Motivational Interviewing Techniques For Dealing With Resistance In Substance Abuse

Statement

Commentary

DR: It upsets you that I might be suggesting

something that could hurt your clients.

You really care about them.

Resists the righting reflex and attempts

to communicate understanding of the

practitioner’s motivation through a

reflection.{EXAMPLE}

Rick: Damn right. If I let them scam me,

then they aren’t going to recover.

Rick responds positively and reasserts

his goal.{EXAMPLE}

DR: They don’t benefit from your being

naive.

Has an understanding perspective but is juxtaposing the view point of Rick and is encouraging him to be mature

Rick: Right. They’ll just take advantage of

you.

Sounds pessimistic and in a undermining tone

DR: And so sometimes it feels like you

really need to get in their face, so

they know that you aren’t being

fooled.

DR tries to encourage Rick and help him develop confidence

Rick: Yeah. I guess. I mean, that’s what I

know works. They pay me to do a job

and that’s what I’m doing.

Reassuring his confidence with a back up of logic but in a tone that is contemplating the discussion

DR: As best as you know how . .

Still persisting to support Rick but is interrupted by an interrupted  of idea

Rick: . . . with what I know works.

The tone in this message is much reassuring than when the conversation first began (Rohsenow et al. 2014).  

DR: Because you’ve seen it. Sometimes it

works really well

DR is trying to boost the decision of Rick by motivating self- effacy

Rick: Yeah.

Reassuring that he is in the same page with DR and is having an moment of inducing intrinsic motivation

DR: . . . but not always . . .

Again, this is taking a risk to build

motivation by noting a discrepancy,

though statements prior to this exchange indicate that this is accurate.{EXAMPLE}

Rick: No. Not always . . . it’s a tough disease.

There is a sense of understanding in between the two people in this conversation. This is the situation of rolling with resistance where the person is avoiding argument, but is still trying to take the conversation ahead.

DR: And that’s what worries you. You

might consider something different,

if—and only if—you thought it might

work for your clients, and that’s the

spot you’re at now.

Listens to client/trainee and empowers

him around doing something different.

The relationship is collaborative, and I

respect his autonomy to choose.{EXAMPLE}

Rick: Exactly. I’m just not sure.

Again in a position of confusion setting a contrast with his previous behaviour. Rick is needs more back up and encouragement from the DR.

DR: Well, I am not going to try to

convince you that this is the right or

only way to work with people, but it

sounds like you might be open if you

Thought it could help.

This shows that he is listening intently to the client and is trying to get to the problem. But he wants Rick to take his own decision and not induce any idea in his head.

Rick: I’ll do whatever works.

Rick is always showing an tendency in this tone and in his words that his aim is clear, what he is unsure is the procedure

DR: You’re committed to your clients and

good practice. It’s just now you need

some other kind of data—something

other than what I’ve said—to convince

you.

Trying to develop a support of rational to support and balance the previous statements. To make the statements more evidence based so that the client can believe that to gain long term success a step has to be taken ahead (Cartes-Velasquez et al. 2017).

Rick: I’d need to see it work in practice. I

need to see it work with some of these

meth addicts.

Again Rick is also looking for evidence to back up his decision which is a good way to move ahead by in order to see evidence a step has to be taken.

DR: So, you want to reserve judgment until

you’ve tried it and see how it works.

Rolling of resistance where he is not dismissing the perspective of the client but is motivating him to go ahead with the decision without thinking about the results from beforehand (Magill et al. 2014).

Rick: I guess I do need to try it first. I am

someone who has to see it first hand.

Rick is also reassuring his decisions, and agrees with DR that he need to first implement the steps and then gather evidence to check the results.

DR: I wonder if you decided to give it a try,

how you might do it.

Taking the discussion forward and is trying to analyse the decision of the client. And see how clear the client is about the idea.

Rick: I’ve got a follow-up session tonight

with a client who had a dirty UA [urine

analysis]. I could try it then.

Rick is hopeful and talks about his plan to implement the first step. He is saying this so that he gets an assurance back from the DR in his decision.

DR: I’d be curious to hear what happens if

you do try it. What, specifically, might

you do?

DR has to believe in the capability of the client in order to induce motivation in the interview here he is trying to talk to client through his plan so as to develop confidence in Rick.

Rick: I guess instead of arguing about the

accuracy of the UA, which is what

usually happens, I’d try to understand

this guy’s view. Doing more of the

Reflections and open questions.

Rick is discussing his plan and is trying to understand weather he is taking the right step, he is suggesting to develop discrepancy and then slowly get to the point of solution.

DR: You sound pretty clear about your goal

and how you’d do it. So, what do you

think about tonight?

Analysing that the goal is clear, Dr helps the ease the conversation by stating positivity in the decision and the stage that Rick is in.

Rick: I’ll give it a try. See what happens

Rick seems to be in a state where he is no more in a dilemma, but is looking forward to deal with the issue in the way that he has imagined (Goyder et al. 2014).