Addressing Ambivalence Using Change Talk

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Addressing ambivalence using change talk involves understanding the conflicting motivations that service users may experience regarding behavioral change. Ambivalence manifests when a client recognizes the benefits of change but simultaneously perceives maintaining the current behavior as equally or more advantageous. Effective intervention hinges on identifying the specific “flavor” of ambivalence the client demonstrates and employing strategies to evoke change talk, thereby facilitating movement toward change.

In the context of motivational interviewing (MI), ambivalence is considered a normal part of the change process. Miller and Rollnick (2023) emphasize that ambivalence can occur in various forms, such as wanting to change but feeling unable, or wanting to stay the same despite recognizing the benefits of change. By discerning the particular "flavor" of ambivalence, practitioners can tailor their approach to address the client's specific conflicting motivations.

Identifying the Flavor of Ambivalence

In the assigned Hart City case study, the service user demonstrates a form of ambivalence characterized by internal conflict about the perceived benefits and drawbacks of making a behavioral change, such as reducing substance use. The client acknowledges the negative impact of their behavior on personal relationships and health, yet expresses reluctance to alter their routines due to fear of losing social connections or experiencing discomfort during withdrawal.

This form of ambivalence aligns with what Miller and Rollnick (2023) describe as “approach-avoidance” ambivalence, where the client simultaneously desires change but fears the consequences or discomfort associated with it. The client’s statements reveal a tug-of-war between the motivation to improve their situation and the attachment to familiar habits.

Using Change Talk to Move Beyond Ambivalence

Evoking change talk involves strategic techniques aimed at reinforcing the client’s own motivations for change. The goal is to help the client articulate their reasons for change, which increases their commitment and reduces ambivalence. Several specific strategies can be employed:

OARS Technique

• Open-ended questions: Asking questions like, “What are some benefits you see in making this change?” prompts the client to explore their own motivations.
• Affirmations: Validating clients’ expressions of motivation, such as saying, “It’s great that you recognize how the change could improve your health,” builds confidence.
• Reflective listening: Restating clients’ statements to confirm understanding, e.g., “You’re saying that social connections are important to you, and that worries you about losing them if you change,” demonstrates empathy and helps clarify ambivalence.
• Summarizing: Summing up key points of the conversation reinforces motivation and highlights the client’s own arguments for change.

Specific Application in the Case Study

For instance, if the client states, “I know I should quit drinking because I’ve lost my job and my wife is upset,” you might respond with, “You’re recognizing that quitting could help improve your relationships and employment. What makes you consider making a change now?” This invites the client to elaborate on their reasons.

Additionally, employing metaphors or storytelling can deepen the client's reflection. For example, comparing their journey to a mountain climb—acknowledging the difficulty but emphasizing the view from the top—can inspire motivation and diminish fear.

Conclusion

Understanding the specific flavor of ambivalence exhibited by the service user is critical in tailoring intervention strategies. In the Hart City case, the approach should focus on evoking change talk through open-ended questions, affirmations, reflective listening, and summarization. These techniques help clients articulate their own reasons for change, address their underlying fears and conflicting motivations, and ultimately facilitate movement beyond ambivalence toward meaningful behavioral change.

References

• Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change (4th ed.). The Guilford Press.
• Walden University, LLC. (2020). Hart City. [Interactive media]. Walden University Canvas.
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