A common therapist mistake is to be unaware of how our agendas and values may be impacting the therapy process. Do you think you do not bring your own agendas into therapy? Think again. One of our primary agendas as a therapist is to help people change and we can't help but have our own values about what is best. However, when a person is highly ambivalent, what is best is often very difficult to discern and actually not even up to us as the therapist. People generally experience fear and anxiety, regardless of whether they are working on change or resisting change. As they attempt to avoid fear related to one side of the dilemma, they will be met with the fear associated with the other side, thus swinging from one side to the other. Patients often get stuck as they seem to have nowhere to turn. If the therapist tries to work on just one side of the dilemma at a time such as by choosing a side rather than working on the dilemma itself, it is likely that the therapeutic process will get stuck or worse.
For instance, Ashley talked in therapy about how she wanted to break up with her boyfriend. She would spend most of her session describing how he was not good for her because he said things that made her feel hurt and inadequate. Her therapist agreed with her perception that she would be better off if she broke up with him (you guessed it, without having ever met the scoundrel).
This is potentially a very dangerous yet common therapeutic stance.
We can never assume our clients' perspectives are accurate since perception is very influenced by narrative (subject of another blog). For several sessions in a row, Ashley would decide to break up and make plans as to how to carry it out. The therapist waited each week to find out how the breakup had gone, just to be told again that it had not happened. As long as the therapist was on the side of breaking up, Ashley was left with the other side of the dilemma.
Finally, the therapist confronted Ashley on her “resistance,” and Ashley began to state, shamefully, the reasons that she couldn’t break up. It is regrettable that she experienced shame for something that she wasn’t yet able to do simply because she hadn’t yet worked directly on her ambivalence. As she spoke of the reasons that she couldn’t break up with her boyfriend, the therapist learned more about the relationship and about some of the positive aspects he brought such as companionship and helping her believe that she was lovable. Ashley even admitted, for the first time that when she contemplated being without him she experienced suicidal thoughts believing that she would always be alone. Now the therapist changed her mind about supporting her to break up and began asking Ashley if maybe she should stay with him. Predictably, Ashley would then change the subject back to talking about how he didn’t treat her well. The therapist felt as though they were swinging back and forth and getting nowhere. Exactly!
In an attempt to avoid the fear on one side of the dilemma, Ashley would be thrown into the fear on the other. Contemplating breaking up with her boyfriend would highlight her fear of being alone and unloved, but the thought of staying with him would shift the focus to her fear of never being with someone who encouraged her. She was stuck in fear with nowhere to turn. The therapist unknowingly was participating in the swinging. If the therapist tried to join one side of the dilemma, it just pushed Ashley to the other. It is important to note that there is not a simple solution when someone is ambivalent regardless of how obvious the healthy path may seem.
Ashley and her therapist were stuck because they were addressing only one side of the dilemma at a time. A more effective therapeutic reflection might be “You feel confused because you aren’t ready to break up with him since he helps you believe that you are lovable even though he also does some things which hurt your feelings”. This is active listening in Carkhuff style. In this way, Ashley could see, in the same moment, that there are positives and negatives on both sides of the dilemma - a dialectic (two opposing views which coexist in truth). She isn’t forcing herself to choose immediately and thus, she may be able to look at her ambivalence in a new light. She might realize that if she heals her old belief that no one would want her, then when he acted insensitively, it wouldn't threaten her as much. Conversely, she might decide that if she begins to believe she is lovable, she won’t be as afraid to leave the relationship.
As therapists, it isn’t really our job to decide which path our client takes. I believe that once she sees why she’s stuck, she is likely to find the path through her own wisdom. By assuming that your clients have this wisdom within, your task becomes much more about helping them understand the nature of their ambivalence than about showing them how to make changes or which change to make. Thank goodness, we don’t have to feel responsible for this because we generally can’t go home with our clients and meet the other people in their lives and determine with any certainty if the relationship is healthy or unhealthy. One of my favorite quotes by Alexandra K. Trenfor is “The best teachers show you where to look but don’t tell you what to see.”
My book A Clinician’s Guide to Pathological Ambivalence: How to Be on Your Client’s Side Without Taking a Side can teach you how to avoid this and other common therapeutic mistakes by developing skills to work directly on resolving ambivalence. I would love to hear from you. Please scroll down to the bottom of this page (past the banner of recent posts) to leave a comment.