The ambivalence mire: Escape with motivational interviewing

by | Feb 6, 2024

Could be substance dependence. Or maybe it’s depression that’s taken its toll. Fact is, you’re stuck in the mire. And still, you aren’t sure you want to do anything about it. That’s ambivalence, and we need to talk about motivational interviewing.

Readiness to change is not a trait of the subject, but a fluctuating result of interpersonal interaction.

We’ve reviewed a variety of therapies and intervention approaches here on Chipur. And, yep, here we go with another.

Motivational interviewing may not get cognitive behavioral therapy press, but it’s a great approach when ambivalence – in the face of change – rears its indifferent head.

Let’s see what we can see…

What is ambivalence?

To grab a solid understanding of motivational interviewing, we need to define ambivalence. According to the American Psychological Association…

  1. The simultaneous existence of contradictory feelings and attitudes, such as pleasantness and unpleasantness or friendliness and hostility, toward the same person, object, event, or situation.
  2. Uncertainty or indecisiveness about a course of action.

Don’t have to be a PhD to know that ambivalence can put the kibosh on any emotional, mental, or physical recovery mission.

I mean, we can be desperately ill, but if we haven’t decided what to do about it – or if we even want to do anything about it – well, that desperate illness isn’t going anywhere.

Okay, on to motivational interviewing.

What is motivational interviewing?

Motivational interviewing (MI) is an evidence-based approach to change largely developed by psychologists William R. Miller and Stephen Rollnick. Miller kicked things off in the early-1980s, his efforts grounded in work with alcohol dependent patients.

MI isn’t exclusive to counseling/therapy, as it can be used in environments, such as vocational and educational. That’s why I prefer “subject” over “client,” “facilitator” over “counselor/therapist.”

Goals

what is ambivilence

Together: engagement, generating positive behavior change, creating motivation

The goals of MI include subject/facilitator engagement, generating talk of positive behavior change, and creating the motivation to make the decided upon change.

Given motivation is crucial, gaining insight into – and resolving – ambivalence is huge. And resolution is found in the conscious and unconscious weighing of the pros and cons of changing and staying the same.

Finally, when it comes to change, awareness of potential problems, consequences, and assumed risks of the behavior in question go a long way toward painting a realistic picture.

The rules of motivational interviewing

Let’s take a look at what we’ll call the rules of MI…

  • Motivation to change is elicited from the subject, and is not imposed from outside forces
  • It’s the subject’s task, not the facilitator’s, to articulate and resolve ambivalence
  • Direct persuasion is not an effective method for resolving ambivalence
  • The session style is generally quiet and elicits information from the subject
  • The facilitator is directive, in that they help the subject examine and resolve ambivalence
  • Readiness to change is not a trait of the subject, but a fluctuating result of interpersonal interaction
  • The helping relationship resembles a partnership or companionship

Within those rules, it’s on to the work at hand. A few highlights…

  • The subject discovers their own interest in considering and/or making a life change
  • The subject expresses the desire to change in their own words
  • Ambivalence about change is openly discussed
  • A plan is drafted to facilitate change, to include the initial steps
  • “Change talk” is elicited and strengthened
  • Enhancement of the subject’s confidence in taking action, as well as noticing even small, incremental changes, are important
  • Strengthen the commitment to change

So what do you think? Can you sense the power of MI?

For the record, MI is supported by hundreds of randomized clinical control trials across a range of target populations and behaviors. Included are substance abuse, compulsive behaviors, health-promotion behaviors, medical adherence, emotional and mental challenges, vocational rehabilitation, and criminal justice.

Change: It’s always your call

Okay, substance dependence, depression, anxiety, work issues, and more – you may be stuck in the ambivalence mire. To escape, why not turn to motivational interviewing?

If you’d like to give it a go for an emotional, mental, or substance concern, make sure your counselor/therapist of choice is competent in motivational interviewing. There are assorted certifications and training classes you can inquire about.

But maybe you’re already seeing a mental health professional. Ask them if they’re able to facilitate motivational interviewing. If not, ask for a referral.

You may not have much choice with facilitators in a vocational environment. However, it may be different if you’re referred to an employee assistance program (EAP).

Bottom-line: do what ya’ gotta’ do to take care of you. After all, change: it’s always your call.

This is an update of an older Chipur article. Be sure to check out – and add to – the comments.

Plenty more Chipur info and inspiration articles where this came from. Don’t be shy, scan the titles.

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