Resistance and Relationship

"Resistance is something that occurs only within the context of a relationship or system." ¹ This quote from Miller and Rollnick got me thinking about how often I hear clients being labelled resistant, particularly mandated or involuntary clients. It's often said in a pejorative way. The term "resistance" seems to suggest that things are not going smoothly because of something one person (the client) is doing. It risks setting up an unhelpful dynamic in the interviewer-client relationship, with the client getting ‘blamed' for the resistance.

Yet, resistance cannot occur in a vacuum. The client may certainly begin by expressing resistant behaviours, but once these behaviours are expressed, what happens to them is strongly influenced by what the interviewer does, and not simply by what the client does. Hence, how you behave towards someone affects how they behave back to you. In motivational interviewing terms this is the reciprocity principle, slightly reworking the biblical phrase into - others do to you as you have done to them. ²

Types of resistance

I've noticed that often when asked to describe client resistance, practitioners describe a ‘digging their heels in' type of resistance. However, there's more than one type of resistance. Miller and Rollnick identify four types of resistance which I've found useful when thinking about the dynamics in client relationships and understanding what sits underneath resistance. Think about clients you've worked with when reading these descriptions.

The ‘digging their heels in' type of resistance is described as rebellious. These clients are heavily invested in the problem behaviour and don't want to change or they just hate being told what to do. So the resistance will show itself in arguments, bad grace and failure to complete any tasks required in treatment or intervention.

Another type of resistance is embodied in the reluctant client. You know when you are encountering this type of resistance because it feels like you're wading through treacle. These clients have not fully committed to change and therefore do not bring energy to the work. You might find yourself attempting to persuade them to change, and any change made by clients as a result of persuasion will be done half heartedly and will probably not sitck.

Resigned resistance is different again in that it stems from a lack of confidence in the ability to change. The client may have been engaged in the problem behaviour for a long time or have made repeated attempts to change that have met with failure. The feeling is one of hopelessness. They will lack energy and investment in the work.

Finally, Miller and Rollnick identify a fourth type of resistance, that of rationalizing. The reasons for this type of resistance may be similar to the other types of resistance; however the expression of the resistance will be to provide reasons why a certain task, for example, is not relevant or necessary for them. They use their head, cognition, rather than emotion to block therapeutic work.

Counselling style

Often motivation is viewed more like a fixed client trait (particularly in the correctional field). Therefore if the client displays little motivation and lots of resistance, the temptation is to attempt to break through the denial, rationalizations and excuses: "you've got a problem", "you have to change" or "you'd better change or else."

But think for a moment of a time when you had to do something that you didn't want to do. What kind of thoughts did you have about it? What were you feeling? What behaviour did you engage in? And....think about the effect on your relationship with the person involved? I know for myself that I was thinking things like, "who do you think you are to tell me what to do" whilst feeling angry and resentful, and I did my best to do as little as I thought I could get away with. And when I think about that relationship now, it's tinged with suspicion. So how different are our clients? Not so very much!

A research study with problem drinkers found that a directive-confrontational counsellor style produced twice the resistance, and only half as many "positive" client behaviours, as did a supportive, client-centred approach. The researchers concluded that the more staff confronted, the more the clients drank at twelve-month follow up. Problems are compounded as a confrontational style not only pushes success away, but can make matters worse.

Research clearly demonstrates that a change in counselling style can directly affect the level of client resistance, driving it upward or downward. This means that it is not fixed and that there is something you can do about it. It is obviously desirable to decrease client resistance because this pattern is associated with long term change.

Miller and Rollnick advocate a more relational view, in which client resistance behaviour is, at most, a signal of dissonance in the relationship. Therefore client resistance is a meaningful signal.

Reflective practice

Resistance is inevitable, as there is no such thing as a consistently perfect practitioner; so given this, what does this mean for my practice? As it's about relationship, it means that one of the things I need to do is take a good look at myself. Reflective practice is a critical aspect of all client work, so here are some questions to begin the reflective thinking process in relation to resistance:

• What is my level of investment in the client making a change?
• How able am I to let the client make their own choices (even when I think the choice is less than wise)?
• What kind of resistance do I react to?
• What am I doing to influence the resistance?
• What is the resistance telling me about myself and about my client?

Rolling with resistance is an approach and a set of techniques for decreasing resistance; more of this in a separate article.

_¹ Miller, William R. & Rollnick, Stephen. (2nd edition) Motivational Interviewing: Preparing People for Change. New York: Guildford Press (2002)
² Farrall, Mark, The use of motivational interviewing techniques in offending behaviour group work, published in motivational interviewing Newsletter: Updates, Education and Training, vol 8, issue 1 www.motivationalinterview.org/mint/MINT8_1.PDF