Counseling for Resistance

Thank you for your question. Counseling addicts at a methadone clinic can be a challenge for even the most experienced counselor. Some of them don't want help, some of them aren't sure if they want help, some of them do want help but want to tell you what kind of help they need and a few do want your help. But whether they want your help or not, it's your job to provide it.

How you go about providing that help can make all the difference. The best advice I have for resistant clients is to not give them something to resist. If you offer suggestions for things they can do, they can always come up with reasons why it won't work. Instead of trying to get them where you think they should be, work with them where they are. Shift the way you look at resistance. Resistance is often looked at as the client isn't willing to do something. Try thinking about it as if the client isn't ready to do something and it's your job to help them discover why. It's not your job to get them to do something. You cannot change the client. They have to change themselves. The only thing you can change is how you interact with them.

Instead of fighting with them to get clean, go to meetings, etc. Explore where they are, where they want to be and how they can get there. Motivational Interviewing is a good tool for dealing with both resistance and ambivalence. Motivational interviewing is goal oriented counseling that helps the client find internal motivation to change. It works with the client in the context of the stage of change they are in.

After you determine a goal for the client, you can resolve any ambivalence by exploring the pros and cons for and against the goal. If the problem is drug use, explore the following,

• pros of using
• cons of using
• pros for quitting
• cons for quitting

Once you discover where they are and where they want to be, you can explore ways to get there. You can come up with a couple ideas and they can come up with a couple ideas. Then, you can explore the pros and cons of each idea. You might be very far apart on your ideas. For example, they might think going to one meeting is enough while you think they should do a 90 in 90. In this case, make a written agreement that they will try their idea and if it doesn't get them where they want, then they will try one of your ideas. So if being clean is the end result, they can go to only one meeting but if they relapse, they agree to go to 90 in 90. You can even let them pick the second option from your list of ideas so they feel like they have more control. Or have three ideas to try. One idea that is least to do, one that is moderate and one that is the most to do. They can start with the least and work up to the most until the goal is reached.  

I hope this gives you some ideas on how to work with resistance and ambivalence.