Written By: Tzvi Prochnik, LCSW
Have you ever wanted to make a change, while at the same time felt reluctant to? This
question describes a well known mental state called ambivalence. For a long time, mental
health professionals thought that if someone knew they needed to make a change, but was
hesitant to take action, they were being resistant. This theory arose in addiction treatment. The
person can understand on a logical level that the substance they are using is harmful for their
health, but they struggle to quit. The prevailing theory was if someone is ambivalent, they just
need to be convinced more strongly. This type of intervention would sometimes become
extreme and use approaches like confrontation and shaming the person in an attempt to help
the person stop using. What was discovered, however, is not only is this approach ineffective, it
can serve to worsen someone’s addiction by increasing their shame and secrecy around their
behavior.
Eventually, a different theory arose called motivational interviewing (MI) that challenged
the whole concept of how to help people change. Rather than seeing ambivalence as a sign of
resistance, it was seen as a normal part of the change process. Everyone is ambivalent about
issues, big and small in their lives. For example, I know I should get up early to work out, but I’d
rather sleep in. I know watching TV for hours on end is not healthy, but it can be hard to
motivate myself to do something more productive. Now that we can see that ambivalence is not
a character defect, but a part of human nature, how can we use this knowledge to help people
make positive change in their lives?
MI suggests that rather than berating yourself for not being able to change an unhealthy
behavior, it is more helpful to look for what is already working, or maybe worked for you in the
past and apply it to your current issue. So for example, let’s say you know that you should
exercise more both for your health and because you want to look good, but you haven’t
exercised in years and don’t even know how you would start. A good question to ask yourself
might be: when was the last time I exercised regularly? How did I make that happen? Maybe
you were part of an exercise club in college or had joined a gym. Could you do that here? You
might say, well things were different back then. I had more time on my hands. I was already in
shape because I was young. The gym was 5 minutes away from my dorm so it was easy, etc. A
useful approach here could be saying to yourself, “I know that there are some challenges that I
am going to face, but getting in shape is important to me because I want to be able to play with
my kids, improve my blood pressure, look good for my partner, etc.” Essentially, you
acknowledge the challenges, but you focus your energy on the reasons you are motivated to
make this change. If there are certain issues you are concerned about, like lack of time,
convenience, etc. you could ask yourself: how could I make time for this? How could I make this
more convenient?
The spirit of MI is trusting that the answers to the issues in your life lie within you, rather
than being held in the hands of a therapist who is meeting you for the first time. The role of the
therapist or helping professional is to help you find the answers that work for you and reflect
back the plan you have created, rather than creating the plan for you. MI is a great approach
that I use with many of my clients to help them make positive changes and stick with them. If
you are relating to this style of thinking or interested in learning more about this approach, reach
out to me to schedule an appointment.
