Addressing Ambivalence In Motivational Interviewing

By  | 

If you are using motivational interviewing and not addressing ambivalence, meaning simultaneous conflicting feelings about moving on to the next stage of change, then you’re missing out on a rich source of information that can positively influence the whole therapeutic endeavor. The stages of change are pre-contemplation, contemplation, planning, action, and maintenance, and at each one of these stages there are very good reasons to move forward but also very good reasons to stand pat. Both sides of the coin must be discussed.

Intuitively it seems to make more sense to focus in on all the reasons for movement, to keep encouraging that forward progress by reinforcing the positive benefits of enacting and then maintaining some lifestyle change. But the problem with this strategy is that all change has a downside to it, things to lose, comfortable and familiar ways of being that must be left behind. Neglecting to discuss the downside doesn’t make these thoughts and feelings¬† go away they simply go underground and become what psychoanalysts call resistance. The result will be a lack of movement, an almost stubborn refusal to move forward despite the fact that doing so is clearly in the best interests of the client, and no one will really understand why.

At bottom it’s about human freedom. We all strive towards towards being the primary movers in our own lives. We tend to rebel, either openly or in secret, against various forms of control, even when these forms of control are meant to help us. By addressing ambivalence, by creating an open and honest space where reservations and drawbacks can be discussed and worked through, you put the power in the client’s hands to make a free decision based on all the information, not just the positive aspects.