Saturday, September 17, 2011

Bye Bye Resistance

If you are like most, you didn't relish the shift from toward "resistance" when the book Motivational Interviewing first was published.  Next year, when the 3rd edition of Motivational Interviewing (MI3) is published, the concept of "resistance" will be gone completely. 

And I for one am glad.

Counselors who slap clients as in "denial" are pathetic and should surrender their license. 
        (what, you don't like being labeled?!). 

Fortunately, labeling clients as in denial has become in many places "politically incorrect" meaning is has been replace with "resistant" (code word:  "denial") when blaming clients for our lack of clinical ability.  What will these people do when this concept is gone in MI3?

MI3 has many changes -- it is looking like it will be as different from the second edition of Motivational Interviewing as the second edition was from the first.  But this shift completely away from "resistance" is, IMHO, the biggest (and best) change.  

"Resistance" has been replaced with sustain talk plus discord between the client and the counselor.

For those unfamiliar with motivational interviewing these days, we are focused on two client verbal responses:  

  • sustain talk and 
  • change talk.

What we know works is change talk.  The more the better.  And, at the risk of over simplifying motivational interviewing, our techniques in counseling are focused on getting more change talk and less sustain talk.

Two other factors come into play here:  the client is either connected with the counselor (there is harmony in the relationship) or disconnected with the counselor (there is discord in the relationship).  Make sense -- are you with me?

Now, let's look at what happens when these factors interact around a particular target behavior:

  Harmony Discord
Sustain Talk High potential to move client toward change talk Low potential to move client toward change talk
Change Talk High probability of behavior change High probability of behavior change

To illustrate, consider this framework using the example of stopping cigarette smoking as a target behavior:

  Harmony Discord
Sustain Talk Client engages with counselor to discuss his smoking. Client argues with counselor, wants to leave treatment, etc.
Change Talk Client comes up with a plan to stop smoking. Client stops smoking despite counselor.

The great thing about this framework is that all areas are impacted by the counselor. So blaming the client for clinical shortcomings should be a thing of the past next year!

What do you think?  Share your comments.

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