Background: Pathological Ambivalence and its common forms will be described and strategies for resolving ambivalence to improve therapeutic outcome will be taught. Also presented will be strategies for assessing scripts and avoiding common pitfalls such as prematurely discounting client beliefs, and unknowingly participating in, or becoming the target of, the projections.
I. Understanding resistance as ambivalence
A. Relabel resistance as ambivalence
B. Ambivalence is normal
C. Brain functioning
II. Etiology of Pathological Ambivalence
A. Working Definition
B. Sensitivity vs learning
C. Serotonin and biology
D. Development of Narratives and scripts
III. Theoretical Perspectives On Resistance
A. Psychoanalytic
B. Object Relations
C. Transactional Analysis
D. Gestalt
E. Dialectics
F. Dissociation
G. Family Theories
H. Cognitive
I. Adlerian
J. Narrative
K. Humanistic,Rogerian
L.Social Interaction Theory
M. Behavioral Viewpoint and ACT
IV. Common Forms of Ambivalence
A. Ambivalence Continuum
B. Splitting
C. Manipulation
D. Power Struggles
E. Avoidance and maintaining status quo
F. Denial
G. Lack of skills
H. Therapist error
V. Treatment Strategies
A. Education
1. Emotional triggers
2. Function of symptoms
3. Brain functioning
4. Shame/regret continuum
5. Ego states
B. Stage of Change
1. Motivational Interviewing
C. Assessment of Scripts or narratives
1. Common Pitfalls of failing to full assess narratives
D. Function of behavior
E. Rewriting the script
F. Avoiding Power Struggles
G. Integrating internal splits
1. Acceptance and Commitment therapy
2. Working with ego states,
a. Empty chair
b. Inner child metaphor
3. Identifying that the client has dilemmas
4. Split column journaling
5. Acceptance of dialectics (DBT)
H. Imbalance in status quo
1. Concept of multiple motives
2. Acknowledging alternative thoughts or behaviors
3. Acknowledging exceptions to the rules
4. Working with ego states
I. Identifying and Avoiding projections
1. Acknowledging the script
2. Seeking wisdom from within
3. Accessing client’s wisdom
4. Combining wisdom
J. Second order change
1. Paradoxical interventions
2. Refreaming and relabeling
3. Ordeal therapy
4. Prescribing the symptom
K. Cognitive therapy
1. Identifying distortions
2. Hypothesis testing
L. Group Therapy
This workshop will focus on relabeling resistance as Pathological Ambivalence. Ambivalence is generally related to the cognitive scripts, narratives or schemas which individuals form in childhood and, when operating, can slow down, confuse or even halt the therapeutic process. These schemas include identity-based introjections such as “I am bad” and schemas related to beliefs about others such as “No one will help me”. These scripts affect the way clients feel, behave, and interact. The potential impact of these scripts on the therapy process is implied in the specific beliefs embedded in the schemas, making an identification of these schemas vital in the early phases of treatment. Without a thorough assessment, therapists are vulnerable to prematurely discount the schemas, be the target of them, unknowingly participate with the schemas or label the client as resistant..
The most common form of participating in schema is to prematurely counter the schemas without fully understanding the function and basis of these. Such as simplistically trying to convince a patient that he or she is not bad. Another participation occurs when a schema is serving a function that the client is convinced is still needed such as keeping them safe from others. Therapists may try to convince the patient that she is in a safe environment when it is the internal environment of the client that is actually unsafe. Another form of participation occurs when the client projects their schema onto the therapist who is seen as uncaring, judgmental, or a savior. Similarly, a client may complain to the therapist about another person. The therapist may take the clients’ side in what is actually a projection in which the incident is distorted in the clients’ mind. Since it is nearly impossible to know if the client’s interpretation is accurate, the therapist will be most effective when utilizing skills promoting a sense of being on the client’s side without taking the client’s side. Skills from many theoretical perspectives such as MI, Gestalt, ACT and DBT will be presented which enable the therapist to avoid these common pitfalls focusing instead on facilitating a resolution of pathological ambivalence.
Dr. Linda Buchanan is the founder of the Atlanta Center for Eating Disorders, an Intensive Outpatient and Day Treatment Center for individuals with eating disorders. Dr. Buchanan received a masters degree in Counseling from Georgia State University, and a Ph.D. from Georgia State University in Counseling Psychology. She has published two chapters on her model of treatment of eating disorders which have been used as texts in a local doctoral program for Clinical Psychology students. Additionally, she has published four research articles on the treatment of eating disorders. She has been married for 30 years and has two teenaged boys.
