What is preventing your client from making the necessary change? Is it their ambivalence OR are they resistant? This isn’t an easy question to answer, and it’s worth deep exploration. First, let’s ensure we are on the same page by defining ambivalence and resistance.
Ambivalence: [noun] uncertainty or fluctuation, primarily when caused by an inability to make a choice or by a simultaneous desire to say or do two opposite or conflicting things.
Resistance: [noun] the act or power of resisting, opposing, or withstanding; the opposition offered by one thing, force, etc., to another.
dictionary.com
Let’s look into how change happens. Below is the Transtheoretical Model (TTM) of change. It focuses on the steps needed for change to happen.
Prochaska & DiClemente
- Precontemplation – In this stage, people do not intend to take action.
- Contemplation – In this stage, people intend to change, but feelings of ambivalence and consideration of the pros and cons keep the person in limbo.
- Preparation – In this stage, people are ready to take action and take small steps toward change.
- Action – In this stage, people have recently changed their behavior and intend to keep moving forward with that behavioral change.
- Maintenance – In this stage, people have sustained their behavioral change and intend to maintain it —working hard to prevent relapse.
- Termination – In this stage, people have no desire to return to their previous behaviors.
The best way to answer the question of “is it ambivalence or resistance?” We should look to the literature on Motivational Interviewing.
Why Motivational Interviewing? It’s an evidence-based counseling method used to strengthen our motivation to change. Specifically, the Third Edition of Motivational Interviewing: Helping People Change by William R. Miller and Stephen Rollnick. I will touch on a few points made by Miller and Rollnick to support my claims.
Motivational Interviewing is unique in that it is a non-authoritative approach that allows the clients to lead the discussions and discover their own solutions. The practitioner’s role is to act as a compassionate facilitator, listening without judgment and acknowledging the client’s experience. The practitioner’s role is also to maintain the focus on the behavior the client hopes to change.
Motivational Interviewing is a collaborative conversation style that strengthens a person’s motivation and commitment to change by exploring and resolving ambivalence. MI used the specific conversation OARS.
Ambivalence: Feeling Stuck
Ambivalence is an internal debate. It’s deciding whether to maintain the status quo OR move toward change. What might that look like in session? You might have a client deciding if they should:
- Continue their substance use OR deal with their unresolved trauma.
- Decrease their sugar intake OR address the consequences of sugar on their diabetes.
- Stop cheating on their partner OR deal with their insecure attachment.
I don’t want to oversimplify our client’s experiences, but I wanted to make a point. It’s not as simple as choosing between having apples OR oranges. The options being weighed by our clients are equally desired and attractive, as both have their advantages and disadvantages.
I want to BUT…
Depending on what the ambivalence is centered around, it will take time AND intentionality to resolve. Therefore, we should normalize the feelings of ambivalence. We’ve all been ambivalent about something and can empathize with one’s experience to varying degrees.
And no, it’s not a lack of information. More often than not, our clients usually have a wealth of information for and against change. Trust and believe that a lack of knowledge isn’t behind their ambivalence.
We, as mental health practitioners, need to accept our client’s autonomy. It is ultimately the choice of their client on whether they choose to change or not. We are working alongside our clients, not being forceful OR directive in our approach.
Ambivalence humanizes the experiences of our clients. Like a door or a window ushering in the possibility of change. It’s a sign of hope. Simply put, any form of ambivalence is an asset to both you and your client, especially when the goal is to evoke change.
How should we view ambivalence in sessions? Ambivalence is uncomfortable for the client, and resolution needs to take place to mitigate. When we see our clients through a lens of ambivalence, it should grow our empathy, patience, and compassion for our clients. And again, it’s not our place to decide for the client what that resolution is. We could, however, use principles of Motivational Interviewing (MI) to strengthen motivation towards change. MI teaches us to think of the two sides of ambivalence as either sustain talk OR change talk.
Sustain Talk: Any client speech that favors the status quo rather than movement toward a change goal.
Change Talk: Any client speech that favors movement towards a particular change goal.
Miller & Rollnick
Having a positive mindset is key when dealing with our client’s ambivalence. It requires us to make the choice to continually search for the silver lining and make the best out of any situation we find ourself in.
Motivational Interviewing has come a long way from the 1st to the 3rd Editions. The earlier edition used the expression “rolling with resistance.” “Rolling with Resistance” was a technique used to recognizes that attacking or confronting clients does not always work – it may cause clients to retreat or lead them to become defensive or confrontational.
Motivational Interviewing has moved away from using the word resistance. Why? Because there is power in language. Language can be used to build people up and tear them down. We will discuss when we get to resistance.
Think Positive Thoughts
Resistance: Issa No
The word resistance doesn’t belong in the therapeutic setting. It implies that there is a right and a wrong way to approach change. In fact, resistance hints at a possible character flaw; it has a negative connotation. It’s accusatory and blaming. This doesn’t set the client up for success. We tend to think of resistance as something that the client is doing to us and negatively internalize their behaviors and actions.
Let’s take a moment to step into the shoes of a “resistant” client… we don’t have to step fully into the role; we can feel the countertransference. Do you feel safe to open up and truly share?
When we show up in a manner that causes the patient to push back, we shut down any room for progress. The client is no longer exploring their ambivalence but rather defending themselves because their sense of autonomy is threatened. How might that happen? A sure-fire way to do this is by leaning into the “righting reflex.”
In MI the urge to tell clients how they should change is known as the “righting reflex. We as practitioners need to recognize our urge to make “right” OR fix our clients. When we feel this bubble up, lean back into our seat, let that thought float away, and utilize the OARS communication tool.
I’ve noticed that “resistance” is often the mislabeled expressions of ambivalence. Our experience / interpretation to the parts of the client that doesn’t want to change often reads as “resistance.” Dare I point out how countertransference plays a role in the client’s experience. That breeds discord and disharmony in the collaborative relationship between client and practitioner.
I’m coming out swinging with the following statement.
The term resistance can consciously and subconsciously affect how we view our clients and the level of care we provide. When we label a client as resistant, it can make the client resistant to the process of change.
If you find yourself labeling a client as “resistant,” ask yourself. What am I doing to encourage sustain talk? Am I playing a part in the client’s ambivalence? How can I be an asset to my client’s ambivalence and help them work towards resolving their ambivalence?
Conclusion: It’s not your goal to eliminate your client’s ambivalence but to tip the scale towards change.
If your client shows up for their session, consider yourself lucky. Ambivalence is working in your favor. That person made up their mind that they wanted to be there. The client could have made the clear decision NOT to show up. Use your skills to help the client recalibrate toward change.
Move away from labeling clients as “resistant.” Why? Pathologizing, blaming and labeling does you and the client a disservice. Instead, we should see our client as ambivalent. Ambivalence is part of the change process. Being ambivalent and one’s expression of ambivalent is one in the same.
Tip: Find your client’s ambivalence.
Grow your empathy + therapeutic alliance by minding your manners and your language.