How can you effectively roll with resistance in MI?

1 What is resistance in MI?

Resistance in MI is not a fixed trait of the client, but a signal of how they perceive the interaction with you. It may indicate that they are ambivalent about change, feel threatened by your agenda, or have different goals or values than you. Resistance is not something to be eliminated or overcome, but rather to be understood and respected. Your role as an MI practitioner is to explore the sources and meanings of resistance, and to adjust your style and strategies accordingly.

2 How to recognize resistance in MI?

Resistance in MI can take many forms, such as disagreeing or challenging your statements, ignoring or avoiding attempts to engage, giving short or vague answers, expressing anger or frustration, minimizing problems, and making excuses. You can identify resistance by observing verbal and non-verbal cues, like tone, facial expressions, body language, and eye contact. To check your understanding and show empathy, you can use reflection, paraphrasing, or summarizing.

3 How to respond to resistance in MI?

The key to responding to resistance in MI is to use the principle of rolling with resistance, which involves validating the client's perspective rather than challenging it. This can help reduce defensiveness, build rapport, and elicit change talk. Reflecting back what the client says without judgment or interpretation is one way to roll with resistance. You can also emphasize the client's autonomy and choice, while avoiding giving advice or directives. Open-ended questions that invite the client to explore their ambivalence or reasons for change are also useful. It's important to affirm the client's strengths, values, and efforts, while expressing confidence in their ability to change. You can also reframe the client's statements or behaviors in a more positive or constructive way, as well as use humor, irony, or exaggeration to lighten the mood or challenge the client's assumptions.

4 What are some examples of rolling with resistance in MI?

Using the OARS skills (open-ended questions, affirmations, reflections, and summaries) in MI can help you roll with resistance. For example, if a client says they don't need to quit smoking because it's not that bad for them, a simple reflection could be "You don't see any benefits of quitting smoking for your health". If they respond that it helps them relax and cope with stress, a complex reflection could be "Smoking is a way of managing stress for you". Reframing could be "It sounds like you would like to have some other coping skills". An open-ended question could be "What are some things that you enjoy doing or that make you feel good?".

If a client says they can't exercise because they have no time or energy, a simple reflection could be "You have a lot of demands on your time and energy". An affirmation could be "You are very responsible and committed to your work and family". A complex reflection could be "You are doing your best, and you also want to take care of yourself".

If a client says they don't want to talk about their drinking because it's none of your business, a simple reflection could be "You feel that your drinking is a private matter". An affirmation could be "You value your independence and freedom". A reframing could be "Most people do, and they also want to live a fulfilling and healthy life". An open-ended question could be "How does your drinking fit into your vision of a fulfilling and healthy life?".

5 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?