Jim: I'm wondering if there might be a hostile or angry quality to this woman's bid (demand?) for motivation. You went several rounds of "Why don't you...Yes, but..." to no aviail. It may be that she's challenging you and the group to fix what she sees as a hopeless situation given her family history. She may be angry at the "medical establishment" for failing her family members. I've found paradoxical interventions useful with resistant patients. The trick, of course, is always to deliver them with utmost sincerety and without a hint of sarcasm. Let us know when you find something that works for this patient.
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