Ambivalence is Two Simple Things

By Anne DeCore, LMFT

Ambivalence is a natural human phenomenon, one that we all experience every day. It is common to want change, and also not want change, at the same time. The brain will contemplate the pros and the cons (the “decisional balance sheet”) of a particular change and then, voila, we find ourselves stuck. We come up with a reason for, and a reason against, and then ambivalence settles in.

As a clinician I regularly see clients experiencing ambivalence. Common ones are: ambivalence about changing one’s alcohol use habits; about whether or not to set a boundary with a family member; about staying or leaving an unstable relationship. My thinking toward ambivalence has been shaped by the works of Bill Miller. Miller is the author of Motivational Interviewing: Helping People Change, and he focuses on the topic of Ambivalence more directly in his most recent book On Second Thought: How Ambivalence Shapes Your Life. His writings, research, and techniques have been praised and used by professionals across disciplines such as teaching, coaching, medicine and psychotherapy to name a few.

Ambivalence, he says, is two simple things: change talk (arguments for change) and sustain talk (arguments against change).

Interestingly, when we want to help a friend or family member whom we think would benefit by a change in their lives we tend to argue for change. But because of the way the brain is structured, when we push for change in someone else, we end up evoking the other side of their own ambivalence. We often cause the other person to talk himself or herself out of changing. This happens between partners in a couple, between parents and kids, between friends, and occurs in the therapy and medical worlds between clinicians and clients: sometimes, the more a clinician pushes for change, the more the client responds with opposition. This oppositional reflex, found in all of us, is called the righting reflex. The clinician’s attempt to help can have a paradoxical effect, reinforcing the maintenance of status quo.

So what then is the path to resolving ambivalence? How does a person decide whether a change is advantageous?

The pathway to breaking through ambivalence is about setting your GPS to a clearly defined destination and asking if making that change helps you get to the coordinates you set for yourself. If you are stuck in ambivalence, have a series of wide-ranging conversations with yourself or with a therapist where you explore what you clearly know you do want in your life. What do you care about most? What do you want your life to mean? To look like? What is most important to you in terms of who you are, and who you want to be? Explore your values and goals. These talks will define the coordinates you want to travel toward. Then, and only then, do you ask yourself, does the change I’m considering help me get there. You look at your goals in relation to the alcohol use, the boundary, the unstable relationship. Does alcohol help you accomplish that goal? Does setting the boundary with the family member help you be the kind of person you described? Is the unstable relationship neutral or does it act as an obstacle to what you care most about?

As friends, family members, or therapists, when we know with clear conviction that a person really needs to make an important change, we need to listen to their sustain talk without trying to reason the person out of it. When we listen with empathy, their need to say it goes down because their experience of feeling understood goes up. Through non-judgement, empathy and curiosity we can be a helpful part of the person evoking their own reasons and motivations for change. As frustrating as it can be at times, we cannot instill in them our reasons for their change.

Reference:

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press.

Miller, W. R. (2021). On Second Thought: How Ambivalence Shapes Your Life. Guilford Publications.

The Dilemma of Attachment and Authenticity

By Anne DeCore, AMFT

Trauma expert and renowned physician Gabor Maté has a new book out that I highly recommend. He writes poignantly about something that therapists talk about every day with clients. In “The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture,” he states that the most widespread form of trauma in our society is the lower case “t” trauma of “disconnection from the self” in order to have attachment needs met by our parents. Because it is a largely invisible process, unlike upper case “T” trauma, people are often unable to identify how their childhood affected their development. I wanted to share Maté’s explanation of this process on the blog because I think this concept is essential for adults to understand as they self-reflect, and for parents to consider as they raise children.

Attachment is the core drive for proximity, responsiveness, and attunement from our caregivers from infancy and beyond.

Authenticity is the other core need: to be true to oneself, to honor our “gut” feelings, to express our felt emotions.

Maté explains the dilemma in these terms: “What happens if our needs for attachment are imperiled by our authenticity, our connection to what we truly feel?”

Maté tells us that the outcome of that dilemma is pre-determined. When a child senses that being true to their sense-of-self will not be acceptable to a parent, the child will conform to please the parent. We will always “secure our physical or emotional survival by relinquishing who we are and how we feel”. This adaptation is not something we have control over in childhood. Feedback loops with our caregivers over time get wired into our nervous systems and the internal adaptation to privilege inauthenticity becomes second nature. We even tell ourselves that certain traits within our personality are “who we are” instead of what they really are: the “scars of where we lost connection to ourselves”. A few examples of these traits are people-pleasing, hyper-responsibility, stoicism, perfectionism, compulsively charming, compulsively helping. Many of these adaptations in our families-of-origin are reinforced by society as admirable.

These adaptations work for us into adulthood until they don’t. There are costly consequences for repressing one’s thought, feelings and needs. Maté’s book impressively documents the link between inauthenticity and physical illness. Other consequences may be divorce, depression, addiction, and midlife fragmentation. These crises tend to force us to examine the self-concepts we hold. Often, these moments lead us to therapy.

Thankfully, Maté doesn’t leave us hopeless. He writes that developing self-awareness and self-compassion can carry us back toward authenticity. We can re-train the brain and nervous systems to expect both needs, attachment and authenticity, to simultaneously be served in our adult relationships.

Reference:

Maté, G. and Maté D. (2022). A Traumatic Tension: Attachment vs. Authenticity. In The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture; (pp. 96-112). Penguin Random House.

Healing Isn’t Linear

By Megan Allcock, AMFT

With the start of the new year I think there is often this pressure for people to reflect on what they did in the past year and how they want to be “better.” Now there isn’t anything inherently wrong with reflection and wanting to grow, in fact it’s a wonderful aspiration to have. I think sometimes though it doesn’t leave room for the idea that many things in life take more than a year to heal, process and move on from. And even when it is healed, there will always be difficult days or moments of struggle because healing isn’t a linear process.

Let's use asthma as a metaphor here. Typically, asthma is worse in the winter because the dry air can irritate the airways. Now in the summer someone’s asthma will still exist but perhaps isn’t as severe. Similarly, if someone with asthma is working out that could cause a flare up more than sitting on the couch. Now if we think about mental health this way, I think there is a lot more flexibility in the space and grace we can give ourselves to heal.

With trauma and mental health in general, there will be seasons of life where something is more triggering than other times in life. Let’s say for example someone has mostly processed a childhood trauma experience, but they get into a new relationship and their new partner does something that brings up feelings related to their initial trauma. There will be moments that people don’t feel fully healed anymore from that. It doesn’t undo all the work they’ve done, but it really drives home the point that healing isn’t linear. It is OKAY to have time periods that are more difficult than others. There are so many factors that contribute to having bad mental health, so next time you want to be mean to yourself practice reminding your brain that healing isn’t linear and bad days are all a part of the process.

The Process of Change in Therapy

By Michaela Choy, AMFT

As a therapist, I am in the business of change. Change takes many forms depending on who is pursuing this change. Clients bring a whole host of variables to the equation of change including learned behaviors and viewpoints from families of origin, unique belief systems, and significant life experiences. This list goes on. Whatever you bring to the table, will shape your path. Part of my work is to meet you where you’re at and use your strengths to promote change.

Often I’m asked how long the therapy process will take or what the roadmap of change looks like. I’ve found it helpful to discuss a few things (below) with my clients to set realistic expectations for them AND to expand their definition of change so they get the most out of this work.

It’s Messy

The preferred method of change is a map with check points and linear movement – once you’ve completed one task, it’s on to the next. You know you’ve made progress and know exactly where you’re headed next. And that’s very comforting. Change can happen like this, but in my experience, change tends to look much different. It’s messy. It’s not linear. When my clients experience new ways of being, responses and realizations are activated and new paths in the work are uncovered. Responding to what becomes activated for you makes the work rich and thorough, and this will help promote lasting change. Your responses are happening for a reason, and it’s best to honor them versus bulldozing past them. If not given the time and attention they need, they will pop up again.

It’s Gradual

One of my teachers explained the impact of small change over time. He used the metaphor of a boat changing its course by several degrees. At first it may not seem like much is happening, but over the long run, your boat’s course will look much different than its initial course. Even a small 2-degree change has big impact over time. Develop respect for this process. You may want faster results, we all do. But change is in fact happening.

The 80/20 Rule

Your commitment to the work is key. It’s going to be hard. If it wasn’t, you wouldn’t be here. It takes persistence, curiosity, and effort outside of therapy. Many wonderful moments and realizations happen in therapy, and it’s the client’s responsibility to reflect on this work and experiment with these ideas outside of therapy. 80% of the work happens outside of the therapy room. 20% happens in the room.