20 Reasons for Ambivalence in Psychotherapy

Everyone comes to therapy at different levels of readiness to change their behaviour.  The first step in therapy is often to explore your conflicting feelings about change.  The list that follows will help you to start thinking about the sources of your ambivalence.

1- Shame

You think that you are lacking something in yourself and feel incomplete. You believe that you do not deserve the help that is available and you stay in a vicious cycle of suffering.

2- Guilt

Returning to your past again and again reinforces feelings of guilt. Shame and guilt reinforce each other. You might try to resolve this issue by being angry or blaming others. Guilt and shame further complicate your problems.

3- Lack of support

Lack of support in your life can lead to the sense that, “There is nowhere to go.” It can be difficult to accept support from unfamiliar sources or strangers who claim to be professionals.

4- Stigma

Consciously or unconsciously, society places a stigma on you.  You feel discriminated against and this keeps you from seeking help.

5- Denial

It seems to you that there is no problem to solve. You believe that luck or a miracle will end your suffering. Problems worsen with denial. It is difficult to realize and accept the realities of life.

6- Withdrawal

Treatment for addiction or any all-consuming behaviour may require you to face withdrawal symptoms. These symptoms could be physical and emotional.

7- Fear of treatment

You fear the unknown. It can be frightening to share your personal feelings and stories and risk being judged.

8- Fear of change

Any change can be stressful. You might wonder: “Can I survive without alcohol?” or “I can’t remember a time when I didn’t feel depressed.” These issues have become an integral part of your life.  Removing these “companions” from your life is not easy.

9- Acceptance and trust from others

If you are in a situation where you have to build (or rebuild) trust, you may wonder:  “How will society or my friends or family respond to me after I ‘come back’ and become ‘productive’? Will I be trusted? Who will trust me? How do I create trust?”

10- Low self-confidence

You have lost confidence in your capacity to overcome difficulties. Gaining self-confidence is a continuous battle.

11- Fearful of yourself

When you ask yourself: “Who am I really?” you feel anxious and distressed. Sometimes you fear yourself or, even worse, fear that others will see you the way you see yourself.

12- Living in a world of your own

You think of yourself as completely different from others.  The problems you face seem unique and no one could or would understand. It feels like you are constantly disappointing others and you become dejected and give up trying.

13- Hostile world

You see the world as a hostile place to live.  The world is a place where your needs are not met and you are not understood.

14- Lack of financial resources

Change can sometimes cost money (but not changing can be even more expensive!).  Poverty can be the biggest obstacle to change.  Lack of financial stability creates stress and can be a barrier to treatment.  It may seem nearly impossible to find or accept financial help.

15- Isolation

You have isolated yourself due to shame, lack of confidence and lack of social skills. You have created more difficulties in your life by denying yourself the support of others.

16- Dependency

It is hard for you to decide anything.  This can prevent you from taking steps to help yourself.

17- Non-supportive family environment

If your family is non-supportive, it can escalate stress in all areas of your life. When the family is not emotionally supportive, the result is tension and depression.  When your family members support you and listen to you, you feel energized and validated, but this is rare or does not happen at all.

18- Mixed messages all around you

Society is supporting treatment on one hand and on the other hand drugs and alcohol are available everywhere and therapy is often stigmatized. Temptation and criticism is all around you. It can feel like there is no escape.

19- Perfection dilemma

You feel like you need to be perfect.  Perfection is just impossible but it is the only standard you use. Making small changes, taking baby steps is the solution but you don’t know how to start.

20- Job loss or other risks of accepting treatment

If you openly disclose your problems you are concerned about losing your job or your licence or perhaps the respect of others.  This anxiety causes you to avoid accepting help and taking the risk.


If one or more of these factors apply to you, a skilled therapist can engage in a collaborative conversation to help strengthen your resolve for change.  We all need to find our own reasons for change.  There is nothing better than an environment of acceptance and empathy to support this process.


The views expressed in these blogs are the author’s own and not necessarily reflective of those of Psychotherapy Matters. 


Iftikhar Bhatti

Iftikhar Bhatti is the founder and Clinical Director of Bhatti Psychotherapy and Counselling Centre. He is a Registered Psychotherapist and has a Master's degree in clinical psychology with certifications (ICCAC- International Certified Clinical Addictions Counsellor) through CACCF. With more than ten years of experience working in teaching hospitals and residential treatment centres he believes in a client-centered approach.

One response to 20 Reasons for Ambivalence in Psychotherapy

  1. Karen says:

    Thank you this valuable information. Sadly I can see that some of these apply to me and my life. I am pushing through the challenge of looking at change and feel that fear has robbed enough of my life. I am willing and wanting to make “Change” a friend rather than a foe. I hope that your article comes across someone else’s computer screen as I feel that fear of anything only robs us of life, which is so precious.


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