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Addressing Resistance to Recovery

March 1, 2008
by Lori Ashcraft, PhD and William A. Anthony, PhD
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Strategies for working with staff resistant to change

Afew columns back, we offered additional information on helping staff move beyond resistance to recovery practices. Those who requested the information often included interesting comments in their e-mail such as “I swear you must have been sitting in on our staff meeting when you put this information together” and “Please send the information as soon as possible since we are right in the middle of a major struggle around this.” Since we had more than 60 requests for the information, we decided that this topic warranted further consideration. So in this column we revisit and expand on the many faces of resistance that surface when change is in the air in a behavioral healthcare setting.

Some of us have no patience when it comes to resistance. We don't like it. It makes us cranky. We want everyone to jump at the opportunity to put their shoulder to the wheel and help us push toward transformation. We don't want to hear any excuses—no whining, no pouting, no digging in of heels.

In essence, we begin to resist the resistors. The more they resist, the less credibility they have with us. We usually stop listening to them altogether and begin to hope they get a job somewhere else.

You may be wondering if we are speaking from experience. Well, yes, we are. But as we've worked through our reactions, we've learned more productive approaches for dealing with resistance, and that's what we are sharing with you.

Let's step into the past for a moment and take a look at how our perspective has changed. Before we understood the dynamics of recovery, we didn't like it when the people we provided services to resisted what we thought was best for them. We called them noncompliant, unmotivated, treatment-resistant, uncooperative, and downright difficult. Then we realized that their resistance to what we wanted them to do was usually a good sign—they had some ideas of their own. We learned to listen to them and to help them move ahead with plans they could resonate with. We had to stop resisting what they wanted to do.

While we were getting over ourselves, we noticed another form of resistance emerging. Oh no—it's coming from our own ranks (“We have met the enemy, and it is us”)! Our own teammates were resisting this new way of being with people! Now we had to deal with their resistance!

In our training of our and others' staffs, we have found that the voices of employee resistance come in many creative forms, and there tends to be a sequence to them. The two that often are spoken first are:

  • “Our people [first of all, they aren't “your people”] are much sicker than yours. They won't be able to recover.”

  • “We already do all of this recovery stuff. We've done it for years.” While there may be a few exceptions, this is almost always never the case. You only have to look at outcomes or ask about treatment approaches and you'll hear a string of chatter that doesn't even resemble recovery practices.

Once resistors realize that these first two comments have not convinced you that you should stop all this “nonsense” about recovery (and, God forbid, transformation), they often move to the next level of resistance. The voices at the next level sound like this:

  • “Develop healing relationships? We don't have time for that. We have to get the paperwork done.”

  • “We don't have any extra funds to do this recovery approach. In fact, we have a lot of cuts coming up.”

  • “This may be how it works for you guys, but we're really different. We are very unique. We'll have to develop all our own material and ideas, which will take decades.”

  • “We have too many regulations, way more than anyone else, and our board of directors is really conservative. Our funding source dictates a very prescribed method of doing everything. We could never get through all that red tape to do something new.”

  • “We do only evidence-based practices here. Recovery isn't an evidence-based practice, is it? I'll need to see some proof.”

There are of course many more ways to hold transformation at bay, but these are the common ones that we hear. When these don't work, the next level will surface. Now the voices of resistance start sounding a little desperate:

  • “I've been looking for a new job. I want to work somewhere that does real clinical practice. After all, I'm a clinician.”

  • “I think we can outlast this new wave of recovery. We've seen new ideas come up before, and if we just hold our ground, sure enough, nothing will happen.”

You can start to see the line being drawn in the sand at this point. You can hear heels digging in. Yet don't blink. Politely hold your ground. It may not feel like it, but you're starting to win. The next level of resistance takes on a slightly different tone—maybe a bargaining voice?

  • “If we must hire peers and parent partners, let's not hire too many of them. What if they take over? What if they take our jobs?”

  • “Can't we change just a few of the forms?”

The last line of resistance usually is related to the doctors. Yes, you doctors out there, the resistors are counting on you to save the day. Some probably hope you'll take your prescription pad out and prescribe an end to this “nonsense.” If not that, then there's hope that you'll cross your arms, put your collective foot down, and declare an end to this. Thus, the final voice of resistance is simply:

  • “Our doctors will never agree to this.”