The first quarter of the year is coming to a close. Do the resolutions you made at the beginning of 2008 feel like distant memories? Are the goals you set a couple of months ago untouched by action? Do you feel as if your passion for practicing flew south for the winter? Don't despair; you're not alone.Chiropractors are, as a rule, ambitious and full of good ideas about how to grow their practices. They plan for more effective marketing, find new ways to engage their staff, work hard to gain loyalty and more referrals from patients, and are always on the lookout for ideas to have better life balance. So why is it that despite being highly motivated, enthusiasm seems to ebb and flow, and well-intentioned practitioners miss the mark when it comes to achieving what they set out to do?
Goals fail to come to fruition for any number of reasons. Perhaps you set a very specific and worthwhile goal but forgot to create a corresponding action plan. Or maybe you voiced a resolution that when it came right down to it, wasn't compelling enough to motivate you beyond the first few steps. Sometimes individuals fail to reach goals not because they're unmotivated or unwilling to work, but because they don't have the resources they need to achieve success. These are fairly common explanations for why we fail to achieve our goals. However, there is also a deeper and less understood reason for why chiropractors don't follow through and achieve what they say is most important to them: their own internal resistance to change.
It's critical to understand resistance because it is one of the challenges you face in your practice every day when patients question the benefit of your service, refuse recommendations or don't follow through with treatment plans. How to address and work with resistance on the part of patients will be covered in part 2 of this article (April 8 issue). Before exploring that topic, however, it's important to first understand your own internal resistance to change - specifically how to diagnose, manage and make it work to your benefit. The ability to meet resistance and deal with it effectively determines much of your ongoing experience and outcomes. Tolstoy wrote, "Everyone thinks of changing the world, but no one thinks of changing himself." I think he was onto something. So let's dive in and explore resistance from the inside out.
The Psychology and Physics of Resistance
When we resist change, there is often an underlying dynamic or hidden force at work. We resist as a way to defend ourselves against some anticipated or perceived potential for loss - status, reputation, security or control, for example. Instead of focusing on what we might gain by taking a risk or making a change, we resist and hold on to what we already have, even if it's not exactly what we want.
Dictionaries typically define resistance as a force that slows or stops movement, or as the act of resisting. This definition may then be expanded specifically for the application or field in which it is a driving factor - electrical, mechanical, psychological, biological or medical. Remember the basic physics principle: For every force, there is an equal and opposing force. Resistance is a force; it's energy and it can be a protective factor in human experience. It may be internal or external. It is invisible, yet palpable. It can be a repelling force that is distracting and insidious. Still, resistance is not in itself negative or positive. It just is. How we interpret resistance is personal. Push resistance away and you may unintentionally increase the strength and power of the "equal and opposing force." Look upon resistance as something to be explored - with curiosity, not judgment - and you can put it to good use.
Because we're exploring how to work with and learn from internal resistance, let's consider some common scenarios:
- You want a stable staff, and you know the actions you should take to have such a staff. Why then do you find it so hard to listen, empathize, hold your staff accountable and lead in a way that will bring about the outcomes you desire?
- Nothing is more important to you than building your practice and enhancing word-of-mouth marketing about your services. So why do marketing activities always fall to the bottom of your "to-do" list?
- You've just returned from yet another motivational seminar where you and your staff created a vision and action plan for moving toward a cash practice. But now you're back at the office and find that neither you nor your team is doing anything to implement the plan.
I have worked with clients in all of these situations. They have good intentions, they're motivated, they make plans and they have the resources they need to achieve their goals. And yet, many don't follow through, becoming frustrated and disappointed. They again resolve to take action, and again hold back. They finally get started on something and then stop midway through, daunted by some obstacle or fear of the outcome, consequences or risks involved. It sometimes seems that these individuals have acquired a powerful immunity to change. To move beyond this immunity, I recommend the following five practices: evaluating readiness, understanding patterns, reframing and embracing resistance, looking at dueling intentions, and learning to evaluate "in the moment."
It's important to be able to distinguish between a plan that you will carry out and one that you won't. Every day, practitioners challenge themselves to keep up with paperwork, market their practice, deal with a chronic staff problem, spend more time with their families - and then they don't follow through. They promise themselves, "I'll do it tomorrow." If you tend to make the same resolutions, set the same goals year after year and then fail to follow through, it's time to take a deeper look at the issue. Ask yourself these four questions:
- Are the resolutions, intentions and goals I set out to achieve really important to me?
- If they are important, what are the obvious obstacles (internal and external) that get in the way?
- To what extent does achieving the goal or keeping the resolution depend on someone or something else changing?
- When I fall short or fail, what is my typical reaction (i.e., dismiss, deny, blame, rationalize, learn)?
To understand resistance and use it to fuel your change efforts, you must become acquainted with your own patterns. Resistance can make itself known in any number of ways. Some people experience a sense of confusion about what to do next. They deny or rationalize the need to take action. They criticize themselves for previous false starts or past unsuccessful efforts and in doing so, sabotage their future success. Others slip into a state of perfectionism, unable to move forward until they are certain they know everything and can execute their plan perfectly. Many of us demand immediate results or adopt an all-or-nothing attitude. Some people become dramatic, placing blame or becoming envious of others who are seemingly doing better or who are more successful than they are. Still others take on so many projects (and have so few practical strategies for managing multiple priorities) that they hit the wall before they even start running. And then there is good old procrastination: "I'll get started on that marketing project just as soon as I read all the journals sitting on my floor, check on my stock portfolio or rearrange my pencil drawer."
Reframing and Embracing Resistance
The word resistance has a certain pejorative quality to it, as if we are refusing to do what is best for us. It hints that we are being intentionally stubborn or lazy. More often than not, resistance is seen as something we need to eliminate, overcome, neutralize or conquer. We try to meet resistance with more force and use our willpower to bring about the desired change in others or ourselves. Our difficulty with change is often attributed to insufficient motivation or lack of commitment to the change process. "Just do it," your coach may tell you. Then, when you are not successful, you judge yourself as weak, not trying hard enough or somehow faulty. Given this level of negativity about resistance, it's easy to see why we tend to want to push it away. The idea of embracing and studying our own resistance is a foreign concept.
So, resistance has gotten a bad rap, but before you resist the idea of embracing resistance, consider your own immune system and the natural biological function that is activated when a foreign substance or challenge to the body is introduced. Our physical response is to expel or neutralize what is unknown or harmful. In a similar way, we can mentally and emotionally become triggered by the unknown and develop an immunity to change - sometimes for good reasons. Even when we are genuinely committed to a different experience, the prospect of change threatens our current thinking and habitual behavior. Even when it's inevitable, we very often resist change. A different future may seem riskier than the status quo, even when the status quo isn't desirable. It's at least familiar.
Dueling Intentions and Commitments
When you find yourself acting in a way that is contrary to your commitment or intention, there may be another force at work. Your immunity to change may be triggered by an unconscious (though active) commitment to keeping certain things from happening - experiencing conflict or confrontation, having to say no, being disliked by patients or staff, or making a mistake. For example, you are committed to transitioning to a cash practice and have a good, solid plan in place. Still, you've always been known as amiable, flexible and generous. Taking a stand for transitioning your payment method feels risky, counter to your natural tendencies, and even challenging to your identity. Is it surprising, then, that you would hesitate and resist implementing your plan?
This dynamic pattern is a form of self-protection and is frequently the cause of stalled change efforts. Understanding your underlying reasons for resistance can help you accept, work around, learn from or manage resistance. Here is a simple exercise to support you in determining whether your resistance is the result of dueling commitments:
We often generalize and hold underlying beliefs that keep us from living the way we would prefer. One additional step in this exercise is to consider what assumptions you hold that keep these competing or dueling commitments in place.
Remember, you may not always be able to clearly see resistance in yourself. Or if you do recognize that you are resisting, you may consider it self-protective or necessary. But if you can identify resisting behaviors, you might then be better able to see how those behaviors are keeping you stuck. To enhance the likelihood of real change, it is necessary to disturb the balance between competing commitments.
Evaluating in the Moment
Begin to identify your own patterns of resistance by practicing self-observation and reflection. Honestly inquire into your own unique (and often wily) brand of resistance. Because each individual manifests and manages resistance in their own way, it's important to take a personal approach to dealing with it, instead of simply adopting mind-over-matter and positive-affirmation approaches. Here is a series of questions you can use anytime you find yourself in resistance mode. These are designed to help you engage, learn from and manage your resistance.
- What change am I resisting? What am I avoiding or trying to keep intact?
- What triggered this resistance?
- When I realized I was resisting, what were my thoughts, judgments, feelings and physiology?
- What can I learn from this particular experience of resistance?
- What are my external reactions or behaviors (ignore something, make a deal, shoot the messenger, give in too soon, or use control or manipulation)?
- What are the short- or long-term consequences to continued resistance in this area?
- What, if anything, do I need to do about this resistance?
Resistance is normal, predictable and inevitable. It's a natural part of the cycle of change. The fact that you resist does not mean you aren't resolute or that there is something wrong with you. Resistance is not a character defect. At times, we all resist working on a complex project, confronting a sticky situation, trying something new, taking advice or asking for help. The trick is to understand your own patterns of resistance and use them to your advantage. In the process of doing so, you can develop the resilience needed to support sustainable change in your practice.
Now that you have a deeper understanding of internal resistance, be sure to read my next column in the April 8 issue, when we'll look at how to deal with the resistance you encounter from patients and others in your practice or life.
Click here for previous articles by Shelley Simon, RN, DC, MPH, EdD.