Respond to sustain talk by reflecting it rather than arguing with it. A plain reflection, a double-sided reflection that ends on the person's own reason for change, or a statement that the choice is theirs will usually lower the pushback. Arguing back tends to make the person defend their position harder. When the tension is with you rather than with the change, that's discord, and it calls for repairing the relationship first.
Two kinds of pushback
Older MI writing used the word resistance for any pushback. In the third edition of their book, Miller and Rollnick split it into two ideas, because they need different responses.
Sustain talk is about the change. "The checklist takes forever and half of it doesn't apply to our patients." "I need a few drinks to sleep." It's one side of normal ambivalence.
Discord is about you and the relationship. The person is pushing back on you, not on the change.
So you've been tracking when I come in? That's great. Really makes me feel trusted.
That's discord. The MA isn't arguing about the late arrivals. They're telling you how the conversation feels.
Common signs of discord:
- Defending: "It's not my fault, nobody told me."
- Squaring off: "You don't know what it's like out here."
- Interrupting: talking over you before you finish.
- Disengaging: flat answers, checking their phone, "Sure. Whatever you want."
Both are signals about the conversation. Sustain talk tells you about their barriers. Discord tells you something you did, or something about your role, has raised the stakes.
The righting reflex
Most pushback is made worse by the same thing: the helper's urge to fix it. Miller and Rollnick call this the righting reflex. You hear a reason not to change and you want to correct it.
I don't need the statin. My dad had high cholesterol his whole life and lived to 88.
That's one person. The data on statins for someone with your numbers is pretty clear.
The data also says they cause muscle problems. My neighbor couldn't walk on them.
The physician is right on the facts, and the patient now has two arguments against statins instead of one. Every time you argue for change, you hand the other person the job of arguing against it.
Notice the reflex in yourself. It often shows up as a tightening in your chest, a "Yes, but," or a sudden urge to explain. That's the moment to slow down and reflect.
Strategies for sustain talk
Simple reflection
Say it back, plainly. This lowers the temperature because the person no longer has to defend the point.
The checklist takes forever and half of it doesn't apply to our patients.
A lot of it feels like busywork for the patients you see.
No "but." No correction. Often the person will soften on their own: "Well, the allergy part matters."
Amplified reflection
Reflect the sustain talk a little more strongly than they put it. People often respond by backing off the extreme.
I don't drink that much. Everyone has a few on the weekend.
Your drinking is nothing anyone would worry about.
Well, my wife worries. But she worries about everything.
Say it in a neutral voice. With any sarcasm, an amplified reflection becomes mockery and creates discord.
Double-sided reflection
Reflect the sustain talk and the change talk together, joined with "and," with the change side last.
Bedside report wakes patients up and drags on. But I guess families do like being included.
It can feel disruptive at the bedside, and you also see what it means to families to be included.
If you haven't heard any change talk yet, you can pair the sustain talk with something they said earlier.
Emphasizing autonomy
State that the decision is theirs. This often reduces pushback, because people stop defending a choice when nobody is trying to take it.
Look, I've heard this already. The deadlines are arbitrary and I still get the work done eventually.
You've heard it before, and you're the one who decides how you run your month. I'm not here to tell you how to do it.
Only say it if it's true. If the deadline is firm, say that too: the deadline is fixed, and how you meet it is up to you. The MI for managers guide covers non-negotiables in more detail.
Reframing
Offer a different way to see what they said, one that opens a door.
I've tried quitting five times. I always go back.
You've kept coming back to trying. Quitting matters enough to you that you haven't given up on it.
Agreeing with a twist
Reflect or agree with part of what they said, then add a small shift in direction.
The new staffing model doesn't work for nights. Nobody asked us.
You're right, nights weren't part of the planning. That's why your read on what nights need matters so much now.
Coming alongside
When someone is strongly against change, sometimes you side with the status quo. It's an advanced move and easy to get wrong.
I finish notes at home most nights. It's fine. It's what everyone does.
It might be that finishing at home is the price of this job, and changing it isn't worth the trouble.
Use this when other strategies have stalled, and only if you'd accept the person agreeing with you.
Strategies for discord
Discord means the relationship needs attention before the topic does. Pushing on the content will make it worse.
Reflect the feeling
So you've been tracking when I come in? That's great. Really makes me feel trusted.
I'm not tracking you. The system logs everyone's badge-ins.
It feels like I've been watching you instead of talking to you.
The defensive reply is accurate and beside the point. The reflection meets the MA where they are.
Apologize
A brief apology costs nothing and can shift the whole conversation. Use it when you contributed to the tension.
I didn't ask you to fix it. I was telling you what happened.
You're right, I jumped to solutions. Tell me more about what happened.
Affirm
Name something real and positive about the person. "You care a lot about how your team is treated." It reminds both of you that you aren't enemies.
Shift focus
Move away from the sticking point to something you can work on together. "We don't have to settle the policy question today. What would make next week's schedule more workable?"
When you've stirred up the sustain talk yourself
A lot of sustain talk can mean the conversation has gotten ahead of the person. Check a few things.
- Did you skip engaging? If you opened with the problem, back up and ask how things are going.
- Is the focus shared? If they didn't agree to talk about this, ask permission.
- Are you planning too early? If they haven't voiced reasons to change, a plan will draw objections.
- Are you asking "why not"? "Why haven't you started?" invites a list of reasons.
A sample turnaround
Here's a team lead with an analyst who has missed three month-end deadlines.
Look, I've heard this already. The deadlines are arbitrary and I still get the work done eventually.
From where you sit, the date feels arbitrary, and the work gets done.
Right. I mean, I know finance waits on me. That part I don't love.
The date itself doesn't mean much to you, and you don't like holding up the people who depend on your numbers.
No. Lisa had to stay late twice last month because of me.
The team lead never argued for the deadline. Two reflections, and the analyst produced their own reason for change. Learn to spot moments like that in change talk vs sustain talk. If you're preparing others to handle moments like this, see our trainer page.
Questions people ask
What is the difference between sustain talk and discord?
Sustain talk is about the change: reasons to keep things as they are. Discord is about the relationship: tension with you, such as arguing, interrupting, defending or tuning out.
Why did MI stop using the word resistance?
In the third edition of their book, Miller and Rollnick replaced it with two terms, sustain talk and discord. Resistance implied the problem was inside the client, when it's often a product of the conversation itself.
What is rolling with resistance?
An older MI phrase for not arguing back when someone pushes against change. Current MI teaches the same idea through specific responses to sustain talk and discord, such as reflecting and emphasizing autonomy.
What is the righting reflex?
The urge to fix, correct or persuade when someone is heading in a direction you think is wrong. It comes from caring, but it usually draws out more argument against change.
Should I ever argue with sustain talk?
Arguing tends to strengthen it, because the person defends their position and hears themselves do it. You can still share information or concern, ideally after asking permission.
Reading it is step one.
The skill shows up when you practice it out loud. Try a five-minute drill or a role-play with someone who isn't ready to change yet.
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