stephenrollnick

Hi,

Recently I found an article "Vewing Resistance as Ambvivalence: Integrative Strategy for Working With Resistant Amvivalence" by David Engle and Hal Arkowitz; Journal of Humanistic Psyholog 2008 48: DOI: 10.1177/0022167807310917.

To me sounds very logical, but is it appropriate phrase "Resitant Ambivalence" to be used in the context of MI?

Or maybe the right question is How in MI should be describe this expression?

Sincerely,

Ivaylo Raynov

P.S. I am a Bulgarian and apologize if the questions do not sound logical in English.

Dear Ivaylo,

how good to hear from you in Bulgaria.  We had a good training the trainers workshop in Sofia some years ago, and I even appeared on that Friday night chat show, and experience I hope never to repeat!

Ivaylo, its been a struggle, finding the useful terms for things that are so hard to understand. A bit like swimming across a coral reef, seeing all the colour and life, then coming up and describing it. Our understanding is far from complete, and Miller and I are not the "last word" on the subject!

Hal Arkowitz is a psychotherapist who Bill Miller describes as his mentor. A wonderful man.  His work is well worth absorbing.

Bill and I have agreed that it might not be helpful to use the term resistance at all, because it could pathologise the client, the term coming from the depths of psychoanalysis. Moreover, we have also agreed that its a mistake to view the expressions of ambivalence as in any way a problem.  We now use the term sustain talk to describe the clients arguments for no change, and change talk for the opposite.  Very normal expressions.

Then what term do we use to describe little and larger breakdowns in the relationship, that occur for all sorts of reasons at various times? We wonder about the term discord.... but that's another story...

Ivaylo, it is hard enough trying to share ideas about what's going on in the coral reef, but quite how you do this in your second language just amazes me!

Warm greetings,

Steve

Hi Stephen,

Thanks for your sharing.

I agree with you about the archaic meaning of the term "resistance" in the context of MI. I think the expression "discord" as a good substitute for what happens between us (consultants) and client and this gap between us which occurs for various reasons.

On the other hand I think the need to distinguish between different levels of sustain talk as it is in change talk (DARN ACT).

I look forward to MI-3.  Keep up the good work.

Best wishes,
Ivaylo

P.S. I hope one day Bulgaria to host MINT forum again.

Dear Ivaylo,

that's a great idea, having different levels of sustain talk.  We will probably find that its been tackled by researchers like Terri Moyers, who has run so many studies on the process-outcome relationship in MI.  But clinicians might find this helpful.

Ivaylo, here's a slightly wild idea: if you and I share this concern about a term like resistance because it pathologises the client, are we not guilty of this trap by only focusing on client aspirations, like sustain talk and change talk?  In other words, what about the counsellor's aspirations?  Why have they not been described and studied?   Here's a suggestion: in any conversation about change both parties have aspirations for change in the client. These can be positive and negative, and they can vary in strength.  Funnily enough, very strong counsellor aspirations, unlike strong client ones (like change talk), might not necessarily be productive, because counsellors too often push clients towards change when their aspsirations get too strong.......

All best wishes

Steve

Hi Stephen,

This is an interesting idea!

Best wishes,

Ivaylo