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'Ambivalence' and 'resistance to change' would appear to be problem areas that are frequently encountered during the therapeutic process. It would also seem that the potential for a positive therapeutic outcome may be significantly influenced by the therapist's perception and understanding of this. The purpose of this paper by Scott Kane is to discuss the concepts of 'ambivalence' and 'resistance to change' when using a motivational interviewing style which Miller (1996) described as 'a directive client-centred counselling approach for initiating behaviour change by helping clients to resolve ambivalence'. Particular reference will be made to difficulties encountered in clients with substance misuse and eating disorders along with potential therapeutic pitfalls and how they may be overcome
Some clients who decide to enter into therapy, particularly with addictive problems, such as problem drinking or eating disorders are often in a state of conflict. In other words, they wish to address some aspects of their difficulties but resist changing others. They often have fairly good insight into their problems, recognise the destruction this causes, but on the other hand they become somewhat attached to the behaviour for various reasons. For example, the problem drinker may recognise that his work, finances, relationships and physical health are deteriorating as a result of excessive drinking. On the other hand, he may be attached to the social aspects of drinking or 'fear' withdrawal symptoms that may be experienced following reduction or abstention. That is, they develop an attachment to the addictive behaviour.
Similarly, a female with an eating disorder, may recognise that her physical health is deteriorating, her teeth are beginning to decay quite rapidly and she has developed amenorrhea (Fairbairn and Wilson, 1993), but will resist change since this may be perceived as having lost control or self worth.
This state can be described as 'ambivalence' which results in the client's attitude shifting back and forth from one of defiance to one of 'readiness to consider change' (Miller and Rollnick, 1991).
Some therapists believe that when individuals display this ambivalence they are being defensive or are in denial and, therefore, their readiness to change is virtually nonexistent. The approach they then adopt to allegedly enhance this readiness to change or break down these defences is one of harsh confrontation. This...