Ambivalence in Psychotherapy

credit Ermell

ambivalence

1. simultaneous and contradictory attitudes or feelings (such as attraction and repulsion) toward an object, person, or action

2. a. continual fluctuation (as between one thing and its opposite) b.uncertainty as to which approach to follow

Merriam-Webster

 

Ambivalence – the urge to go in two directions at once; to stay and to go; to step forward and retreat; to try and to give up; to change and to stay the same; to travel and to stay at home.  At its best ambivalence can be the ability to hold two apparently opposing ideas or emotions in one’s consciousness at the same time.  Like standing at a fork in the road looking at the possibilities without succumbing to our urgency to choose.  This is a skill and faculty that allows for the possibility of creativity, creative understanding, appreciation of life’s paradoxes and problem-solving.  Life rarely presents us with pictures in black or white, and a tolerance and eventual understanding of the ‘grey areas’ of both life and our experience can enrich our sense of being alive.

“Before I go on with this short history, let me make a general observation– the test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.
One should, for example, be able to see that things are hopeless and yet be determined to make them otherwise. This philosophy fitted on to my early adult life, when I saw the improbable, the implausible, often the “impossible,” come true.”
F. Scott Fitzgerald

However, when ambivalence is either not clarified, understood or well tolerated it can result in a conflict between two sets of needs that become opposing sides, with our battling within ourselves on whether to meet one side or the other; a fork in the road at which we can become stranded in our indecision, or prompting a hastey choice between accepting one and rejecting the other without realising that we may have simultaneous needs in both directions.

Mixed Feelings About Therapy

In therapy, for example, patients sometimes seek out the help of a psychotherapist only to then spend a significant amount of energy avoiding the relationship or the work involved as their conflict then adversely influences their way of being.  This can be for a variety of reasons, some of which I will mention here.

It seems counter-intuitive to suggest that a person might spend the time, energy and money he or she has to engage in psychotherapy, whilst at the same time avoiding the therapeutic tasks that may be a direct means of bringing about the changes that they initially requested.  Yet this scenario is common in the change process, often at the edge or outside of immediate awareness.  From very mild mixed feelings, to one minute thinking therapy’s a great idea and the next a really bad one, ambivalence if left unaddressed or not made clear can become a destructive force that can undermine or even sabotage the therapeutic endeavour.  It is therefore best to address it in open discussion as soon as – or even before – it appears.

“What am I doing? Tearing myself. My usual occupation at most times.”

Charles Dickens

Knowing What You Want

In order to avoid ambiguity in your understanding, it’s important to be clear from the start on what type of therapeutic help you need: counselling or psychotherapy.  Talking for an hour, being listened to and reflecting on the week’s events is all that some people assume therapy involves: a kind of secular confessional.  To some extent, just talking can help and be cathartic in itself.  However, sometimes you need to do more than just talking, and psychotherapy that simply coasts along comfortably for months or even years in some cases, with little or no substantive change, resolution or growth can become a process of avoidance or co-dependence.  The patient then wonders why nothing has changed because their orginal idea of psychotherapy was based on something they saw in a Hollywood film.  They become ambivalent, torn between feeling like they’ve failed, and feeling like the therapist has failed.  In truth, both parties share responsibility in this scenario.

This is why it is important to clarify the kind of help you want and the control you have  over what kind of and how much work you do at each session:

You can utilise any or all of these therapy modes in my practice:

Counselling can be a gentle therapeutic process; a way of creating a space each week for you to speak freely and feel heard with some occasional challenging from the counsellor.  Challenges help you reassess your position; look at things you may be missing. This in itself can bring about enough change and growth to satisfy some clients.

If this is not sufficient to bring about more significant changes or resolutions, then  Psychotherapy – depending upon the practitioner and orientation – may be more active and challenging, helping you focus specifically on deeper needs and changes that discussion alone may not allow you to meet.

Other kinds of Personal Development work allow you to focus on learning and developing specific life skills.

Some people go to counselling and expect psychotherapy.  Others go to psychotherapy and expect counselling.  This can result in ambivalence and cross-purposes.  Being clear with your therapist about what kind of intervention you want in each session – counselling or psychotherapy – and what it can yield, will mean you both set off on the right footing.  In my practice I offer psychotherapy, counselling and personal development modes of working, and it is possible to alternate between all of these, according to your needs at each session.  Some weeks you may just need to talk and feel listened to.  Other weeks you may want to explore things in more depth or have more guidance.  All you need do is ask.

Inner Conflict

Once we realise what might be involved in personal change we might think one thing but act in other ways.  For example, ‘I want to make changes’ might be the thought, but the behaviour might say ‘I don’t want to feel uncomfortable or spend time doing things that are different’.  This can become a common enough conflict in some people who attend therapy.  One side of you seems open to changing and the other seems to be doing its best to maintain the same old familiar patterns of behaviour: otherwise known as staying in your comfort zone.  Instead of just being aware of two sets of needs, the weeks pass as you give yourself more and more excuses for avoiding the work necessary to bring about the changes that you claimed to want to make:

  • I didn’t have time
  • I was too tired
  • I had to work overtime
  • I forgot I had something else arranged
  • I’ll start next month
  • I’m not very disciplined
  • This therapist or therapy isn’t for me.

Expecting personal growth without some effort and discomfort is like trying to get fit without doing the exercise, so it’s important to be honest with yourself and your therapist about what change entails and about your true level of motivation for change.

Ambivalence: Log Cabin

You need to keep the fire of your log cabin burning on a winter’s night in order to stay warm.  You’re running out of fire wood and you know the only way to get it is to venture out into the sleet, cold winds and darkness and do some hard chopping.  You know what you need to do, but you prefer to stay inside and be comfortable until the fire dies and your discomfort forces you to make a decision.

In therapy ambivalence about therapeutic work itself should be addressed by you and your therapist as soon as it becomes evident.  Failure to address conflicted feelings can result in a destructive process that begins to ruin the work or make it frustrating, more difficult than it has to be, or even impossible.  You might then find yourself cancelling sessions, or procrastinating and avoiding doing therapeutic tasks; evading questions and perhaps talking in circles in avoidance of exploring your elected focus.  These are all signs that you may have turned your initial mixed feelings into a conflict with yourself over what is required for personal growth and change.

Identifying the needs on either side of the conflict is the first step to resolving the conflict: this resolution in itself can be enough reason to attend sessions if it’s done honestly.  Otherwise, it may well be the case that you just aren’t ready to engage in a therapeutic process at the moment, in which case admitting this openly can save you time, energy and money, and your therapist the frustration of, for example, repeated cancellations.

Ambivalence: Maybe Next Year

After over-indulging during Christmas you decide that you need to get back in shape in the new year.  You make a resolution to join the gym, lose weight, tone up and get fitter.  You buy the gym clothes and training shoes, sign the direct debit for the gym membership and go along for the induction.  Over the weeks your motivation dwindles as you make more excuses to avoid going to the gym.  You feel deflated, disappointed, discouraged and start comfort eating in an attempt to feel better.

Being in Therapy for Someone Else

Some people make the mistake of entering therapy motivated mainly by their parent or partner or employer, or in an effort to please or influence someone in their life who thinks it a good idea.  This can sometimes turn out well, but more often than not it is doomed to failure.  The reason being that the patient him/ herself isn’t providing the motivation from an authentic need to grow and develop as a person.  Attending therapy in order to try to please or win back a partner is generally a waste of time and effort.  In this case couples therapy may be more appropriate.

Ambivalence: Skating the Surface

George came to therapy saying that he had anger issues and that his marriage to Anne was almost over because of it.  It became apparent that he thought by simply coming to the sessions, paying the fee and telling his wife about it that he could win her back. He consistently avoided doing any meaningful work both during or between the sessions.  When his wife left him his rage returned.  He blamed her, he blamed her family, he blamed the therapist, abandoning therapy with fees left unpaid as he attempted to punish other people for George’s own unwillingness to be honest with himself and those around him.

Acting Out One’s Conflict

Occasionally a patient will come to therapy with vaguely formed ideas of what they want, and then gradually begins to use the therapeutic relationship to act out their own inner conflicts.  As mentioned above, this can be a potentially very destructive route to take, which is why psychotherapist’s are usually trained to spot this type of behaviour.  It can take the form of passive-aggression, lying, lack of openness, other destructive behaviours, and negative transference towards the therapist, and sometimes follows the patient’s attempts to place the therapist in a role that serves one side of the patient’s inner conflict; the side that the patient has a resistance to facing.

For example, a patient may assume the victim role in life, with the desire to elicit sympathetic rescuing responses from the therapist, who is then expected to reinforce a victim narrative that the patient wishes to maintain.  When the therapist refuses to be manipulated into such a role (because the therapist’s role is to help the patient empower him/ herself, not reinforce learned helplessness), the patient might then cast the therapist in the role of ‘bad parent’, proceding to then act out his or her aggression towards the therapist via destructive or obstructive behaviours, ultimately sabotaging the therapeutic endeavour and blaming or punishing the therapist for failing to do his or her job properly.  This, even though in fact the therapist has fulfilled his proper role rather than yielding to the patient’s efforts to cast them in another role.  Some patients will do this as a means of avoiding change, regardless of the therapist’s best efforts to help a patient see what they are doing.

In rare cases, some patients have developed an interpersonal style in which they attempt to empower themselves by actively trying to disempower others.  In therapy, the goodwill of the therapist is undermined by the patient’s desire to outdo, diminish, obstruct, or dismiss the efforts of the therapist.  Ambivalence becomes a tool of manipulation and in such cases the therapeutic endeavour will often be sabotaged by the patient.

Ambivalence: It’s the Therapist’s Fault

Joan was super-nice to her therapist when she started going to sessions: polite, considerate, seemingly motivated.  Gradually her narrative of being victim emerged: she self-diagnosed as autistic, she thought she had been bullied, victimised and excluded from various groups. When it came to looking at how she could heal her wounds, overcome her fears, and make the changes necessary to live a more fulfilling life, she grew increasingly angry at her therapist for failing to sympathise enough, blaming her for being bad at her job.  Joan’s ambivalence allowed her to avoid change and so maintain both her role and her ambivalence as a perpetual ‘victim in need of help’.

Fear of Feeling Vulnerable

Being open and honest about oneself and revealing truths that may be difficult to admit even to ourselves, can be a source of fear for some people, as they resist allowing themselves to risk experiencing shame, guilt, anger, and other emotions that may leave them feeling vulnerable.  An unwillingness to be vulnerable means that some patients never experience real support, personal growth, affirmation or resolution to conflicts or events in their lives that produce such feelings.  They remain guarded, sometimes lonely, and often stuck in their old ways until they begin to understand that feeling vulnerable is not the same as being in danger.  Beginning an active dialogue on building security in the relationship might be a first response to this type of avoidance.

“The mental mist of ambiguity and the fog of ambivalence hamper human existence.”

Kilroy J. Oldster

Fear of the Unknown

Fear of the unknown is related to fear of vulnerability.  People who tend to avoid the unknown can sometimes also avoid risk and being open about their own experience and thus the unknown of what might happen if they dare risk revealing truths to themselves and others that they can no longer avoid (e.g. dissociated memories, child sexual abuse, trauma etc).  Trust in the therapeutic relationship is built by both patient and therapist: the patient trusting the therapist enough to risk herself, and the therapist providing sufficient understanding and support in response.

Ambivalence: to stay or go?

Craig procrastinated right from the start of therapy.  He avoided filling his intake form in, eventually rushing it at the last minute, with incomplete and dismissive answers.  When asked about his motivation for therapy, he said that he felt that he really had to look at his life in therapy.  But the message his behaviour sent each week was ‘I really don’t want to be here’.  After several weeks of this ambivalence, with his therapist inviting Craig to look at both sides of his ambivalent feelings, Craig eventually discovered that he had held onto an old anger (originally aimed at his father) that he was expressing as resentment (aimed at the therapist). He resented having to face his own personal change, when it had been his father who was at fault for Craig’s problems, and so by rights his father was the one who should have to face the discomfort of change.

Fear of Overwhelm

Similarly, experiences, memories and emotions that have been kept hidden and unspoken for a long time can hold the threat of overwhelm if we dare begin to speak about or express them.  ‘If I start crying it feels like I may never stop’ is a common statement heard in therapy.  It is the expression, once again, of fear of disintegration and vulnerability.  For some, the idea that they can somehow work around their feelings in therapy can form the basis of ambivalence that becomes intractable, bringing any therapeutic endeavour to a frustrating impasse or unexpected end.

Perfectionism

It’s one thing working to a high standard, but an entirely different matter when it comes to perfectionism that applies to the self.  Some patients have developed habits of expecting themselves to be perfect, so that revealing truth to the contrary, or lies or self-deception that show them to be as imperfect as everyone else, becomes too unbearable a prospect.  Therapy, rather than being a space where both therapist and patient can be candid and honest with one another, can then become stifled by the patient’s efforts to maintain a delusion of perfectionism at his or her own expense.  Real healing comes from uncovering the needs behind perfectionism and finally embracing life’s and one’s own imperfections.

When Change Becomes a Real Possibility

Patients sometimes reach a point of realisation that reveals what they might have to give up in order to address their problems and implement the changes they initially desired.  Whether this might come in the form of a problematic behaviour or a relationship with which they are struggling or alcohol, cigarettes or other substances, there comes a point where we either let go of what is toxic to us, or decide to hang on to it.  Feeling stuck at the fork in the road of one’s choices can be a powerful source of ambivalence in therapy.

fork-in-the-road

Lack of Confidence in the Therapist

It is also entirely possible that your ambivalence comes from a well-founded concern that your therapist or counsellor just isn’t up to the job of understanding or containing your experiences.  They may founder when you need them to hold fast; they may not seem genuine or capable.  Or, you may just have started and don’t know the therapist well enough to know if he or she can help you.  Or your ambivalence may be based on a misunderstanding or the result of your transference, perfectionism, or be a way for you to avoid facing your difficulties by simply blaming the therapist for something he allegedly lacks.  All of these scenarios are common for some individuals who attend therapy.

In any case, making the problem clear – first to yourself – and then tackling it as a concrete problem in an effort to determine what is happening, is an essential step in resolving the issue for you as a patient.  Since the therapist or counsellor – regardless of their ability – is genuinely acting with your best interests in mind, it is respectful to raise any concerns you might have with them, rather than simply abandoning the relationship.  This serves both to empower you the patient in asserting your needs for some adjustment or at least discussion on the matter, and offers a minimal degree of respect to a fellow human being who may be doing their level best to help you get what you need from the work.

The Solution

If you are in any way in doubt about your motivation for therapy, or your counsellor or psychotherapist brings your evident ambivalence or conflict to your attention, it is a better use of your time and energy to discuss any doubts or mixed feelings honestly in your next session.  Your therapist won’t be annoyed or frustrated with you about this, but will value your openness and honesty.  In this way you allow the opportunity to identify and meet the needs you have on either side of your conflict, thereby providing yourself with a means of resolving any ambivalence that may otherwise keep you stuck or struggling with yourself.  Honest exploration of these experiences amounts to genuine engagement in the therapeutic relationship, even where the immediate outcome might well be your deciding – after an honest appraisal – to take a break from therapy or delay the start until you are ready to fully engage for the right reasons.

Related:

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16 Comments Add yours

  1. LovingSummer says:

    Thank you Stephen for this. I cannot even begin to tell you how timely this was to read. I know I am facing a cross-roads as therapy just got, well, pretty uncomfortable in a whole new direction, and my usual resolve to remain honest and open has temporarily fled. I can recognise I don’t want to be vulnerable or takes risks into the unknown, but your article is like a map reminding me of how my compass points to true north because I was starting to forget.

    Liked by 1 person

    1. Stephen says:

      Thank you LS. It can be a difficult one to figure out, because sometimes we can have legitimate concerns about a therapist’s ability to understand or ‘contain’ us. Once we can clarify that this is not the case, then it’s a matter of identifying what inner struggle we might be having to take the stepp forward into uncomfortable territory. Glad my post helped you with this in some way.

      Liked by 1 person

      1. LovingSummer says:

        True. Pretty stuffed if it’s the worst of both worlds though; personal struggle as well as a therapists inability to understand/contain us (whatever containing someone means – am off to look that up!). Still, it doesn’t detract from the fact this has given me some incentive to pursue it with as much openness and honesty I can find, right down to my very bones!

        Liked by 1 person

      2. Stephen says:

        Yes, that is a double-barrelled problem.

        Containment just means the ability to listen, understand, empathise and provide support to an experience being expressed. A simple example might be a parent responding to a child who falls over and bumps her head. Containment might be the parent picking the child up calmly, offering verbal reassurance and holding the child until she feels safe. Lack of containment might be the parent becoming hysterical or shouting at the kid to ‘stop being stupid’ for example. Extereme examples to hopefully illustrate the point.

        Liked by 1 person

      3. LovingSummer says:

        Oh okay, thanks. You saved me a google search!

        Liked by 1 person

      4. LovingSummer says:

        Stephen would it be okay with you if I refer to what it’s meant to me in my own blog? I won’t cut and paste or anything, but I wanted to make it clear where I got it from, so someone else could also benefit from nipping over time your page and reading it themselves if they’re in a similar place.

        Liked by 1 person

      5. Stephen says:

        Of course LS, I’d be honoured. I’ve actually just added a paragraph near the end of the post based on our earlier dialogue.

        Liked by 1 person

      6. LovingSummer says:

        That’s brilliant, thanks 😊

        Liked by 1 person

  2. A very interesting read 🙂

    Liked by 1 person

  3. Amir Saeedi says:

    Thanks for the article, it is interesting, especially during the identification formation when the child, on the one hand, identify himself with his parents (or their figures), and on the other hand, he refuse to be like them. I find such challenge in myself between me and my father. There were many of his traits and habits which I have never liked, but when I study my own behaviour sometimes I find myself exactly repeating what I didn’t like about him. I also wrote a short article in my page about Super-Ego and the role of ego-ideal and ideal-ego in the formation of our identification. If you were interested you are welcome to have a look.

    Liked by 1 person

    1. Stephen says:

      Thank you Amir. I think the tension you describe is one we all have to resolve (many don’t) and there are straightforward ways to do that. Yes, I would like to read your article. Will take a look at your website.

      Liked by 1 person

      1. Amir Saeedi says:

        I cannot call it a real website yet, I just made my account a couple of days ago. But thanks for your comment man.

        Liked by 1 person

      2. Stephen says:

        I’m sure it will be good.

        Liked by 1 person

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