1. Assessing Motivation Decisional Balance BenefitsConcerns BenefitsConcerns

2. Using scales Readiness 0 1 0 20 30 40 50 60 70 80 90 100 Importance How much better life will be 0 10 20 30 40 50 60 70 80 90 100 Confidence

3. The Flow of Change Talk Motivational Interviewing Change TalkCommitmentChange

4. Resistance / sustain talk Take three minutes to write down resistant statements that you come across in your practice

5. Responding to Resistance   How have you felt in the past when working with resistant clients?   What responses have not worked well?   What responses have worked well?

6. DEALING with RESISTANCE THERAPISTS ROLE   Not to assume it is wholly a client characteristic   Greater resistance = less chance of change   Lower levels of resistance is a good sign (change talk)   Resistance should be a therapist concern   Same therapist switching styles can affect outcome (Patterson & Forgatch, 1985)

7. Cont… RECOGNISING RESISTANCE   Anything inconsistent with change   Suggests the client and therapist are not at the same point.   Change talk is the opposite to resistance   Resistance may be normal initially. Therapist task is not to elicit more but to manage effectively

8. STRATEGIES for DEALING WITH RESISTANCE   Simple reflection   Amplified reflection   Double sided reflection   Shifting focus   Agreement with a twist   Emphasising personal choice / control   Reframe   Paradox

9. Therapist Style and Client Response Miller, Benefield & Tonigan (1993) JCCP 61: 455-461

10. Avoid eliciting resistance

11. Cont…   Confrontation is likely to elicit resistance   At 24 month follow up lower levels of alcohol consumption were noted in the group that had least in-session conflict Miller, W.R., Benefield, R.G. and Tonigan, J.S. (1993) ‘Enhancing motivation for change in problem drinking: a controlled comparison of the two therapist styles’ Journal of Counselling and Clinical Psychology, 61: 455-461

12. Research & Resistance  Level of client resistance during counseling predicted absence of change in drinking (Miller, Benefield & Tonigan, 1993)  Verbal commitment to drug use during MI predicted continued drug use (Amrhein et al., 2003)  Resistance / poor outcome relationship replicated in several other studies

13. Practice Responding to Resistance  Resistant client  Use some of the resistant statements you have already written down and in pairs practice responses

14. Further Reading  motivationalinterview.org  Motivational Dialogue Raistrick & Tober (2007)  Motivational Interviewing Miller & Rollnick(2002)  Email contact: jon.mcgowan@leedspft.nhs.uk