As I said in the last post, a common therapist mistake is to be unaware of how our agendas and values may be impacting the therapy process. One of our primary agendas as a therapist is to help people change. However, if this agenda is too much about you, your values or presented prematurely, a person with ambivalence may become even more resistant to change. Out of fear, these patients hold on to narratives and behaviors that, although dysfunctional, feel familiar and even at times, necessary. If you focus your energy on trying to pry them loose because you have an agenda focused on outcome, it may actually feel to the client that you are being insensitive—or even worse, simply caring about your own success.
The challenge is to communicate both goals: that you sincerely care about your client’s growth and that you are somewhat indifferent toward outcome—a dialectic (two opposing views which coexist in truth). Being indifferent sounds harsh, but it’s all about timing. When focused on what is currently happening in the client’s life regarding her change attempts and difficulties making changes, I am fully engaged. As I listen to the client talk, I sincerely communicate that being with her is the most important thing to me in that moment. I communicate both verbally and non-verbally that she is fascinating, beautiful, and fabulous in her own unique way. I want her to believe that there is no place I’d rather be than with her in this moment. At the same time, I communicate a rather indifferent stance when talking about outcomes. It is a message of neutrality that can be empowering. I might say something like, “What you choose to do with your future is up to you,” or “You hired me to help you but you can fire me at any time.” Another example of when I communicate neutrality is when suggesting a higher level of care. I might say, “Here are your options, and my decision to continue working with you will be based on these factors, but it’s totally up to you which path you take; only you truly know which is possible or best for you.” By dispassionately respecting her choice to choose, there is no need for a power struggle. This frees the patient to explore her reasons for wanting to change as well as her fears of changing.
If you have expressed enough sincere caring when focusing on the present moment, the client generally feels relieved that you are not emotionally invested in making him change, but are invested in him as a person. This concept is related to knowing when to take control and when to let go, or the dialectic of accepting the client as he is while encouraging change. I am constantly weaving between stances of caring and indifference. There is a kind of energy shift that I experience as I navigate between caring and indifference, or letting go, which is similar to a pattern I developed in waterskiing. To improve my skill, I had to be willing to let go and risk falling as I made a turn, knowing that after the turn, I usually would regain my control. In a session, when I let go of my agenda for change and am fully present with the client, I can focus completely on what he is experiencing in the moment, such as when he says, “This is why I couldn’t follow through with our goals last week.” At this moment in the session, I might say something like, “Yes, I can see why you didn’t,” or “I can see how hard that must be.” I surrender to the turn. Anytime I feel myself wanting to yes–but or argue with the client, I try to remember the energy of letting go in waterskiing. I might follow up the empathy with a question such as, “What might work better?” or "What can help?" rather than try to problem-solve on my own. If waterskiing is not your thing, draw on a significant experience in your own history as a metaphor for knowing when to let go in the therapy session.
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.