We are excited to announce that our own Dr. Linda Buchanan, Senior Clinical Director for Walden’s Georgia programming has become a published author! Bringing more than 30 years of clinical experience, Dr. Buchanan’s debut book, “A Clinician’s Guide to Pathological Ambivalence,” describes a common experience that many therapists face with clients; feeling stuck. Whether sessions with a client seem to be going around and around in circles – or have come to a halt altogether – many clinicians blame their own perceived inadequacy when things aren’t moving forward.
“I was searching for a name that would describe this behavioral pattern that is so common in our field,” Dr. Buchanan said. “I thought, rather than be frustrated with ourselves or our patients for a lack of progress, if we could identify a pattern of behavior – and develop strategies to address it – we would be much better positioned to help our clients.”
To avoid damaging labels (think borderline, resistant or defiant) that have the ability to unintentionally hinder therapeutic progress, Dr. Buchanan coined the term, “Pathological Ambivalence” as a way to re-conceptualize the state of resistance. This shift in perspective benefits both the client and the therapist by helping to explain why some people tend to sabotage progress in therapy, and how the therapist may often become an unintentional enabler.
Informed by evidence-based theories such as Object Relations Theory, Narrative Therapy, Gestalt and Family systems/Imago Therapy, Pathological Ambivalence is the co-existence of opposing attitudes or feelings toward a person, object or idea that negatively impact quality of life. Dr. Buchanan believes that a lack of change often occurs when different parts of a person have different wishes or needs that are not being effectively integrated.
“All people have parts, and different parts of the same person can have different needs or wishes, such as needing companionship but fearing rejection. When resistance is encountered in psychotherapy, it is usually because either the client or therapist (or both) doesn’t realize that the resistance is actually caused by ambivalence,” Buchanan explained. “Thus, when a therapist takes a side (presumably the part that wants to change in a healthy direction), the client is likely to voice the other side, resulting in what looks like resistance. Therefore, the therapist must learn how to be on the client’s side without taking a side.”
To better understand this theory in practice, I asked Dr. Buchanan to provide us with an example of what this strategy might look like for someone who is living with an eating disorder.
“I was recently speaking with a client who was afraid to fully recover from her eating disorder because she didn’t want to have to experience the feelings that her eating disorder allowed her to avoid. Saying something like ‘Yes, but your eating disorder symptoms can cause you physical problems and you need to learn ways to manage your emotions without using behaviors’ (both of which would have been correct observations) could have resulted in her needing to explain again why this is hard to do. Using a Carkhuff statement, I instead responded, ‘So you feel afraid to recover because you can’t yet believe that you can manage hurtful feelings without your eating disorder.’ I didn’t take either side, just reflected. She looked at me as if I’d just performed magic and said ‘wow, it’s like you’re in my mind…I guess I’m going to have to find other ways to manage my feelings.’ Ultimately, our pathologically ambivalent clients are much more likely to take their own advice over ours.”
We feel very fortunate to have Linda’s expertise as part of the core group of compassionate professionals that lead our clinical efforts. We admire her commitment to her patients and for her dedication in identifying a universal need and developing strategies that will help move the field forward in a different way.