By Daniel J. Benor, MD

Another consideration when people appear to be ambivalent or opposing a change is to explore whether the person is compliant or defiant. Most therapeutic interventions are based on the expectation that people will go along with the caregivers’ suggestions, recommendations and prescriptions. While this is generally true for the majority, there are significant numbers of people who are somewhere on the spectrum of “cussedly independent – oppositional – defiant.”

Another giveaway is a smile when people are telling you about how the change was short-lived or only partial. My experience is that confrontation over the smile works only with those who have been in therapy for a considerable time and who have a substantial capacity for self-reflection and insight. Insights offered in therapy are often denied, become the subject of disagreements and arguments, or are thoroughly and denied by those who are defiant.

For people like this I find it helpful to use what I call ‘mental judo’ – which is more often labeled ‘paradoxical interventions.’ Milton Erikson, one of the worlds best known hypnotherapists, was a master at this. I learned a lot of what I know about this from books written about his methods, in addition to training I had when studying family therapy at the Child Guidance Clinic in Philadelphia many years ago.

Were I to say to someone like this, “I think you might have let go of this too quickly, so that some part of you is uncomfortable and is wanting still to hold onto it,” their most likely oppositional response would be to say something like, “I don’t feel that’s right,” or “I really did my best and don’t feel that I want to hold onto this at all.” Further discussion would end up being an argument.

A better approach is to invite them to argue their way into a more healthy frame of reference and more positive responses. So, accepting that they are cussedly independent, I would say something such as “I have a suggestion for you, but I don’t know if you’re ready for this just now,” or “Maybe I made a mistake in suggesting too quick a change, what I’m hearing is that you’re saying your system just isn’t ready to change so quickly.”

These are clear invitations to oppositional people to argue back that they are ready to change, or at least ready to hear my suggestion NOW!” When they respond in the anticipated way to a judo maneuver, we have to be very careful not to switch into the compliant mode of discussion and relationship. If we were to say “OK, so let me tell you what I think…” then they would come right back in their usual manner and argue against my suggestions.

The more helpful way for me to respond to their request for immediate information is to hold back and express further skepticism about their readiness, so that they put even more energies into convincing me that I should at least give them a chance to hear what I have in mind. Again, my response will be best received if it is phrased hesitantly and skeptically, such as “I really expect this will be too much, too soon, but if you were ready, I’d be suggesting that you look for some sort of statement about why this isn’t working or can’t work – something your unconscious mind might come up with that you haven’t thought of consciously – like “If I change too quickly then … [you fill in the blank – IF you can, though I really think you unconscious isn’t yet ready for this] – and if you were ready you’d continue “and I still love and accept myself… etc.”

So I always maintain a skeptical attitude, which is the way to accept that they are going to argue against me. This way, the suggestions will be accepted and will help.

If they explore doing this immediately, in my presence, or if they return for the next session and report that they did it on their own and had a partial or complete success, then again I must express surprise and skepticism whether their unconscious mind is truly ready to let go just yet, and whether it won’t just come back all over again.

When I first learned this approach, I was concerned that these oppositional people would think I was making fun of them or playing around with them. The exact opposite has been the case. Most of these people have no idea how cussedly independent they are. What they experience is that people tend to argue with them a lot and they feel misunderstood and unappreciated, if not downright rejected in many interactions. Mental judo gives them the feeling that the therapist really understands and accepts their ways of being and relating in the world.

References

Haley, Jay. Uncommon Therapy: The Psychiatric Techniques of Milton H Erickson, MD New York: Ballantine 1973. (Reprinted by permission of WW Norton & Company, Inc. Copyright 1973 Jay Haley.)

Rossi, Ernest. Hypnotic Realities: The Induction of Clinical Hypnosis and Forms of Indirect Suggestion , New York: Irvington/Halsted/Wiley 1976.

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