Ambivalence, Not Defiance: How to Recognize the Difference

Indecisiveness, or ambivalence, is something you need to be able to recognize in your patients. The difficult part comes in knowing the difference between ambivalence and defiance, resistance, or non-compliance. When a patient has conflicting feelings about his or her behavior change, it does not necessarily mean he or she is not willing to make the change, it just means the patient needs more information and/or more time to determine his or her true feelings.

So, how can you tell the difference?

The “but”.

For example, “I try to eat healthier, BUT I struggle to stay on my diet” or “I was given a prescription for _____, BUT I don’t think it’s really going to help me”.

Now, once you have identified the patient’s ambivalence and ruled out true defiance or resistance, how can you help?

Fuller and Taylor (2008) suggest having the patient work through both sides of the issue to determine what the real sticking points are so that you can help the patient move towards positive change. A verbal or written pros and cons list, for example, can be a simple exercise that can determine the underlying issues.



Fuller, C. & Taylor, P. (2008). A Toolkit of Motivational Skills: Encouraging And Supporting Change

               In Individuals (2nd Edition). West Sussex, England: John Wiley & Sons, Ltd.

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