Working with Ambivalence in Motivational Interviewing
August 12, 2026 2026-08-17 20:14Working with Ambivalence in Motivational Interviewing
Working with Ambivalence in Motivational Interviewing
Working with ambivalence in Motivational Interviewing begins with recognising that people can experience competing motivations about change. A person may want something to be different while also having powerful reasons for things to remain as they are. This is not unusual or irrational. It is a common human experience.
Exploring Ambivalence in Motivational Interviewing
“I want to, and I do not want to”
Important changes often involve gains and losses. Giving up smoking may improve health while removing a familiar way of coping. Leaving a difficult relationship may increase safety while bringing loneliness or financial uncertainty. Engaging with treatment may offer hope while also requiring someone to acknowledge something they would rather avoid.
“I know I need to change and I am frightened about what will happen if I do.”
Replacing an automatic “but” with “and” can sometimes help us hear that both sides are real.
Why persuasion can make ambivalence harder
When practitioners become responsible for arguing the change side, the person may naturally voice the other side. The conversation can become polarised, with one person explaining why change is necessary and the other explaining why it cannot happen.
MI aims to avoid that trap. We listen for both change talk and sustain talk, while helping the person explore their own motivations and values.
Using double-sided reflections
Double-sided reflections can help hold both sides of ambivalence in the same response without deciding for the person which side should win.
Person: “I know the drinking is affecting my health, but it is also how I cope after work.”
Reflection: “You are worried about what drinking is doing to your health, and at the same time it has become an important way of managing stress.”
The aim is not to balance the conversation mechanically. It is to communicate that we have heard the dilemma and to create space for the person to explore what matters most to them.
Explore rather than resolve too quickly
Practitioners can become uncomfortable with uncertainty and move prematurely towards solutions. Sometimes the more useful work is helping the person understand their dilemma more clearly.
A useful MI conversation does not always end with a plan. Greater clarity can itself be meaningful progress.
Questions that can open exploration
“What are the things you value about how things are now?”
“And what concerns you about continuing this way?”
“If you did decide to make a change, what might be better?”
“What makes this decision difficult?”
The purpose is not to mechanically complete a pros-and-cons exercise. It is to understand the person’s experience and listen for what matters to them.
Ambivalence and autonomy
Ultimately the person may choose differently from what the practitioner hopes. Respecting autonomy does not require us to hide professional concerns. We can be clear about those concerns and still recognise who owns the decision.
Continue exploring
Change Talk · Sustain Talk · The Fixing Reflex · Importance and Confidence
You can also explore further Motivational Interviewing resources through the Motivational Interviewing Network of Trainers (MINT).
