There is nothing which we receive with so much reluctance as advice,” British essayist Joseph Addison, early 18th Century.

Client resistance is such a big concept and can seem an insurmountable barrier in Motivational Interviewing. We know that recognizing and rolling with resistance is a key variable in effective MI work with our clients. Resistance behaviours include things like blaming others, making excuses, ignoring clues or signs, minimizing importance or significance, and challenging any suggestions for change. In short, clients find ways to say, and often have lived in the place of NO, – as in they can’t or are not ready to change. Rolling with resistance is not easy, in fact, it might be the most difficult and seeminlgy time-consuming process to learn in using MI. Miller and Rollnick (in Motivational Interviewing: Helping People Change, 3rd edition, 2012), emphasize the mindful work that goes into MI practice in their concept of shifting status talk – the way it is – to change talk – the way it might be if the client were ready to change. Another way to frame the process is to think of the KNOW sandwich. If we conceive of resistance as being some derivative or manifestation of a client’s ‘No,’ (as in, I can’t change and/or I’m not ready to change), then some of the MI work we do with clients might be a kind of expansion process, moving NO to K-NO-W. We don’t mean to suggest this is an easy or cute concept, sandwiching NO between K and W; yet it is worth considering. What might this shift loook like? Moving from NO to KNOW might involve a lot of acknowledging and affirming of your clients.

The more we work with both our own clients and with health practitiones serving their clientelle, the more convinced we are about the power of acKNOWledging clients, seeing them, or, letting them know you know them over and over again: “I see quitting smoking is very hard for you and you feel it’s hopeless;” “it’s clear you’re discouraged by the results you’ve had so far with dieting.” Acknowledging is just so critical; it involves reflective listening and mirroring back to clients, in their own words, who you see them be-ing.

Re-framing is another approach, a kind of subtle corollary to acknowledging or affirming. To the smoker who has tried so many times to quit, you might say, “I see how much effort you’ve put into this up til now and each time, you seem to get closer to what you want for yourself.” To the yo-yo dieter, “It’s clear to me how persistent you are. This change in your nutritional habits must be so very important to you in your life.” Notice that there is no judgment in either affirmations or reframes; both are ways of letting clients see themselves through your eyes. In re-framing, you are acknowledging and adding a slight shift in perspective that might start to take them out of their behaviour doldrum.

Some MI practitioners have found that role-playing works with certain clients; have a client argue for change while you argue the opposite. That is, the client tries to encouage you to change. What you want in this role-playing is to evoke all the reasons the client might have for wanting to change; through role-playing, those reasons become known to both of you. The trick in the role-playing is for you to be authentic, not judgemental in over-playing your role as the NO-person. It’s a kind of an MI drama in that you are trying to get the client to see what it’s like to be in the perspective of change, to be in the place of I know I can instead of No, I can’t.