MI identifies two types of ‘resistance talk’: (i) sustain talk and (ii) discord or interpersonal resistance.
‘Sustain talk’ involves statements about sustaining a behaviour and not changing, including direct intentions not to change (e.g. ‘You can tell me all you want, I’m not going to stop drinking with my mates’), the advantages of the status quo (e.g. ‘Drinking is the only way to really relax’), and pessimism about ability to change (e.g. ‘I’ve tried before and I can’t do it).
Interpersonal resistance or discord involves negative statements about the practitioner and / or the relationship (e.g. ‘You will never understand what it’s like for me’) or negative statements about treatment or intervention (e.g. ‘I don’t need to come here’; ‘This program will make no difference to me’).
MI understands resistance as an interpersonal process that arises in reaction to what is happening between the client and the practitioner. It is likely to arise when the practitioner is pushing too hard or too fast for change.
The first step in dealing effectively with resistance is to recognise it early so as not to exacerbate it. The most obvious thing to avoid is direct refutation of clients’ arguments. Direct refutation of clients’ arguments against change tends to reinforce (Miller & Moyers, 2006; p9).
MI emphasises that resistive statements must be met without criticism, correction or counter-resistance. Rather it is essential that the clients’ reservations are heard and understood. Also avoid trying to provide reassurance or trying to persuade the client to change their mind. When resistance arises take care to avoid responding with reassurance, persuasion, criticism, or correction.
The mnemonic ‘Stop, Drop and Roll’ captures the spirit of the approach (Naar-King & Suarez, 2011; p39-40). First you need to ‘stop’ whatever it was you were doing before (this was probably being too directive, persuasive or overly optimistic), and then ‘drop’ back to a neutral stance. Then the four OARS techniques of person-focused guiding are used to ‘roll’ with the resistance.
Reflections of the client’s arguments are particularly important. For example if the client says ‘Well I overdo it sometimes, but I don’t have a problem with drinking’, a simple reflection would be ‘You don’t think of yourself as a problem drinker’; an amplified reflection would be ‘Your drinking has never really caused any problems or unpleasant effects in your life’, and a double-sided reflection would be ‘You think you drink too much at times, and also you don’t think of yourself as a problem drinker’ A (Miller & Moyers, 2006; p9) See Practice Element A6 for more on the use of double-sided reflections.
Other strategic responses to resistance include re-emphasising the personal control and autonomy of the young person, shifting the focus of the discussion to a less controversial issue, and ensuring that you are giving equal weight to exploring the pros and cons of change.