People in the mental health world use the word “resistance” a lot. In fact, they use it so much, and in so many different ways, that it’s hard to know what it means anymore. But there are places where the word is used in a precise manner, and that tells us something about what resistance is and how to use it. The places I’m speaking of aren’t in the mental health or addiction fields, but in the business world, specifically the world of Constraint Theory.
I’ve written before about Goldratt’s Theory of Constraints and how it applies to addiction treatment, but here I want to focus on a more global perspective. I am going to focus on how people change and what makes them resist change. But first, I need to add a bit of a preface.
I work every day with people who treat addiction and have trouble with their patients. In my discussions with counselors and doctors I use a question that seems counterintuitive to them at first. “Why would someone in their right minds act like that?” As you’ve probably guessed the most common answer is, “They aren’t in their right minds, that’s my point!” It’s the only answer I won’t allow. I have my reasons, but here are Goldratt’s.
TOC says that everyone wants to do a good job, that people who have the same goal don’t disagree because they don’t want to work together, but because they have different assumptions about how to meet the goal. Just knowing that alone gives us a leg up. First we need to know do we have the same goal as the patient? If we do but they don’t agree on the plan, we know it isn’t because they want to live in misery or don’t like us; it’s because of a difference between our and their assumptions. So our first task is to get our goals aligned with the patient’s, and after that, to understand what the assumptions are on both our parts that explain why we don’t come up with the same plan.
1. What to change
2. What to change to
3. How to change
In short, what TOC, and other logical systems, give us is a method of understanding disagreement and conflict as well as a method of resolving that conflict. So far, most of the addiction treatment field resolves conflict by saying, “We’re right; you’re wrong. Do it our way,” and wonder why things aren’t working out. So they see a lot of resistance. So would anyone with that attitude.
So let’s consider the first question, “What to change?” We often think that what the patient needs to change is his drug use, and what the patient thinks needs to change is how bad he feels. Unless we agree on the goal and what to change it’s not likely that we’ll come to agreement on what to change to or how to change.
But let’s say we do agree on what to change. After that there’s often disagreement on what to change to. We often think that complete abstinence should be the the end all, but again, the patients may be looking for a way to feel better. Unless we have agreement on what to change to, we’ll never agree on how to change.
Which brings us to the last point. It’s where most of us focus first, the how to change. We tell patients to go to AA, or go to group, or take their medicine, or live in a half-way house, or whatever other thing we think will do the trick. And they don’t do it, and we call it resistance. But if we look at it from a TOC point of view, we could never expect anyone to accept a plan on how to change if they don’t agree on what to change or what to change to. We have a lot to learn from other fields that approach change from a much healthier point of view. It’s the basis for our DAS score and our understanding of how patients change. It’s the underpinnings of why we get the good results we do.