by Susan Albers, Psy.D.

When clients are struggling with depression, they walk into your office ready to get rid of the chronic blues. This is often radically different than the way many clients with eating problems and other compulsive disorders begin therapy. In the event that your client lets you know they aren’t ready to change yet, reassure yourself that is okay—unless he or she is medically unstable, of course.

Embrace and use the ambivalence to your advantage. A helpful technique is to assign each shoulder a side of the ambivalence. Point to one shoulder and list the reasons the client is motivated to change. For example, say, "This side of you wants to change. You want to be healthier and you are tired of the eating disorder." When you hear the client clinging to his or her disorder, acknowledge the benefits to holding onto it. For example, point to the opposite shoulder and say, "The other side of you believes it’s scary to let go of the eating disorder. It’s been with you for a long time. Perhaps you don’t know who you will be without it."

Don’t be surprised if your clients mirror this technique by gesturing to one side or the other when they are for or against changing. There are three primary benefits to this technique.

1. Acknowledging your client’s ambivalence will make him or her feel very understood, which helps lead to change.
2. You can use this strategy to build a strong case for the benefits of changing versus keeping the disorder.
3. You are teaching the client how to address conflicting feelings.

Also by Susan Albers, Psy.D.