When substance-abusing patients do not appear optimally connected with the therapist or engaged in the process of therapy, it is useful to explore the factors that seem to make it in the patient's best interest to oppose the therapist.

Therapists can address this issue head on by noting that there are both advantages and disadvantages to changing one's behavior, and that it might be interesting to look at the pros and cons of attending therapy, as well as the pros and cons of using or abstaining from drugs.

Therapeutic collaboration is facilitated when therapists show that they are willing to look at the cons of change (Grilo 1993). Patients then become more apt to cooperate in the exercise of reviewing the long-term costs involved in not changing. Thus, patient receptivity to change is enhanced.

For example:
Rita's behavior at the start of therapy was quite contentious. She contradicted or made sarcastic remarks about much of what the therapist would say.

After experiencing much frustration and consternation, the therapist finally said: "Rita, given that you frequently disagree with me, my first guess would be that you don't like to meet with me and yet, you always come to your sessions. What are you getting out of these sessions? How is therapy meeting your needs, given that we seem to be at odds so often?"

Rita didn't know what to make of this at first. Upon further reflection, however, she admitted that she gained a sense of power out of being able to intellectually spar with the therapist.

In her view, it would take the fun out of therapy if she agreed with her therapist. This admission led to a fruitful discussion of power, control, and counter-control in relationships.