Lately I’ve come to the point where I’m not completely comfortable using the word “resistant” when referring to clients. Given my psychoanalytic training roots, that’s a considerable shift. This shift has inspired me to reflect a bit on the phenomenon that we used to so blithely refer to as resistance.
In the late 1970s, Stephen de Shazer, the late, great solution-focused theorist and therapist, declared that resistance was dead; he even held a mock funeral and buried something in his back yard to place a metaphorical exclamation point on his perspective.
A bit more recently, William Miller and Stephen Rollnick reformulated resistance as ambivalence in their rather fabulous Motivational Interviewing (1991/2002) text.
I’ve also heard other professionals and writers refer to this particular situation—where clients seem to oppose making healthy changes that appear to be in their own best interest—as reluctance.
And so what’s the right way to think about this thing we used to call resistance?
Do we join with de Shazer’s perspective, celebrate its death, and agree to never again use the term to describe what’s happening in counseling?
Or do we start calling it ambivalence or reluctance or something else?
Or do we stubbornly enact our own resistance to change by insisting that resistance still really exists?
de Shazer’s perspective is interesting and worth a closer look. His point was that resistance really was something counselors brought into the office by insisting that clients change in ways counselors were prescribing. He believed it wasn’t a useful or helpful concept. Instead, and this is very important, de Shazer focused relentlessly on positives and solutions and strengths and in so doing, sought to eliminate resistance in counseling.
This was (and is) a great idea . . . even if it’s not especially consistent with reality.
The problem is that even when counselors bend over backwards to focus on positives and strengths and emanate solution-focused-ness from their pores, clients don’t always follow their lead. For example, in the following short excerpt from de Shazer’s 1985 excellent book, “Keys to Solution in Brief Therapy,” de Shazer is presenting a case with a couple where the wife has complained that her husband’s drug use is adversely affecting their relationship.
Here’s what de Shazer said to the husband (Ralph): It seems to us, Ralph, that your marital problems are being exacerbated by the drugs, or fogged over by the drugs, or perhaps even created by the drugs. Perhaps you need to stop the drugs, just to see what is going on. But, on the other hand, we agree with you Jane, that if you two were to stop the drugs, then there might be nothing there.
And, you might not have time to create anything before the marriage broke up. In short, we don’t know what the fuck you are going to do.
I suggest you think about what I just said, and decide what actions you are going to take ... first. (p. 52)
This is one interesting counseling intervention.
What it looks like to me is that de Shazer is using a cleverly worded Ericksonian confusion technique to get Ralph to deconstruct his firm grip on drug use and take a serious look at the purpose and consequences of his behavior. But what really jumps out at me is that de Shazer sounds a little angry (of course, I could just be over-reacting to his use of the F-word). And, if it weren’t for the fact that de Shazer had already declared resistance as dead and buried back in the 70s, I could swear the “R-word” might be making a cameo appearance in this brief counseling vignette.
I’m guessing most counselors have experienced the emergence of something in the counseling room—at one point or another—that looks, sounds, and smells like resistance. And although I firmly believe we should follow de Shazer’s guidance and avoid blaming clients for being “resistant,” I also think we also shouldn’t ignore the smell of resistance composting in our office.
We do need to do a better job than some of the old psychoanalysts by looking hard at ourselves and trying to figure out how we’re contributing to the emergence of resistance or reluctance or ambivalence. We also need to recognize, using whatever theoretical material might be of help, that some clients are quite naturally ambivalent, or, in the terms of Prochaska and DiClemente, they may not be ready for change.
But in the end, it seems obvious that something is happening when clients refuse to engage in behaviors that are clearly in their own best interest. It could be ambivalence or reluctance or some form of self-sabotage. It could be the counselor’s fault and it is the counselor’s challenge. It could be good old-fashioned resistance. It could be that a rose (or something that smells substantially less appealing) by any other name, still smells the same.
John Sommers-Flanagan is a counselor and counselor educator at the University of Montana. More information on strategies for dealing with resistance is in chapter 11 of his textbook, Clinical Interviewing (published by Wiley). You can access his personal blog at johnsommersflanagan.com.