Responding to Resistance

In the introduction to Chapter 8, "Responding to Resistance" (p. 98) of Miller & Rollnick's Motivational Interviewing, 2nd Edition (2002)--and please note that this is a text that addresses alcohol and other substance abuse specifically, but I sense that its principles are applicable across the counseling spectrum--the authors suggest that some practitioners view resistance to therapy as something inherent in the client's character if not indicative of a presenting problem such as alcohol or other drug dependence, symptomatic, if you will, of the disorder to be treated. They argue that attributing client resistance to an inherent personality characteristic may be something of an erroneous assumption. This may be particularly apropos if the counselor's perception of client resistance is viewed as a clinical defense mechanism and the denial of "the problem" that must be breached if therapy is to progress. Miller & Rollnick suggest instead that resistance, "...to a significant extent, arises from the interpersonal interaction between counselor and client."

I found this argument provocative in light of my long standing problem with the traditional, "kick in the front door" S.W.A.T. team approach to "confronting" client denial and "breaking down" resistance to treatment as the prerequisite to change for addicted clients. These clients, presenting in what Prochaska would refer to as a "precontemplative" stage of readiness to change, are likely to be steeled in their resolve to resist what they must see as "attack therapy" with treatment offered by counselors that seem to suggest that, "addiction is the problem" and "my way or the highway" is the answer. As early as 1973 Lieberman, Yalom, & Miles (Encounter Groups: First Facts, NY: Basic Books) suggested that confrontational group therapy was likely to result in more harmful and adverse outcomes in therapy than alternative approaches. If the first order of clinical business for a practicing counselor or therapist is to "do not harm," then avoiding an iatrogenic result of that counseling may be what Miller and Rollnick are addressing in their argument that resistance is a result of interpersonal dynamics in a session rather than client pathology.

My grandfather used to say that you do not remove a hornet's nest on the porch by beating it with a stick. I am wondering if this was not a layman's equivalent to Miller and Rollnick's argument suggesting that resistance arises more from the interaction between client and practitioner than the pathology of the client...the bees were likely not resisting until the first blow from the stick

You can read more on "Motivational Interviewing" and "Stages of Readiness to Change" at my website, http://www.robertchapman.net...click "Treating Addictions" in the menu

Robert J. Chapman, PhD

http://www.robertchapman.net
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