email author
  • Justine Grønbæk Pors
    • 1
  1. 1.Department of Management, Politics & PhilosophyCBSFrederiksbergDenmark

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