De-Escalating Resistance

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Once a patient acts resistant, the best approach is to not challenge it (Miller & Rollnick, 2012). Confronting a patient's resistance, can serve to increase it. Resistance may show up in different forms:

  • "No" Talk: When a patient resists any proposed treatment suggestions.
  • "Sustain" Talk: When patients describe their reasons to sustain an unhealthy behavior.

Responding to "No" Talk

A patient may reject all suggestions for addressing weight problems. One possible response is to acknowledge the patient's frustrations or statements of other emotions.

I've tried to lose weight before, but it's always ended up with me failing and that just makes me feel worse, so I eat more. It's a never-ending cycle. So, no, I'm not interested in going on a diet right now.

It sounds like you've had a lot of disappointments trying to lose weight. I can see why it is difficult to think about trying again. Can we work together to find something you can do now, no matter how small? The important thing is to get started in a healthy direction.

Responding to "Sustain" Talk

When a patient describes a need to maintain current eating habits, try to discover their motivation to continue the unhealthy behavior. First, acknowledge that their feeling is valid. Then turn the patient's "Sustain Talk" into "Change Talk" by asking questions about the opposite of their sustaining motivation.

I don't want to take weight-loss medications because of the risks. I can't change my eating habits, because I love eating too much. I grew up on pork fat.

I understand your concern about risks with medications and that the pleasure of eating makes it difficult to change what you eat. On the other hand, what motivation do you have toward making some changes to lose weight?

Well, I don't want to end up with an amputation from diabetes, like my brother.

View ReferencesHide References
Miller WR, Rollnick S. Motivational Interviewing. Helping People Change. Applications of Motivational Interviewing Series. New York: Guilford Press. 2012; 3rd edition: . Available at: Accessed on: 2014-07-08.