Talking With Patients Resistant to Changing Their Drinking
When talking with patients about alcohol, physicians may encounter "reactance," patient resistance to relinquishing control in interpersonal situations. Signs of this resistance include arguing, changing the subject, and generally responding negatively. To understand how clinicians should approach resistant patients, researchers observed counseling sessions of adults with alcohol dependence who had participated in a randomized trial of 3 standardized psychosocial therapies (that turned out to be equally effective). Researchers tested the relation between what clinicians said and drinking outcomes in 141 patients 1 year after treatment.
- Among resistant patients, clinician directiveness—characterized by closed-ended questions, interpretation, confrontation, topic initiation, education, and advice giving—was significantly associated with fewer abstinent days and more drinks per drinking day.
- However, among patients with low resistance, directiveness did not significantly affect drinking outcomes.
This study suggests that when patients appear to resist changing their drinking, clinicians should avoid the natural tendency to give information and advice. What should we do when talking with resistant patients in general health care settings? Although not addressed directly by this research, prior studies of motivational interviewing suggest that we should encourage patients to talk about what they find most important and then should spend most of our time listening and demonstrating that we have heard them.Richard Saitz, MD, MPH
Karno MP, Longabaugh R. Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment. J Consult Clin Psychol. 2005;73(2):262-267.