The first step in addressing resistance is to recognize it when it happens. From a Motivational Interviewing (MI) framework, Miller and Rollnick¹ identify four categories of client behaviors that indicate resistance.

4 Categories of Client-based Resistance Arguing with the clinician Interrupting Negating (essentially saying there is no problem nor any need to talk about the target behavior) Ignoring

When any of these client behaviors occur, you should immediately step back and ask “what is it that I am doing to elicit this from this client? Often, if the clinician is clear about his/her self-assessment, one of the following clinician behaviors has preceded the client resistance:

5 Clinician Behaviors that Often Precede Client Resistance Arguing for change by advocating for change and attempting to persuade the client that change is the best thing for him/her. Assuming the expert role in which the clinician presents “answers” for the client’s dilemmas rather than eliciting change talk and possible solutions from the client. Criticizing, shaming or blaming the client for either causing the target behavior in the first place, or for not taking steps to change it. Labeling the client with a pejorative or diagnostic label that elicits negative emotional responses from the client. In the addictions field this is often seen by clinicians as a main focus of treatment—to persuade the client to adopt a label (e.g. “alcoholic”, “addict”)—yet there is no empirical evidence to suggest that this practice is helpful. Claiming preeminence—“I know what’s best for you”. This strategy, although often seen in interactions between clinicians and clients with substance use or severe mental health issues, serves to break the alliance and has not been shown to foster change.

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Featured Course

Motivational Interviewing in Clinical Settings
(4 CEs) by Frederick Rotgers, Psy.D., ABPP

Motivational interviewing (MI) is a behavioral technique that has been shown to be effective in promoting behavior change in a variety of mental health and medical contexts. Specific to behavioral medicine, MI can be extremely effective across the disease continuum – whether used to promote disease prevention or adherence to required regimens to thwart disease progression ^2-10. Moreover, healthcare providers who utilize MI techniques with their patients report better provider/patient communication without apparent detriments to system-based issues (i.e., time management) ¹¹.

This online course presents a basic introduction to the application of MI in clinical practice providing an overview of the history, underlying theory and basic principles of MI. An exploration of how MI has been applied successfully in treating patients resistant to behavior change in a variety of contexts is presented along with basic techniques that can minimize resistance to change and promote motivational readiness leading to the uptake of health-related behaviors.

About the Author Dr. Rotgers is an Associate Professor of Psychology at the Philadelphia College of Osteopathic Medicine. He is Board Certified in both Clinical Psychology and Cognitive and Behavioral Psychology and a Fellow of the American Psychological Association. An internationally recognized expert in the study and treatment of substance use disorders, he serves on the editorial boards of several addictions journals, including the Journal of Drug Issues and has co-authored/edited several books, including Treating Alcohol Problems a presentation of an evidence-based, motivational harm reduction approach to alcohol problems for general clinicians. His clinical interests include motivational interviewing, cognitive-behavioral treatments and harm reduction methods and ethics.

References (Click on reference to view online article)

1. Miller, W.R. & Rollnick, S. (2002). Motivational interviewing: Preparing people for change, 2nd Edition. New York: Guilford.
2. Channon, S.J., Huws-Thomas, M.V., Rollnick, S., Hood, K., Cannings-John, R.L., Rogers, C., & Gregory, J.W. (2007). A Multicenter Randomized Controlled Trial of Motivational Interviewing in Teenagers With Diabetes. Diabetes Care, 30, 1390-1395.
3. Holstad, M.M., DiIorio, C., & Magowe, M.K..(2006). Motivating HIV positive women to adhere to antiretroviral therapy and risk reduction behavior: the KHARMA Project. Online Journal Issues in Nursing, 11(1), 5.
4. Moos, R.H. (2007). Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence, 88(2-3), 109-121.
5. Resnicow, K., Jackson, A., Wang, T., De, A.K., McCarty, F., Dudley, W.N., & Baranowski, T. (2001). A Motivational Interviewing Intervention to Increase Fruit and Vegetable Intake Through Black Churches: Results of the Eat for Life Trial. American Journal of Public Health, 91 (10), 1686-1693.
6. Schwartz, R.P., Hamre, R., Dietz, W.H., Wasserman, R.C., Slora, E.J., Myers, E.F., Sullivan, S., Rockett, H., Thoma, K.A., Dumitru, G., & Resnicow, K.A. (2007). Office-based motivational interviewing to prevent childhood obesity: a feasibility study. Archives of Pediatric Adolescent Medicine, 161(5), 495-501.
7. Vasilaki, E.I., Hosier, S.G., & Cox, W.M. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol and Alcoholism, 41(3), 328-335.
8. Watkins, C.L., Auton, M.F., Deans, C.F., Dickinson, H.A., Jack, C., Lightbody, C.E., Sutton, C.J., van den Broek, M.D., & Leathley, M.J. (2007). Motivational Interviewing Early After Acute Stroke: A Randomized, Controlled Trial. Stroke, 38, 1004.
9. Weinstein, P., Harrison, R., & Benton, T. (2006). Motivating mothers to prevent caries: confirming the beneficial effect of counseling. Journal of the American Dental Association, 137(6), 789-793.
10. West, D.S., DiLillo, V., Bursac, Z., Gore, S.A., & Greene, P.G. (2007). Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care, 30(5), 1081-1087.
11. Rubak, S., Sandbaek, A., Lauritzen, T., Borch-Johnsen, K., & Christensen, B. (2006). An education and training course in motivational interviewing influence: GPs' professional behaviour--ADDITION Denmark. British Journal of General Practice, 56(527), 429-436.