How to Deal with Ambivalence in Psychotherapy: A Conceptual Model for Case Formulation

Abstract

Ambivalence has been considered to exert a determinant role in the therapeutic process and outcome. Throughout the process clients often adopt two opposite positions about change. On one hand, they think about the need for change, on the other, they reject it.  Previous empirical studies have been suggesting that ambivalence is a common process both in poor- and good-outcome cases, however, when it’s not resolved the therapeutic process tends to fail. In this sense the understanding of this phenomenon has the potential to promote better results in clinical practice. In this paper we present a transtheoretical conceptual framework that therapists from different approaches can use to conceptualize ambivalence in psychotherapy. Specifically, we discuss a) the movements towards change; b) the movements away from change, and; c) the processes involved in the ambivalence resolution. One psychotherapy case is used to illustrate our proposal and a set of guidelines is suggested to help therapists to conceptualize and deal with one of the processes most associated with therapeutic failure.