From One Therapist to Another
Updated: Jun 22, 2019
Expressions of Ambivalence in Psychotherapy Part 1: Procrastination
Often times in therapy, clients will set goals, make plans and seem very motivated but come back the next week with very little accomplished. This could be called resistance (and often is) however, I think considering it as ambivalence is not only a gentler description, it also points us in a therapeutic direction. Ambivalence shows up in the psychotherapy office in many forms and the quicker it’s identified as such, the quicker a resolution can be found. My first series of blogs was poking fun at some of the common mistakes that we therapists make while this series will focus knowing when a client is dealing with ambivalence.
Procrastination is one of the most often experienced expressions of ambivalence. It manifests as:
"I forgot about it."
"I didn’t have time this week."
"I needed to think about it more."
It goes by the motto “never do today what you can put off until tomorrow.” Or as Scarlett O'Hara said, "I'll think about that tomorrow!" But the problem with this reasoning is that tomorrow never comes. So it’s beneficial to help the client understand that there is usually meaning behind the procrastination which needs to be explored and understood before they can move forward. In fact, it might be more important to explore why something isn’t happening rather than attempting to make it happen and then feeling badly when it doesn’t happen.
I encourage my supervisees when they become frustrated at a lack of progress with a client to become fascinated with it instead. I suggest that they assume the client is ambivalent and to explore this.
It is helpful to start with the following types of questions:
"Is there any small part of you that doesn’t want to do this for some reason?"
"Do you have any insight into why you may not have gotten that done this week?"
"What are the possible reasons that you didn’t fallow through this week?"
Until a person understands why they’re not proceeding, they may never be able to. Bessel van der Kolk says “a problem cannot be resolved if it is a solution.”
Personally, whenever I realize that I’ve been procrastinating, I’ve made it a habit to start asking myself whether I’m ambivalent. Then I ask myself what are the possible reasons that I have for not following through. Sometimes there is wisdom on both sides of this dilemma which need attention.
For instance, Erin was struggling with ambivalence related to changing her job. She was not very happy in her career but could not motivate herself to start looking at other possibilities. She worked as an accountant, and though she was very good at her job, she was dissatisfied and bored. She was beginning to struggle with depression and had been prescribed an antidepressant. She was very artistic, but since she had always excelled in math, her father and her instructors had pushed her towards a career in accounting. She assumed that it was right for her because she did so well. When asked questions about her thoughts about quitting her job, she described how she didn’t feel happy and dreaded going to work every day. She was afraid that if she didn’t quit, she might get so depressed that she would become suicidal. At this point, I was strongly tempted to advise her to quit her job because it seemed as if her very life could be at stake.
However, when I asked Erin why she stayed with her job, she was just as persuasive about how important it was for her to do something worthwhile. She explained that she knew she was helping others and that being an artist seemed like such a self-focused endeavor. Additionally, she enjoyed the lifestyle that she was able to afford and knew that she couldn’t continue it as an artist. Finally, she enjoyed the relationship she had with her dad — talking about business — and she assumed that he would never be able to relate to her love of art. On a deeper level, she also identified a belief that “my needs are not that important.”
Erin was ping-ponging between two extreme polarities, making it impossible to come to a decision. As she objectively explored the pros and cons, she began recognizing that there was value in both paths and that neither was completely right nor wrong. Erin had been holding onto a belief since childhood that needed to be reevaluated which she may not have done had she just forced a decision on herself. She recognized that she was not actually trapped and that she could find a path that somehow honored as many of her values as possible.
Through values clarification, she recognized that although the lifestyle that her current job afforded her was less important to her, the relationship to her father was extremely important. She decided to have an honest talk with him about their relationship to help her make the decision. Over time, she was able to take small steps toward a decision that incorporated values from both sides of the dilemma. She ended up shifting to doing contract work as an accountant, which afforded her the time to take art classes.
Erin may have been tempted to make an impulsive decision to quit her job since she was getting more depressed. However, it wasn’t her current job choice that was making her depression deepen. Instead, it was that she hadn’t recognized that there was value in both sides of her dilemma and a path which could honor both. Had she made a choice either way, she would have lost things that were of significant value to her. Additionally, she may never have deepened the relationship with her father which resulted from sharing her dilemma with him. This approach was much more effective because it honored the wisdom on both sides of the dilemma and enabled her to move through her ambivalence to a fully informed plan of action.
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 and rewriting old narratives. 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.