Working with Ambivalence in Motivational Interviewing: Practice Lessons from Dr Allan Zuckoff
Working with Ambivalence in Motivational Interviewing: Practice Lessons from Dr Allan Zuckoff
Glenn Hinds MI Practice Companion
Ambivalence is familiar to anyone who has considered making an important change. We can want something to be different and, at the same time, have compelling reasons for things to stay as they are. For practitioners, this can be difficult to sit alongside. When the benefits of change appear obvious, it is easy to begin explaining, persuading or trying to resolve the person’s uncertainty for them.
In Episode 85 of Talking to Change, Glenn Hinds and Dr Sebastian Kaplan speak with Dr Allan Zuckoff about ambivalence as an internal conflict, the role of values, importance and confidence, discord, hidden ambivalence and the practitioner’s capacity to tolerate uncertainty.
This Practice Companion explores learning from that conversation and connects it with established Motivational Interviewing principles. Its central proposition is simple: ambivalence is not a problem the practitioner needs to eliminate. It is an experience we need to understand and work with skilfully.
Listen to the full conversation
Listen to Glenn Hinds and Sebastian Kaplan’s full conversation with Dr Allan Zuckoff on Talking to Change: A Motivational Interviewing Podcast.
▶ Listen to Episode 85 – Ambivalence and Motivational Interviewing
In this Practice Companion
- Ambivalence is not resistance
- Ambivalence as internal conflict
- Listening accurately to both sides
- Values and competing directions
- Importance and confidence
- How well can the person tolerate ambivalence?
- When practitioner urgency contributes to discord
- Hidden ambivalence
- From judgement to curiosity
- Deliberate practice
- Practice takeaways
Ambivalence is not resistance
A person can have strong reasons for changing and equally meaningful reasons for not changing. In MI, this does not need to be interpreted as stubbornness, denial or a lack of motivation. It may simply mean that change carries both potential gains and potential losses.
When practitioners label this uncertainty as resistance, they risk locating the difficulty inside the person. A more useful question is: What are the different motivations operating here? This creates room for curiosity and helps the practitioner listen rather than immediately trying to overcome one side of the person’s experience.
This is closely connected with Working with Ambivalence in Motivational Interviewing and Sustain Talk in Motivational Interviewing.
Understanding ambivalence as internal conflict
Allan’s discussion invites us to think of ambivalence as conflict within the person rather than conflict between practitioner and client. Someone considering reducing alcohol use may value improved health and relationships while also valuing the relief, enjoyment or social connection drinking provides. A person considering leaving a relationship may want safety or independence while also wanting to protect their children, financial security or an important attachment.
Seeing ambivalence this way changes the practitioner’s task. We do not need to win an argument for one side. We need to understand the competing directions well enough for the person to hear and examine them.
Listen: Separate the Two Sides of Ambivalence
Allan describes how MI can interrupt the unproductive back-and-forth of ambivalence by helping people separate and explore the different sides of the dilemma.
Listening accurately to both sides
Ambivalence often becomes audible through a mixture of change talk and sustain talk. If the practitioner listens only for reasons to change, the person may feel that an important part of their experience has been ignored. If the practitioner dwells exclusively on reasons not to change, the conversation may lose direction.
A double-sided reflection can acknowledge both without deciding for the person.
Person: “I know drinking every night is affecting my mood, but after dealing with people all day it is the only time my mind stops.”
Possible reflection: “Drinking gives you relief at the end of an exhausting day, and you are increasingly concerned about the effect it is having on you.”
The purpose is not to produce a perfect formula. The reflection communicates that both sides have been heard and offers the person an opportunity to confirm, correct or develop the practitioner’s understanding. See also Reflective Listening in Motivational Interviewing and Change Talk in Motivational Interviewing.
Values can illuminate competing directions
Values can help us understand why both sides of ambivalence matter. A decision about work, medication, substance use, health or a relationship may connect with several values at once: independence, belonging, responsibility, security, enjoyment, health, loyalty or freedom.
Values exploration is not a technique for exposing inconsistency so that the practitioner can persuade someone to change. Used in the spirit of MI, it can help a person understand what matters to them and how different choices relate to those priorities.
This requires acceptance and partnership. The practitioner is not the judge of which value should win.
Importance and confidence are different conversations
A person may believe change is extremely important while having little confidence that they can achieve it. Another person may feel completely capable of changing but see little reason to do so. Treating these as the same problem can lead the practitioner in the wrong direction.
“I desperately need things to change, but I don’t think I can do it.” points particularly towards confidence.
“I could stop if I really wanted to. I’m just not convinced I want to.” points particularly towards importance.
Scaling questions can sometimes help clarify this distinction, but the number is not the destination. What matters is the conversation the scale opens. Explore more in Importance and Confidence in Motivational Interviewing.
How well can the person tolerate ambivalence?
One of the most useful themes in Allan’s conversation is that people differ in their capacity to tolerate ambivalence. For some, staying with competing motivations long enough to explore them may itself feel highly uncomfortable. If we invite someone to remain in an experience they find difficult to tolerate, Allan suggests that avoidance, impulsive decision-making or discord may follow.
This has an important implication for the practitioner. Rather than assuming that more exploration is always helpful, we need to notice how the person is experiencing the conversation and adjust our approach. Sometimes the first task may be helping the person tolerate and stay with ambivalence before trying to resolve it.
Listen: Can We Tolerate Ambivalence?
Allan considers what practitioners may need to do when staying with ambivalence is difficult for the person, including adjusting the conversation before trying to resolve it.
Practice reflection
Think of a conversation in which you strongly wanted another person to make a change. What did you notice yourself beginning to do? Did you explain, persuade, repeat information, ask more questions, offer solutions or move towards planning? What might have happened if you had stayed curious for a little longer?
When our urgency contributes to discord
Sustain talk and discord are different. Sustain talk concerns the status-quo side of a particular change. Discord concerns strain in the working relationship. A person saying “I don’t want to stop drinking” is not necessarily in discord with the practitioner. “You’re not listening to me” is much more clearly about the relationship.
Practitioner behaviour can contribute to discord. Arguing, correcting, giving unwanted advice, directing the conversation towards our priorities or moving prematurely into planning may all create pressure. When discord appears, the question is not simply what is wrong with the client. It is also useful to ask what is happening between us and whether our approach needs to change.
See Discord in Motivational Interviewing and the Fixing Reflex.
Ambivalence can have value
Uncertainty is uncomfortable, but it can also signal that a decision matters. Ambivalence may invite a person to examine consequences, priorities, relationships and possible futures more carefully. Moving too quickly to remove it can deprive the person of an important process of understanding.
This does not mean remaining indefinitely in exploration. MI is directional and evoking helps people articulate their own motivations for movement. The challenge is to support direction without replacing the person’s deliberation with the practitioner’s argument.
Hidden ambivalence
Apparent commitment does not always mean that every concern has disappeared. A person may agree to a plan while still holding reservations they have not voiced. Those concerns can emerge later as non-completion, withdrawal or a return to an earlier behaviour.
Allan discusses hidden ambivalence and the use of values card sorts. The broader practice lesson is to remain interested in what may still be unresolved, even when the conversation appears to be moving towards change. Values work should remain exploratory rather than becoming a device for steering someone towards the conclusion we prefer.
There is a reason for what people do: from judgement to curiosity
Late in the episode, Allan offers a deceptively simple idea: there is a reason for what people do. For practitioners, this can be a powerful antidote to judgement.
If our internal response is “He is just making excuses”, curiosity might ask: “What does continuing this behaviour provide that I have not yet understood?”
If we think “She obviously doesn’t really want to change”, we might wonder: “What are the competing motivations here, and which of them have I not yet heard accurately?”
Understanding a behaviour does not mean approving of it, regarding it as harmless, removing boundaries or abandoning responsibilities for risk and safety. It means trying to understand its function within the person’s experience.
Listen: There Is a Good Reason for What People Do
Allan invites practitioners to begin from curiosity about what a behaviour is doing for the person, rather than from judgement, while recognising that understanding a behaviour does not make it harmless or acceptable.
Turn the learning into deliberate practice
1. Hold both sides
Choose an ambivalent client statement. Write three responses: a reflection of the sustain side, a reflection of the change side and a double-sided reflection. Notice how each response might influence what the person says next.
2. Notice your own urgency
After a challenging conversation, write down the point at which you most wanted the person to change. What did you feel tempted to do? What might an MI-consistent response have looked like?
3. Importance or confidence?
Listen for statements that indicate low importance and statements that indicate low confidence. Practise responding differently to each rather than treating both as lack of motivation.
4. Rewrite judgement as curiosity
Write down a judgemental practitioner thought such as “They are not taking this seriously.” Rewrite it as a genuine question about the person’s experience.
5. Two-minute ambivalence practice
Ask a colleague to speak for two minutes about a manageable real-life change they feel uncertain about. Respond only with reflections and brief summaries. Do not advise, solve or seek commitment. Afterwards, discuss whether both sides were heard and what it was like for the listener not to fix the situation.
Practice takeaways
- Ambivalence is a normal part of many change conversations.
- It can be understood as internal conflict rather than opposition to the practitioner.
- Change talk and sustain talk can coexist and both may express meaningful concerns.
- Arguing for change can leave the person articulating the case for not changing.
- Values can illuminate competing directions without becoming a tool for persuasion.
- Importance and confidence call for different conversations.
- Practitioner urgency can contribute to discord.
- Listening to sustain talk does not mean reinforcing it indefinitely.
- Apparent commitment may coexist with hidden concerns.
- Curiosity supports acceptance and accurate empathy.
- The aim is not to erase ambivalence but to help the person understand it and decide what it means for them.
Put this learning into practice
MI Practice & CPD is in development.
We are developing an optional registered learning activity to accompany this Practice Companion. It will invite learners to respond to client statements, compare their responses with MI-informed examples, test their understanding and reflect on their own practice. Completion will be designed to provide a record of continuing professional development without implying certification of MI competence.
Episode guide
- 0:00 – Introduction
- 10:10 – Allan’s introduction and early MI story
- 15:00 – The core of MI stays the same
- 16:17 – Ambivalence as conflict between competing directions
- 23:46 – Separating the two sides of ambivalence
- 24:34 – Change, the status quo and values
- 29:12 – Importance and confidence scaling
- 36:44 – Resonance as a metaphor for listening and responding
- 46:23 – Capacity to tolerate ambivalence and discord
- 59:57 – How ambivalence can support thoughtful decision-making
- 1:12:47 – Hidden ambivalence and the Values Card Sort
- 1:22:51 – “There is a good reason for everything that people do”
- 1:29:56 – Foxes and hedgehogs
- 1:34:18 – Closing conversation
About Allan Zuckoff and episode resources
Dr Allan Zuckoff is a clinical psychologist with three decades of experience in Motivational Interviewing research, training, implementation and practice. He has contributed to intervention development, training and fidelity monitoring across substance use, mental health and health behaviour research, served on the Board of the Motivational Interviewing Network of Trainers and worked as a MINT trainer of trainers.
- Email: allan@allanzuckoff.com
- Website: www.allanzuckoff.com
- Book: Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There, Guilford Press, 2015.
For the complete episode and original show notes, visit Episode 85 – Ambivalence and Motivational Interviewing.
Continue learning
Explore related MI resources
Continue with the Motivational Interviewing Knowledge Centre, especially Working with Ambivalence, Sustain Talk, Discord, Reflective Listening, Importance and Confidence and the Fixing Reflex.
Discover related podcast conversations
- Episode 57 – Motivational Interviewing & Discord – a useful next conversation for exploring strain in the working relationship.
- Episode 51 – Lessons from the Lab: The Dynamics of Change Talk – further exploration of how practitioner responses and client language interact.
- Episode 89 – Doing and Being MI – a conversation relevant to the practitioner stance underlying skilful work with ambivalence.
- Episode 45 – Effective Psychotherapists with Bill Miller & Terri Moyers – further consideration of practitioner qualities and effective helping relationships.
Develop your MI practice
Explore Motivational Interviewing training for organisations with Glenn Hinds.
Continue with Talking to Change
Podcast: podcast@glennhinds.com
Glenn: glenn@glennhinds.com
Sebastian: sebkaplan34@gmail.com
Follow Talking to Change on Bluesky
Listen: Browse the full Talking to Change podcast listening archive.
Support the podcast
Learn: Explore Talking to Change episodes and learning resources on glennhinds.com.
