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Managing Patient “Resistance” with MI

August 23, 2017 by Dr. Ellen

If your work involves helping people change their behavior, you have probably encountered a “resistant” client. I put the word in quotes because it implies there is something wrong with them. They are resisting something they should want to change and it’s so very clear to you that it’s true.

In Motivational Interviewing, we assume that when faced with change most of us are a minimum ambivalent. Sometimes we are just down right resistant, even when we know it would be best to make changes. If you have ever been in that position (and most people have), you know how hard change can be.

Here are some ideas for preventing or minimizing resistance in your clients.

  • Use reflective listening: Try a content reflection or a complex or meaning reflection.
    “You’re working very hard on getting more exercise, and wondering why you haven’t made more progress.”
    “Making this change has been harder than you thought. You’ve found that smoking is really a part of who you are.”

  • Emphasizing personal choice and control:
    “I want you to know that whatever I think about your decision, you’re the one who gets to decide. You know your own life best!”

  • Acknowledging and accepting the client’s decisions and choices, even if you disagree!
    “I get that your eating disorder is really an important way of coping for you.”
    “You’re wondering what I think about your choosing lower salt foods. I think it’s a very good idea for your heart function, but it’s up to you to follow through.”

  • Presenting clients with options and possibilities for change:
    “There’s more than one way to accomplish this change. Can I suggest one or two ideas I have?”

  • Offering support and guidance if client desires
    “Would you like a suggestion about that?”
    “Some of my other clients have found this works…”

  • Encouraging clients to be as active as possible in making decisions about health behavior change
    “I’m guessing you have ideas about how to make these changes.”
    “You know best what will work in your life.”

  • Expressing confidence in the client’s ability to make a change when ready
    “I’m confident you can come up with ways to incorporate more fruits and veggies into your life.”

Filed Under: Change, Learning Motivational Interviewing: Introductory, Motivational Interviewing and Behavior Theory, Motivational Interviewing Techniques, Personal, Teaching Tagged With: Behavior Changes, change, change talk, clinician, listening, motivation, motivational interviewing, tips

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