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.

Comments:

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

Reference:

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.