Managing Resistance

Data collected about why patients decided against participation revealed many common forms of sustain talk. Learning to respond appropriately to sustain talk is an important aspect of motivational interviewing because the more people use sustain talk the more people connivence themselves not to change their behavior. On this page you will find some common responses in the capstone project data as well as the literature and strategies for responding. These approaches have been adapted from Miller and Rollnick (2013).

Reflections

Use of reflections can assist in responding to sustain talk. You can read more about reflections here. You can reflect in 3 ways:

Straight reflection – This would be a simple or complex reflection of what the patient says. For example:

Patient:”I don’t think smoking is a problem”
Provider Response: “Smoking has not impacted your health”
Patient: “Well… I get sick more often”
- If smoking has impacted their health, this will often prompt them to tell you about it.

Amplified Reflection – This is when you reflect what the patient has said but increase the intensity or certitude of the statement.

Patient: “I don’t have enough time to quit smoking”
Provider Response: “you don’t have any time for quitting smoking”
Patient: “Well I could try to make time or I guess there is some time in my schedule.”

Double Sided Reflection – This form of reflection acknowledges sustain talk and pairs it with change talk. This often gets to patient ambivalence.

Patient: ” I mean I know its bad for me but it’s really going to be hard to quit and I don’t know if I want to”
Provider: ” You think is is going to be a challenge to quit smoking and you also know that quitting smoking is important to being healthier.”
Patient: “Yeah, I mean, I don’t want to make my asthma any worse.”

Emphasizing Autonomy

Sometimes telling patients that they do have a choice helps them see they can change. This strategy often goes against our natural inclination to tell people that the should stop smoking but can be effective in MI sessions. It is important to pay close attention to your inflection with these responses because if the patient perceives your tone as sarcastic, paternalistic, or dismissive, it can negatively impact the conversation.

Patient: “I really don’t want to quit smoking”
Provider: “It is your choice to quit smoking. No one can make you quit.”

Patient: ” I am just not ready to quit smoking”
Provider: “You can decide when you are ready”

Reframing

Reframing often offers a different perspective. It can also show a different meaning to what the patient has said. The purpose of reframing is not to argue or correct the patient’s perspective, but is to give them a different point of view. With this approach you can turn something daunting such as uncertainty in to a challenge.

Patient: “I don’t have time to quit smoking”
Provider: “It would be a challenge to fit quitting into your busy schedule”

Patient: ” I have too many appointments right now”
Provider: ” You have been working hard to take care of yourself”

Patient: ” I have so much going on right now, I don’t know if I want to take on quitting smoking too.”
Provider: “You are a survivor” or “you can take care of a lot of things at once”

Agreeing with a Twist

This is done by agreeing with what the patient has said but also provides a twist, which is a reframe of what the patient has said. These can be hard to deliver and it is important that the reframe is not delivered with sarcasm.

Patient: “Smoking is just part of me, part of everything I do”
Provider: “Smoking is a part of you and you wouldn’t be you without it. It is so important that you might have to keep doing it no matter the cost.”

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