Resistence

(1) William White has conducted annual evaluations of Project SAFE since the Project’s inception in 1986.

Resistance	Resistance is the totality of forces that inhibit change in the client.
Sources of Resistance	These forces can come from within the client (neurological deficits, prior victimization and abandonment), be exerted by the power of a drug over the client (euphoric recall, cellular craving), spring from the client’s physical and social environment (paramour sabotage), or emerge from within the treatment milieu and the client-staff relationships (transference and counter-transference).
Types of Resistance	Resistance may be characterological, issue specific, relationship specific, or time specific.
Reality or Resistance?	What has often been called resistance in our clients is actually the reality of their daily lives that preclude consistent treatment engagement. These are addressed in Project SAFE through the provision of child care services, daily transportation and case management services designed to resolve problems that interfere with treatment.
Pain Threshold	The developmental trauma experienced by most Project SAFE clients produces an enormous capacity for pain and loss. As one outreach worker notes: "My clients don’t hit bottom; my clients live on the bottom. To suggest that these clients aren’t ready for treatment because they don’t have enough pain in their life is the ultimate in clinical arrogance. They have more pain than most of us could comprehend. The issue is not a shortage of pain and consequences; the issue is an absence of HOPE."
Pain vs. Hope based Interventions	Interventions that increase the client’s experience of pain and consequences without simultaneously inciting hope increase suicidal ideation and destructive flight. Hope-based interventions rely on an enduring, consistent relationship in which the client is forced to re-evaluate herself and her relationship with the world. In Project SAFE, the first of these relationships is with an outreach worker.
Empowering vs. Enabling	Interventions that would have been historically labeled "rescuing" or "enabling" when applied to addicted men may be essential strategies in the engagement of significant numbers of addicted women. The purpose of these strategies is to engage and then disentangle the client from what has become a chronic cluster of hopelessness, learned helplessness, passivity and esteem-sapping dependence.
Focus on Doing	Given the pervasiveness of the dependency cluster, clients are unlikely to want to participate in all that is required to initiate a recovery process. The treatment focus is not on the desire but on the doing. It is our experience that changes in the external behavior evoke changes in the client’s internal emotional architecture. Treatment slogans such as "Act as If," "Fake it Til You Make It," and "Just Do It!" all reinforce this principle. The motivation to initiate and sustain this early leap into doing comes from the coaching and cheerleading of staff.
Motivation and Treatment Outcome	Motivation or lack of motivation at the time of initial contact is not a predictor of treatment outcome. Some of Project SAFE’s most successful clients were among the most resistant and treatment-hostile clients at initial contact.
Source & Timing of Motivation	Motivation for recovery for our clients is not a pre-condition for entrance into treatment but something that emerges out of the treatment process itself.
The Change Process	Very few of our clients experience "conversion reactions" through which they suddenly cast aside their drug relationship and addiction-shaped lifestyle. The change process is more evolutionary than revolutionary.
Developmental Stages	There are developmental stages of recovery just as there are developmental stages of addiction. There is an essential sequence to these stages: certain tasks must be completed BEFORE other tasks can be achieved. Some tasks are time-dependent. Treatment interventions must be measured for effectiveness according to their stage appropriateness.
Unfreezing	The acquisition of new perspectives/behaviors requires an unfreezing of current perspectives/behaviors. Unfreezing poses opportunity and threat. In this state, the client is free to move forward or regress backward. Transitions are a great opportunity for leaps of growth and for the threat of regression and relapse.
Safety	The capacity of the client to unfreeze current perspectives/behaviors and move into this area of opportunity and threat requires that we provide an environment of encouragement and physical and psychological safety.
Self-defeating Styles	Most Project SAFE clients bring chronic self-defeating styles of relating to professional helpers. These frozen, superficial styles must be shed or clients will either self-destruct their treatment experience or passively "do treatment."
Testing and Ambivalence	Most Project SAFE clients go through a sustained period of testing before they fully involve themselves in a treatment and recovery process.
Pre-Treatment	Programs must have the capacity to tolerate and work through this process of testing. This stage of engagement we call "Pre-treatment." It is a stage of relationship building and treatment readiness that is designed to enhance safety and trust, reduce environmental obstacles to recovery, and incite motivation for personal change.
Treatment Techniques	Techniques that are successful in lowering resistance vary across developmental stages of recovery. Early techniques focus on accepting the client in her own environment, listening, self-disclosing, and encouraging. These are later expanded to include such techniques as self-assessment exercises, teaching, modeling, mentoring, humor, contracting, story construction and story telling.
Developmental Maturation	Staff have observed that many of the most successful clients went through three overlapping stages in treatment: 1) resistance, 2) regression and dependence, and 3) developmental maturation. The latter stages of maturation often parallel those of healthy child/ adolescent development. Concepts such as "surrogate family" and "reparenting" help describe the therapeutic dynamic within Project SAFE treatment sites.
Positive Resistance	The resistance to change that is an obstacle to early recovery becomes an ally and a primary means of relapse prevention in later recovery.