Change and Resistance to Change

“Do you think he changed?” This was the question my acute psychiatry attending asked me after a presentation. My first rotation in medical school was psychiatry, first in an alcohol rehabilitation facility then an acute psychiatry ward. My patient professed to having had a horrible criminal past and was now admitted for an acute psychiatric episode. My task was to develop a therapeutic relationship with him and generate information necessary to help with the diagnosis.

As I spoke with this man and received some advice from my attending psychiatrist the patient became very happy that I helped him understand his problem and he was going to get better. The flaw in my thinking can with the question "Do you think you changed?" My tinny pointed out that he was too happy and this is a manipulation. If he were going to change then he would have to recognize the seriousness of his behaviors and how he had hurt people. If he felt this, we would expect him to be sad. I had been fooled.

We may change when we recognize that what we are doing is wrong, that our belief system is not working. This has resistance. Resistance may also come from the bad feeling we feel when realizing the things you have done wrong and who you have hurt.

There is another method of change. I ran track and cross-country in high school and my coach would watch me run, and then give me methods to improve. He wanted to better everyday and run faster every race. The more tips he gave me more valued I felt.

We can interpret the information outsiders give us in different ways. From my experience in psychiatry, more suggestions marks me as performing more poorly. However, from my experience in running, the more suggestions I receive the more I am valued and the better I will become. The difference depends upon relationship I have with those around me. And is a leader, I must pursue the relationship of a coach being watchful that my students cannot take these coaching remarks as negative criticisms.

Change can also come from moving toward a goal – becoming better. This is the change from a coach. While we may think of the coach yelling at the team, in reality the coach works to maintain a bond with the athlete for trust. The athlete trusts the coach and changes because he or she wants to perform better.



Coaching to do better is the change of HRO and what I wanted in my staff. It works from the top down but not upward. This places a ceiling on introducing HRO – it can only go down. That is, downward.