SYSTEMIC CERTIFICATE TRAINING: RESISTANCE TO CHANGE

Resistance to change, what is it?

Sometimes, some patients develop a resistance to change which makes them immobile and unable to change. The systemic and strategic approach makes it possible, thanks to specific techniques, to define the different types of resistance to change. Watzlawick and Nardone have defined 4 profiles of resistance to change (Watzlawick, Nardone, 2004). Identifying types of resistance to change is therefore an essential phase of therapy. Once the type of resistance has been identified, the systemic therapist can direct his intervention strategy towards change.

Types of resistance to change

The type of resistance to change and the underlying emotions determine at which level(s) to intervene (cognitive, emotional or behavioral) to have the most impact as well as the nature of the prescriptions intended to mobilize the patient in an optimal way. The stronger the resistance, the less the prescription will be involving and direct and vice versa.

We can identify 4 profiles of resistance to change (Watzlawick, Nardone, 2004).

1. Collaborative: he has both the motivation and the ability to change. With this type of profile, the therapist adopts a rational and demonstrative communication in order to make the patient understand what is dysfunctional,

2. Emotionally prevented: he is motivated but does not have the capacity to initiate a change because he is emotionally blocked by a rigid perception.

3. Opponent: he has the ability to change but is resistant to any collaboration. Communication will be based on its resistance and the prescriptions are paradoxical.

4. Ideologically blocked: the patient demonstrates a mental rigidity that prevents him from seeing reality other than through his vision of the world. The therapist endeavors to adopt the non-ordinary logic of the patient and to gradually change his system of representation. Faced with profiles of perfectionists emotionally hindered and limited by their belief system, the therapist must be careful to be strategic in his communication. The communication used is indirect and evocative in order to bring the patient to “furrow the sea without the knowledge of the sky” that is to say to change without realizing it. The use of isomorphic communication (= adjusted to his way of feeling things, expressing himself and reacting) allows the patient to feel that he is understood and joined in what he is experiencing and what he is suffering from . It also increases the impact and effectiveness of images used to elicit sensations aimed either at creating aversion or reinforcing behavior.

Towards change

Quotations, proverbs, stories come to support these images to initiate the change of perception. Regarding the connection and in order to create favorable conditions for change, the therapist initially tunes in by joining the logic of the patient. He then endeavors to make him feel that his own rigidity contributes to the problem in order to saturate his fear, the source of his blockage, or to stimulate an alternative emotion. By doing so, he puts him in a position to choose between continuing his habits or initiating a change.

According to Milton Erickson, “for a situation to change, the patient must do something”. And according to the strategic systemic approach, this “something” must be the opposite of what it usually does. Thus, for patients with a propensity to repel difficult thoughts or emotions through hyperactivity, indirect tasks are preferred. The objective is to defocus the person from what scares him and to get him out of the action to enter into introspection. Through observation tasks (check-up and logbook in particular), it is a question of getting her to reconnect with herself, with her feelings and to generate exceptions favorable to change. Paradoxical imagination tasks such as "How to make it worse?" » and « the risks of change » are used to identify - the TSRs in order to make them aversive, - the resistances and secondary benefits constituting obstacles to the change process.