Reducing resistance and denial by exercising ambivalence during the treatment of addiction.
Stage change models and motivational enhancement therapies have significantly influenced the therapeutic tactics clinicians employ in the treatment of addictive behaviors. While motivational enhancement strategies have addressed client ambivalence to increase motivation to change, this article suggests that focusing on ambivalence during treatment has even wider clinical utility than previously thought. Resistance reduction concentrates on exercising ambivalence without an investment in clients changing, thereby strengthening client tolerance for ambivalent thoughts and feelings. Exercising ambivalence reduces resistance to treatment and change by validating a wide array of possible outcomes through detailed exploration of how a behavior pattern works for a client. Since resistance reduction does not require clients to want to change for therapy to progress, exploring the decision-making process becomes paramount. A general discussion of the resistance reduction model, ambivalence, and how clients present for treatment precedes clinical case examples.
Division on Addictions and Department of Psychiatry, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. howard_shaffer@hms.harvard.edu
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D000328:Adult; D000437:Alcoholism / Q000628:therapy; D016739:Behavior, Addictive / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000628:therapy; D008960:Models, Psychological; D009042:Motivation; D011369:Professional-Patient Relations; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*