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Addressing Resistance to Recovery

March 01, 2008

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.”

If these voices of resistance sound all too familiar, and you're exhausted just from reviewing them, take heart. There are ways to harness the energy of resistance and use it to help you move beyond sticking points. We have found that people who initially resist change often later become the strongest proponents of change.

Below are some ideas you can use to get started. Once you try them, you'll undoubtedly come up with more creative ways to take the “no” out of “knowing,” so let us know what you come up with. We'll keep sharing the info with others so we all can keep moving forward. These ideas can be used in any sequence you choose. You can mix and match them in any way that works best.

  • Provide a lot of interesting and fun training on recovery that includes new ways of working with people to help them recover.

  • Ask staff to participate in planning for recovery. Even if they don't like the idea, the more they participate, the more they will own it.

  • Listen to your staff's resistance. Your listening does not mean you agree with them, but it does show that you value their input.

  • Hire well-trained peers to work alongside staff and be living examples of hope and recovery.

  • Ask peers to be part of the training crew. This way you are elevating their role and using them as “expert witnesses” to recovery.

  • Avoid anything that creates a “we/they” format. Work toward being a team and creating partnerships.

  • At your local conferences have peers give awards to staff who have helped them recover.

  • At your weekly or monthly staff meetings have peer staff give awards to staff who have used their contribution in ways that really helped others recover. Call in the bosses for these events so it becomes an organizational value supported from the top down.

  • Investigate the possibility of offering staff professional training credits (CEUs) for going to peer-led trainings or peer graduation events.

  • Reward recovery champions on your staff. Make sure they receive a lot of praise and support. This will show your staff how to get your attention and praise.

  • Don't panic. Don't start making rules about how everyone has to get onboard. If some staff leave, that may be a good thing. Most of them will come around and be your strongest supporters. Keep being clear about your vision, and give them ways to get onboard. You don't have to prove them wrong—this just causes more stuff for them to get over.

The recovery movement has created an opportunity for the behavioral healthcare system to undergo major changes in theory and practice. “Change” is a word we hear daily from all corners: politicians, program directors, people who use our services, and advocacy organizations. Our ability to address issues related to change, especially resistance to it, will serve us well and will allow us to direct more of our energy toward transformation.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix, and she is a member of Behavioral Healthcare's Editorial Board. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.

To contact the authors, e-mail lori@recoveryopportunity.com.

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