10 ideas in responding to resistance

Ever felt exposed when talking about difficult issues

Ever felt you were in the hot-seat when talking about challenging issues? I am sure that many of the people we work with find this a really tough assignment  – to sit and talk about their often most embarrassing or distressing issues. In the past two blogs I have explored the nature of resistance being a state rather than a trait. Taken from the thinking around social interaction theory we are clearly working with, rather than imposing our ideas on, people to find a way through problematic behaviour. In my view it is ultimately how we position ourselves in relation to the interaction that will make the difference. Below are a number of key ideas that I have drawn from motivational interviewing, narrative and strength-based practice. It is good to remind myself of when I am sitting in conversation with someone.

  1. Keeping the conversation non-pathological by redescribing problems to open up possibilities. It is easier to look for what is wrong than what is right. Conversations can often become ‘problem saturated’ which lowers energy and can make behaviour more entrenched. Keeping conversations non-pathological requires the skill of reframing from problem to solutions (O’Hanlon& Weiner-Davis, 1989). For example, if a client describes the hassle of getting to the session, then a simple reframe can be to enquire with the person how they managed to get to the session, despite the effort required. This is likely to generate a consideration of agency or an ability to have control in one’s life.
  2. Building intrinsic versus extrinsic motivation. Intrinsic motivation is more readily achieved by eliciting (drawing out) rather than telling. Very few of us respond to being told what to do and having others become experts on our lived reality. I hold the view and talk in training that ‘We believe what we hear ourselves saying’. If we can work with people to change their narrative for example about ‘having to attend sessions’ to ‘approach motivation’, where they argue for themselves the benefits of change, then we start to create movement in the direction of change.
  3. Focus upon the exceptions to the problems discussed during interactions. In other words clients may describe behaviours or thinking that is in direct opposition to the problem behaviour described. The key skill is to hear these exceptions as this is the richness of strength-based work.
  4. When you notice a person’s competency, comment on it intermittently and gather other thoughts on your discovery. This is about noticing the small changes. For example, if you hear a client talking differently about a situation or problem, it is useful to ponder how this different thinking has come about and by thinking differently what people might notice about changes in behaviour. By creating ‘news of difference’ several skills are able to be practiced for example, listening, collaborative learning, feedback to others.
  5. Insight is one aspect of the change process. However, insight alone does not sufficiently provide the agency to act differently when they leave the session. Strength based approaches are clearly targeted at changes in behaviour and so the person should always be able to leave the session with something to try out or do differently. For example reflective questions allow the participant to actively plan for the incorporation of insight into action. Useful questions that enquire as to what the participant is now aware of, and how this awareness will translate into behaviour outside the group room, is very rich material for change work.
  6. Attempt to see the person sitting in front of us as a person with a complaint about their lives, not as a person with symptoms. Linked to this is the challenge to help view their problem as external to themselves. This will help them see the problem as a separate entity that influences but does not always control their lives. This is not to assume that they have no responsibility for behaviour, merely that problems are never a totalising description of a person’s lived experience.
  7. Complex problems do not necessarily require complex solutions. This is a time to assist clients to think in simpler ways. Solution based practice often uses the following ideas, ‘If it ain’t broke don’t fix it’, ‘Once you know what works, do more of it’, and ‘If it doesn’t work, don’t do it again; do something different’. This recognises that significant aspects of our behaviour are habitual, and that if we are to interrupt the patterning, then we quickly shift behaviour.
  8. Adopt the client’s world view to lessen resistance and then work to discover less dangerous and interfering options with the person. This is a fine line and the skill of the counsellor is not to collude in disrespectful behaviour towards others. Work is therefore directional around safety of other.
  9. Focus only on what is changeable. Assist the person in thinking more specifically and less emotionally when setting goals for change.
  10. Go slowly and encourage the person to ease into change. Help clients see each strategy as an experiment, not as a technique that guarantees success. Human beings are analogue learners, we learn from experience, and hopefully adjust behaviour accordingly.
  11. Respectful practice has as an important goal connectivity and social participation in the world. An important aspect of the work is the legacy we leave for participants when they leave the session. Use of internalized other questions can be useful in building an audience for change. If (partner/children) were sitting with us listening to us talking, what would they say about your seriousness to sort out your issues? If (partner/children) were sitting with us listening to us talking, what would they say they would hope to be different as a result of our talking? What advice might (partner/children/ friends) give you about sorting out the issues affecting you if they were with us? The second step in this process is to then inquire as to where the person is prepared to position themselves in relation to that of their partner, children and friends. I call these accountability referenced questions.

a. On a scale of 1-100 how much do you share the hopes of your partner and children?
If a person answers they share the hopes of their partner and children 70%, then you can ask a follow-up question such as:
b. What would your partner make of that?
c. What would we notice in the energy and commitment you would put into working with me to understand and get these problems out of your life?

In summary, a respectful approach to social change requires that we are vigilant for the dominant narratives that we as counsellors/ therapists and clients bring into the room. Our role is one of walking alongside clients to discover alternative explanations to problem behaviour so that they can construct unique realities based upon meeting social needs in pro-social ways. These are my thoughts. Love to hear yours.

Published on Wednesday, June 6th, 2012, under Motivational Interviewing, Practice tips and techniques

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