Does Confrontation Work?

Confrontation, especially confrontation in the process of counseling, is a topic I ask my students to consider in my Intro to Addictive Disorders class – click to review the class assignment associated with this request.  Invariably, students who argue that confrontation does not work point out that

aggressive, in-your-face confrontations are too direct and actually deter meaningful engagement…what Miller refers to as Attack Therapy.  However, those students who do believe confrontation has a place in effective counseling--or in the treatment of individuals with a SUD more specifically--are influenced by Miller & Rollnick’s first chapter in the 3rd edition of their book, Motivational Interviewing (link included in the linked assignment).  They come to see one’s definition of confrontation and, more importantly, he means of delivering a confrontation, as the issue of primacy when considering the utility of this aspect of counseling.

Confrontation—effective confrontation—is, if nothing else, the ability to "hold one’s feet to the fire" without causing injury.  Effective counselors do this by employing what I refer to as the Three Ps of counseling: (1) Patience, (2) persistence, and (3) perseverance.  As Rollnick suggests in a clip from his video on MI (see http://bit.ly/1C9SW66), change can happen quite rapidly when facilitated by a trained and experienced practitioner.  He suggests, and I paraphrase, If you act like you have all day, it (change) can happen in 15-minutes, but if you act like you only have 15-minutes, it can take all day; I can  attest to this, as I imagine many clinicians can. As a matter of fact, one of the nicest compliments a client ever paid me was after a particularly confrontational session, one where I employed the “3-Ps,” as we shook hand at the end and he was leaving the office, he turned, looked me in the eye and said, “You know, Dr. Robert, you could kick someone in the ass and he would turn around and thank you.”

There is a difference between confronting someone when the interaction is viewed as a contest where someone wins at the expense of the other person losing, and one that is approached as an attempt to address an issue of concern, but without the delivery of unsolicited advice or directives steeped in judgmental recommendations.  Remember the quote by Bern Williams: Unsolicited advice is the junk mail of life.

Confrontation a la Wesley Snipes, Bruce Willis, or Keanu Reeves does not work; Wm Miller of Motivational Interviewing fame calls this Attack Therapy.  Confrontation, however, employed by a skillful practitioner who is respectful, understanding, but nonetheless persistent, does.

What do you think?

Dr. Robert