October 21, 2021
By: Dr. Alissa Rubinfeld, Clinical Psychologist
Being on the psychologist side of the therapeutic relationship, I come to the therapy space with a preexisting fantasy that the person sitting in front of me can change. What kind of therapist would I be otherwise!? I have come to recognize though, that owning this bias is important, allowing myself to investigate the incongruence between my hope and a client’s ambivalence.
The American Psychological Association defines ambivalence as, “the simultaneous existence of contradictory feelings and attitudes…toward the same person, object, event, or situation.”1
Ring a bell? You might resonate with this well in a variety of ways. At times it can be experienced as a state of tension, feeling as though you might be torn between opposing thoughts or feelings. In the context of therapy, this is SO normal, but the experience can be preoccupying and exhausting! I chose to write about this this month, as I am faced with expressions of ambivalence in the therapy space with my own clients, some of whom feel shame about this very experience. If you are in therapy or ever considered it, have you ever thought that every part of you “should” be geared toward change? Or maybe you’ve wondered, “Why do I keep doing the same thing over and over again if it’s getting in my way!?” The truth is, we as humans are complex, and well, pretty cool! We get to experience multiple different feelings at the very same time, and while this can certainly feel overwhelming and confusing, this process can give us insight into our inner workings and about the keys to moving forward.
Ambivalence can show up at any stage on your journey to change, at any which time you might not even be aware. Ambivalence can often be held at the unconscious level, because perhaps it doesn’t line up with your goals or values. If you are working on change through therapy, your therapist might be able to help you gain awareness into those undecided feelings. Not because they’re psychic! But because they might notice you are having trouble meeting your goals or letting go of behaviours that you’ve identified as not working for you. Together, you might call these barriers to change.
In my practice, I often work with individuals experiencing eating disorders or behaviours of disordered eating. Because oftentimes, the eating disorder can get tangled into one’s identity, ambivalence towards change is not uncommon. At any given time in treatment, I might check in with my clients to identify how things are going and to identify any barriers to change if applicable. Hints to these might include difficulty with attending sessions, with eating regularly, or with resisting eating disordered behaviours, just to name a few. Here comes that shame I mentioned…these hints are not usually indicative of an inability to change or lack of trying! Sometimes the mechanism keeping the eating disorder going can be so strong that the barriers to change are related to the eating disorder itself2. Fairburn et al. (2008) note that the most common barriers include fear of changing, resistance to change in general, competing commitments, poor planning, clinical depression and substance misuse3.
Ambivalence can be present for a variety of reasons. At times, what I address with my clients is the sadness or send of loss they might feel giving up a part of themselves that is no longer working. It is important to validate these feelings and to explore them without judgment, as feelings are simply cues trying to tell us something important. Ambivalence is not something to be ashamed of, but rather a representation of an internal conflict perhaps worth becoming more familiar with.
1https://dictionary.apa.org/ambivalence
2Dalle Grave, R., & Calugi, S. (2020). Cognitive behavior therapy for adolescents with eating disorders. Guilford Publications.
3Fairburn, C. G., Cooper, Z., Shafran, R., Bohn, K., Hawker, D., Murphy, R., & Straebler, S. (2008). Enhanced cognitive behavior therapy for eating disorders. The core protocol. In C. G. Fairburn, Cognitive behavior therapy and eating disorders (pp. 45-193). New York: Guilford Press.
