Rolling with Resistance
- dee6321
- 2 days ago
- 4 min read
We have written about the first rule to a successful lifestyle change conversation, inquiring about patient readiness by using the Readiness Scale or Ruler. Read here. In summary:
Low readiness (3/10 or less): Likely "Not Ready" or in pre-contemplation mode, with change not on their radar.
Thinking about change (3-5/10): Contemplating change; with prompting, they may need more time or may be ready to move to the planning phase.
Planning Phase (6-7/10): Already thinking about change and pondering how to make it happen.
Action or starting phase (8/10 or above): Open to progressing their current plan or adding an additional action or goal.
How can we Impact the Not Ready Group
How can we impact the Not Ready group with a greater chance of moving them up the Readiness ruler? One way for certain, is not to tell them what they need, must or should do. This can elicit external motivations (instead of the preferred self-motivation) out of fear or to please you or gain your respect. When this happens, it bypasses a person’s autonomy (the desire to decide for oneself) and can result in more resistance from the patient. (Think about how your suggestions for change go over with your spouse or teenager!) The harder you push, the harder they push back or just shut down.
When patients experience high internal or autonomous motivation, new and healthier behaviors persist longer and people experience more enjoyment from making changes. When they make their own choices, they are shifting some of the responsibility for their health onto themselves and away from it being wholly on the healthcare provider and medical system.
When resistance to change comes up, it’s time to use motivational interview techniques to have a discussion filled with curiosity and empathy about the pros and cons of change without judgement, advising, educating or correcting. If these are used during the conversation, it can kick up resistance talk. This takes you farther away from eliciting a patient’s internal motivation. The goal is not to have them change, but help them sort out their cognitive dissonance about knowing that they should change and not wanting to, or feeling that they can’t make the change.
It can be helpful to ask a few open ended questions that guide the conversation to a meaningful close and help with decisional balance.
“What benefits do you get from staying the same?” (not changing to a healthier behavior)
“What will happen in the future if things stay the same, if you don’t change?”
“What could be hard about making a change?” (to add a healthier behavior)
“How would your life be better if you made a change?” (to a healthier behavior)
Your responses to the patient’s answers need to show you are actively listening and you can do that by reflecting back what they told you or just having a moment of silence.
This is how a conversation might go:
Provider: “What are the benefits to you smoking?”
Patient: “It gives me a break in the day where I can go outside and de-stress.”
Provider: “So, life can be stressful and the smoking break is helpful.”
Provider: “What will happen in the future if you don’t quit smoking?”
Patient: “If I don’t quit smoking, I will probably have COPD like my mother has.”
Provider: “So you worry about getting COPD in the future.”
Provider: “What could be hard about quitting smoking for you?”
Patient: “I won’t be able to do it, the cravings will be too hard to overcome.”
Provider: “Sounds like you don’t have much confidence that you can break the habit.”
Provider: “How would your life be better if you gave up smoking?”
Patient: “For one, it would save me a lot of money and I wouldn’t have that nagging craving that I need a cigarette. I also wouldn’t have to sneak around at home to get a smoke.”
Provider: “Sounds like you feel there are some real positives to you giving up smoking.”
A great next question might be:
Provider: “How will you know when it’s time to try quitting or what is it going to take for you to think about giving up smoking?”
This question may reveal what the patient feels would need to happen for them to make the change. This is where you can put on your “expert hat” and offer to share helpful information or brainstorm some ideas, allowing you to co-create a treatment plan together.
Alternatively, It may end in the patient “having to think about it some more”. Any conversation about change moves the patient closer to change. You can end the conversation with “If it is ok with you, maybe we can revisit this conversation again at your next visit to see if anything has changed.”
Quick Start Takeaway
If you are reading this and saying to yourself…”I don’t have that much time to have that kind of conversation!”, see if you can try just 1 or both open-ended, powerful questions to start..
“How would your life be better if you made a change in your lifestyle, took on a healthy habit?
“What is it going to take for you to think about or start a plan to change?”
As part of our HealthyChange Scripts Kit, we developed a specific script called Are You Ready?
This script has a similar list of open ended questions as discussed above. The prescription can be used as a “script” for a provider to guide this meaningful conversation or if time does not allow, a patient can be asked if they would be willing to complete it at home and discuss it at the next visit.
Remember, these conversations don't require an overhaul of your schedule; they require a shift in your approach. Every time you choose curiosity and empathy over correction, you are building the therapeutic alliance necessary for lasting change. You have the skills to move beyond simply prescribing, and by meeting your patients exactly where they are, you aren't just saving time—you are planting seeds for their future health. Trust in the process, trust in your patient’s capacity for growth, and know that even the briefest conversation that fosters autonomy is a victory for both of you. You are the catalyst for their progress, one conversation at a time.
What powerful question or questions will you try tomorrow? Let us know how it goes.
Reference:
Moore, M., Jackson, E., & Tschannen-Moran, B. (2016). Coaching Psychology Manual (2nd ed.). Wolters Kluwer.
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