Podcast-Ambivalence

Hello everyone and welcome to the communication solution podcast. We have Casey Jackson, our director here at the Institute for Individual and Organizational Change. Hello. He's going to be riffing off of an awesome topic today that you may have heard about with motivational interviewing. My name is John Gilbert. I'll be helping facilitate, maybe throw in a few things. And our whole goal here is to help you improve the outcomes with the individuals, organizations and communities you serve, in this case, with a motivational interviewing evidence-based lens. So to do that, we have a topic today of kind of vague, but we're going to get deep into this, a deep dive into ambivalence. So I'm going to kind of cue this up for you, Casey, of ambivalence. What does that mean from a very basic perspective? It seems like it's a fancy term, but what does ambivalence mean and where do you want to take it today? And then we can kind of go from there. So ambivalence, when we look at it through a definition lens or through an ambivalent or through a motivational interviewing lens, is that it's just that people feel two ways. What I've heard about in training that's really interesting is that I've had people that are a little less clear about it, that they have some kind of vague, general idea about it. I've said, it's like, you don't really care about something. That's what they thought it was. I don't care if you make peas or carrots for dinner as a side dish. I don't care when we're the other. And ambivalence specifically in motivational interviewing, there's significantly more energy to it than that. It really has this thing to do with, I've got reasons why I'm stuck, legitimate reasons why I'm fine with where I'm at, and I've got reasons why I might want things to be different. So you may get new, like for me, when I found out that I had excessive lack of cholesterol, I've got reasons why I really want to change that, but then I've got reasons why, like, I don't like to particularly exercise and, you know, the thought of changing my whole eating habits is not highly appealing, but the thought of dying is not highly appealing either. So I literally have reasons on both sides that I can make a case for change. It's kind of like an internal teeter totter of feeling two ways about it. Yeah, that's really interesting you say that because that's a, I haven't heard that from a participant before of kind of like just indecisiveness that's feeling two ways about it. Right. I've never even thought about it like that. So that's an interesting nuance. I don't even tell other, you know, am I trainers out there possibly too of, or just people interested in this? It's not just a blasé, a lack of caring and apathy. It's not that it's, it's an interesting concept here is that it's a care. It's a desire. It's something of a consideration of change and then feeling like I should, but I ought to, but I need to, but that kind of like it would be good if I, but I got lots of reasons that are legitimate to me of not to my time, my energy, my whatever. So when we're thinking about this, then it's about some kind of change, not just some apathetic decision. So I think that's a key distinction that you highlighted there. So then how does that fit in ambivalence with, you know, when you're thinking about am I and do they have to have ambivalence right from the get go then, or how do you start to think about, okay, I get a sense of what it is. But, you know, do they have to have it or who do I target does, do I talk with someone that's always feeling two ways or what if they're only in one way, they're ready to go. Like how does that all factor into it? Well, it's interesting because when you said words like blasé are indifferent. I thought it was interesting. So I was thinking, you know, there's kind of the way we look at ambivalence and motivation or anything, but I was thinking about, you know, generically speaking outside of the world of motivational interviewing. What is the real definition of ambivalence? What's the deeper? And when you were talking about the indifference or blasé, I think like the peas and the carrots, peas or carrots perspective really comes down to the potency of it because you can have a low level of ambivalence like, you know, I kind of feel this way, I kind of feel that way, but I'm not particularly invested in this one where the other, which is more the blasé side of it. So there, you know, I've got, I've got opinions that are different. It takes me back to when I very, very, very, very first was learning about motivational interviewing and we talked about the deers or the readers, however you were taught the acronym about, and the A, the double A was amplifying ambivalence. So by that definition, even back then it meant that you could have a lower level of feeling two ways about it. It doesn't have to be this potent or strong massive amount of ambivalence that as long as ambivalence exists, which is what I've always taught is as long as ambivalence exists, somewhere within their, within their brain, it doesn't have to be powerful and amplified when you interact with an individual. It's just does any form of any inkling of ambivalence potentially exist within their experience or inside their thought process. What MI comes down to is how do I have any access to that, what's my access to it. And when I hold a mirror up to them, does it have any impact on how they feel about it? When they see themselves in the mirror, they can see themselves in the mirror and genuinely still not have much, you know, potency around it. There may not be a whole lot of energy around it. So it's like, I really just don't particularly care about peas or carrots. You know, I'm not a huge fan of vegetables as it goes. I eat both of them. You know, I really don't care which one you pick. I guess, you know, just depends on the color on the plate and the orange pops a little bit more. I mean, it just literally, they can have genuinely no strong opinion, but they do feel, you know, have some sense of feeling two ways about it, but nothing that's very potent. That's where it comes down to how does I mean, literally, if I use that example and keep walking and do a deep dive into ambivalence and motivational or viewing is, you know, if there's no difference to them about if they eat the carrots or the peas, what that comes down to is how much have they really thought about it. And I think that's in MI what I like to explore, not because I'm trying to make them or get them to eat one way or the other, pick one. It's literally to explore the ambivalence to see is their behavior changed to be had based on their own value set. Now this is where it comes into another podcast we've done, how attached am I to the outcome and I try to get them to eat something that I want them to do to pick the carrots and not pick the peas, then you're shifting out of MI fundamentally, but the actual ambivalence piece of it that I think is one of the most intriguing things to explore is how do I explore if ambivalence exists, if there's not a lot of energy or inertia around that. That's where I think is fascinating, especially we move it from peas and carrots to addiction or suicide or, you know, heart disease or, you know, you know, any of these more complex behavioral issues that we start to look at tends to be obviously a little bit more sparked somewhere in there. The one other thing that I'll say to John, just throw it out there and, you know, let you run from there as well is I think it's also the thing about does the ambivalence exist when we throw it out there, or are we able to get past the resistance? Because I hear this often that, you know, what happens if there's no ambivalence? And what I am really clear to point out is you really genuinely, you have to be able to assess how are you, are you assessing resistance, the tension or the discord between two things? If you can't get past that, you may not be able to access to assess if ambivalence actually exists. And what I hear often from the audio tapes that we listen to when we're coding is there are some people that don't get past the resistance, the discord or the tension, and then come around and say, well, I couldn't use MI because they weren't ambivalent. And it's like, whoa, whoa, whoa, whoa, whoa, that's a misassessment. You don't know if ambivalence existed because you didn't make it past the resistance or the discord or the tension in the conversation to be able to even assess if ambivalence exists. Well, there's a, it's very rare around that regarding not having any ambivalence but having all defenses low. It seems to be a rarity from what you've trained on, what you've experienced, what I've experienced. One example comes to mind and then I want to bring it back to kind of what we're alluding to here and then kind of go to a different direction with it. But the example is one of working with a vocational rehabilitation system in a different state where they had a person that had a disability that they're trying to help for getting employment and that person genuinely felt respected and cared for and supported by the person that they were working with at that particular rehabilitation counselor, VRC. And yet that person still thought the way the system worked, he was entitled to and deserved these particular things, even when his defenses were low. That's just his worldview that here's what I deserve and here's how it works and here's my belief system. And I really appreciate what you're doing for me, but I just got to take this to a hearing because that's what they did in that system. You go to a court hearing and you try to vet like that I've been treated unfairly and all these things. He was very much passed a lot of resistance with this person. He still had a very specific view that he had no ambivalence about and around the whole thing. He felt that these things were entitled to him and deserve, which I've seen other people talk about in different, you know, government systems. And so there is this place of this person did their best to my, they were pretty skillful with their MI too, but at a certain point we can't change someone's belief system unless we want to use compliance. And it's very rare, but I think that's a good example of a very extreme slim slice, as you might say, portion of people. But I know that the person that I was speaking with did an incredible job with empathy, getting in this person's skin and saying what it must be like. And this person just felt very engaged and supported by this person without defenses. And that's just so rare. But if you can do that, anything you would have tried anyways, probably wouldn't have ended up in a different outcome. Anyways, you would have been dragging them by their feet or trying to get them to change the whole time when they genuinely didn't want anything, but that one outcome anyways. Well, and I think, you know, to clarify that even further is they may be so solely focused. And I would just, I think because my own writing reflects to that is if they're completely unaware that there's a problem, that is part of definition of pre contemplation. Oh yeah, definitely. So yeah, so, which doesn't mean that there is 0.000 ambivalence. It's that if we hold a mirrored enough angles, can they actually see that there is a potential for discrepancy there. And so it, I think it is such a, it's a very tight rope to walk on with that because we don't want to try to instill the ambivalence. We're trying to uncover or reveal is a potential for ambivalence. And I know I'm sure that situation like multiple skillful reflections were used, but part of just being uninformed that are unaware that by law or by policy, this is not an option. And if they're saying, well, that should be an option, I don't agree, is different than them being completely unaware that the law or the policy exists. So those are the things that I might bring us into a deeper dive with in terms of calling out, you know, what are we looking at in terms of just denial of facts, which form a pre contemplation, that ambivalence could exist if the denial was, you know, if we could work through the denial and there's no denial, then could they look at the facts that exist. That's interesting because that's implying that ambivalence exists there and it could exist in possibly all situations and I'm going to provocatively say that because then you're saying, well, there's always ambivalence to uncover and I might, I'm going to push back a little bit. Well, what about belief systems in religion or conspiracy theories or things like that? Since we're doing a deep dive, I want to kind of open that up to say, well, where is that ethical line where your exploration is actually now you trying to get to this inevitable thinking two ways about it where you're no longer equal position and you're trying to just get the ambivalence that you believe exists no matter what, you know. That is a great distinction, John. That is an excellent, excellent distinction. And here's where the distinction is for me. It is when it is about informed choice, when you know that the person has full access to all information that's available, they're aware and they acknowledge they have access to all the information available and they clearly have a preference and they don't feel too ways about it. The example that I've used before that helps me understand my brain understand where the ambivalence is resolved and it's not denial or lack of information is it's a simple one. It's a really simple one. I just think of like a great uncle or a grandpa who's been smoking cigarettes since they were four years old and they know all the information. They know it causes cancer. They know they can die young from it. They know that it causes all these health complications. They know that people in the family are concerned about it. They know that they could have their life that short and they're not around to see their their grandchildren. Can we pause the recording real quick? All right. So when you think of that from this perspective of an informed choice and like a grandpa has full access to the information, 100% unedited access to the information. They accept the information as truth as fact. That's not the issue. It's not that they don't accept. They accept. I know that smoking causes cancer. I know that this is a potential issue. I know this could end my life at a young age. I know this could have an impact on my family and my extended family. And given all that, I'm okay. I don't have a problem. I'm going to continue to smoke and they are continue to, you know, they can take in new information, continue to evaluate and they've resolved their ambivalence that they are fine with their behavior as it is and it lines up with who they see themselves as as a person. Then that is different than someone who is denying the facts or denying the information or is unaware that there's other information to draw from. So that's why for me, the example that you brought up, it's for me is clearly distinguished between having the accurate information, open to all the facts in front of them, absorb those facts. And now it is a matter of informed choice and they just choose differently than what someone else may want them to choose. So that's that's the distinguishing point when we're talking about pre contemplation, that slippery slope you're identifying is a legitimate real slippery slope, but we need to be clear about how we're defining what that slope is. So okay, yeah, because it, it starts to get into aspects. I mean, this is a deep dive into ambivalence. So that's why we're going there's there's other things that if you're interested in more conversations for most people about competing priorities and stuff, there's a lot of ways we can take this, but I want to keep going into this particular example, just because of what we're getting into or examples along these lines, what is ethical influence, which we have a whole separate podcast that we get into of how we define equipoise at our institute. Yes, yes, but what is equipoise and what is writing reflects and the reason I'm bringing this up is because like, for example, in my world, you can lose of healthcare and try to help people with their health a lot of the time, even in the counseling work I'm doing, it's a lot of times weight loss oriented and things. And so in doing that, there's a lot of ways to lose weight. You can lose weight through all sorts of different methods we don't need to get into from starvation to healthy eating to doing cocaine, right? There's a lot of ways to lose weight. And does that mean they're all healthy, not necessarily, right? And one that's become popular is something called the ketogenic diet, the keto diet that became. And so then when you look at the facts and you look at the objective things, I can have a writing reflex as a healthcare provider that cares for this person's health due to some of those facts that look at mortality and hardening of the arteries and outcomes associated with decreased mortality. Even if there is a short term, I shouldn't say short term, even if there is a benefit of the weight loss and how that's happening, there's these other outcomes. So what is traditional is as a helping professional, I just want to inform this person, I just want to let them know, can't you see what's coming ahead because I care for you and I want to see this. That's my reflex to make it right. I want to give them informed choice, Casey, right? Like there's this level of what we're talking about at like the very seemingly normal level when people are getting into MI like I'm just trying to give them informed choice and help them out. So I'm just trying to see if they have ambivalence, Casey. So there's that level of it, but I know you're speaking to a different level. So I want to kind of walk through this. How do you take someone in that place of like, I'm just trying to reach them. I want them to have informed choice. How does that differ than what you're really talking about of an MI deep approach to really be ethical about that? Well, I love the way you set it up because the way you set it up is, yeah, I want them to have informed choice. I want them to have all the information, because if they did, they'd make the decision that I want them to, that I think is best for them. So I mean, if you play out that thought, it's still... I'm going to jump in and say, that might have been picked up and I might be unconscious of something going on there. I will say that I genuinely, in that example, it was being a practitioner that says, I want them to have informed choice. So my intention of saying that is, and how you've helped train me is I want them to know that there is this mortality thing. And I do know that it's, I want them to, but it's a fact. Like you said with the smoking or some of the other stuff. Sure. So how can you transition then if that isn't my intention, you know, you just coached around that. That's what it is to give them informed choice with that information on the table. How do you now shift from that fix it mode to informed choice mode with being ethical in the process? Sure. Well, the way, you know, in the, in a kind of in a gut sense, and I'll, then I'll clarify that even further, my gut sense when I'm really looking at informed choice is the way I talk about is when I can look in the whites of their eyes and there's something about when I look at them that I know their brain has absorbed more information and usually when that happens, you can see some ambivalence exists or the reconciliation process starting to happen. They're reconciling their ambivalence in that moment when they have informed choice. If it is just a flat stair and you can see nothing is processing or appears, nothing is processing. Then I'm always questioning, are they able to see it or access or feel like they can get enough underneath that their brain can process the information. So, so I think that what are we talking about with informed choice? The way that I look at it beyond the gut feeling or the whites of their eyes is if they can articulate part of what being good at motivational learning is, is being able to be in that level of empathy that you can feel their brain is either processing or not processing, which is wildly different than just throwing reflective statements out. So there should be some level of connection or engagement or rapport through high empathy that you have some deeper sense of is their brain engaging with the information that's being provided. Is it overwhelming? Is it causing a writing reflex or a pushback within them? Those are things that if you're highly engaged with an individual, you should have some level of assessment if that's going on. So with a situation where they are completely undefended, you're providing pure information that the best knowledge and the best research and the best information we have this at this moment in time, they look at it, they study it, they absorb it, they weigh it out with their ambivalence within themselves, and they come up with a solution that this is what I'm going to choose to do from here. In motivational learning, we empower people to make a decision that aligns with their values and their goals based on who they are and what they want to achieve in their lifetime, what their target is for their lifetime. So that's walking through an informed choice perspective. The problem is if the reconciliation they come up with is not what the professional would choose. This is where it becomes a slippery slope. What you are identifying, John, is then is that the practitioner continuing to say they're in pre-contemplation because they're not agreeing with me. Obviously, if they could see the information the way I saw the information, they would not make this choice. No. You seeing the information the way that you're seeing it, you would not make that choice. So it is the level of acuity in which you are assessing their assessment is critical to being able to distinguish is this informed choice or are they still not having enough information or processing information? I think the challenge that we have is if they're not making, especially if it's a critical like you're talking about potential impact on their own mortality, who would not choose the decision that's going to give them a higher level of life expectancy and quality of life? These are the nuances we're talking about that are so-- the level at which we're splitting hairs to get really clear about that requires a significant amount of self-assessment personally and professionally, your capacity to self-assess. Where am I being triggered? Where am I attached to someone else's outcome? And then I will just detach from all that for a second and say, one is not right or wrong. It's just a matter of what are you trying to orchestrate in this conversation? So it's not wrong because you're ever in a righty reflex. It's not wrong because you want them to have a better quality of life and live longer, but then you're going to be pulled further and further out of motivational interviewing in terms of your skill set that you're using, the more attached you get to that. Yeah, and that speaks to-- there's two critical things here. One is just to riff off of what you just said. It's that that is defined as compassion and am I the third edition, right? There's a compassion there in motivational interviewing where you genuinely care. But we're talking about a way of channeling that compassion, a way of concentrating it, of filtering it, of whatever you want to say in a way that's different than maybe would be just outright giving the information right away that would be different than maybe trying to say what someone should do or ought to do because of what I believe is the professional. It's this channeling of compassion that you still care, but you're caring in maybe a different way than is your immediate reactivity, it sounds like. So that's-- Right, and for me, the caring and the compassion in through a motivational lens or energy or the spirit of it is that you're caring and compassion is how do I empower this person to be the best version of themselves as they define it, supporting their autonomy on that level versus I wish they would listen to me because I really think this would put them in a better position, which by definition is more self-centered. So it's not coming from a bad place. You can come from a compassionate place, but it's much more self-centered than that other individual you're talking to centered. And that also gets into my third edition of how to define compassion because it's defined in lots of wisdom traditions and things in lots of different ways and there's lots of conflation. It's that that person's agenda is more important for them in their life than your agenda for them. In essence, you're not projecting your agenda and your values, which is really important to answer things around like this example and then I'll go into others, but what you are saying is being able to really have a nuance of their ambivalence and how much of it you've seen that if you just explore it enough, there's ambivalence there and you're trying to get them to see that versus really exploring what maybe isn't the target behavior. And this is what I wanted to bring it back to from before. That is kind of an interesting discussion in MI is do you always start with the target behavior of what you're going to have for dinner or not? Are you going to stop smoking or not? Whereas what we're kind of alluding to is a certain way that we approach MI that you train me in and that we train on at the Institute, which is can you get in and above the target behavior? So you might not be talking about, for example, in this case, the keto diet. You might be talking about eating more generally, but ideally you're talking about their health and their well-being and their future and how much that relates to them. Just like the smoking example, and at a certain point there's competing values maybe for some people of the short-term gratification versus the long-term well-being and fulfillment. But some people, like we're talking about, they just have a different value bend that their peace of mind of not changing and some of that stuff matters more than any perceived sense that other people have, any belief system that others have about science or anything else, that their peace of mind reigns supreme. That's one example of now I'm trying to get this person to see my values, that I value well-being and that they're not having my value structure and that I believe in science and that if they believe in science too, with this my perceived conspiracy theory that they're having, I would get them to see this thing. And it's like, I think they have ambivalence. I think they need to have more informed choice. I'm putting my values and projecting them onto them versus really being curious and channeling that compassion to step in their shoes and feel what it must feel like, believe what it must believe like and be curious about that and explore it is a whole different way of channeling your compassion seemingly of what we're talking about than trying to help with informed choice from the other perspective of like I need to inform you versus I need to be informed of you and then see what you think about this particular topic. Seems like the energy difference. Well, yeah, and it just summarizes the difference between more self-centered and more other centered. I mean, just that that's what it comes down to is who's narrative are we operating from. And in motivation, we're operating from the other's narrative. And until it gets to a place in a conversation where even if we're operating within their narrative, when they find stuckness in their and their full decision is to try to move forward, we may have insights or ideas or expertise or knowledge that could help them pick a path or approach that's going to align with them getting to the top of where they want to go, getting that ultimate destination. So it is other centered, but even when we provide our insider experience, our knowledge base, it's based on illuminating cobblestones that help them walk in the path that they want to walk down, not the path that we're trying to get them to walk down. So I mean, that's what we talk about partnership and motivational interviewing. So it's not that we are completely absent from our selfness in the entire MI conversation. That is not true. What it is, is during those moments of ambivalence, it's that person's own values and goals and choices and behaviors and options and knowledge base, excuse me for that, that that will actually get identified in the moment to and be able to work through from there. But that's not where we as an MI practitioner are going to be operating from as much. What's coming to mind is like, well, if this is resonating, if someone's listening, if you are listening to this and you've made it this far and you're this MI geeked out like we are on all this ambivalent stuff, there are some things I wanted to kind of bring up. I know that you do these Friday sort of things. So I wanted you to kind of speak to that at a certain point. These calls once a month or something where people can kind of do some Q and A and geek out with you and I want to point people to some free resources. And then I also want to point them to if they really want to get into the skill set, that also we have, it's especially in our advanced training and our refresher training, we get deep into exploring ambivalence. Like that's that's much more about it than our intro training. We also have skill building series. And if you really want to geek out with the skill set, we have immersion trainings where we just practice with feedback, practice with feedback. And then of course, there's the individual practice with feedback sessions. So those are all the kind of like services that relate to this. But in terms of some free resources, I wanted you to speak at least to the Q and A and any other things, you know, for for reaching out to us for people that want to hear more about these types of dialogues so that, you know, people that are really not just focused on the skill set, but they can geek out on MI. I was just wondering, I know you have a Q and A and I didn't know if there are other things. Well, you know, honestly, John, when you say that's what my brain just starts to, you know, ping around is that the whole point of why we do what we do at IFFC is honestly for whatever people want. So there's the things that we have, but there's also just putting in the request of, you know, would you guys offer this or do this or do that? Our whole resource library is based off requests from people professionals just saying, I want access to this. So two of the ones you're referencing, one of them is the supervisor support series that I do. That's monthly for supervisors and there's different groups of supervisors that get together and they want to know how do I stay in the MI zone in a leadership role. So I'm not trying to change one specific behavior and get somebody to stop smoking, but I'm trying to organize and lead a team of individuals. So how do we look at MI through that lens or is that support? And then there's the monthly web. It's not a webinar. I don't know what to call it. I'm doing it for almost a year now and I still don't know what to call it. What tech savvy? It's a monthly gathering, basically a monthly chance to gather, get together with me kind of in the center of that gathering of people to just talk about anything that people want to talk about in terms of MI that maybe you might not bring up in a training or things that you've thought about or run into the client or your personal life. So it's just a chance to actually have open forum dialogue that just looks through a motivational lens. I mean, we veer outside that MI lens and we get into other things as well, but most everything we try to look at is through an MI lens, which doesn't make a right or wrong. So there's so many right ways for people to access more information around all this and more supports because every day, literally every day, we're churning out new resources to support people so they can provide the services that they want to and develop professionally the way that they want to. So that's why I think checking out some of the other podcasts and things. And for anyone that wants to get better, we know the research is so consistent around submitting audio tapes and getting coaching. You know, you've got to get personal feedback. You want somebody to see your work or taste your work and give you specific feedback. I mean, that is the beauty in coding and coaching. With an evidence-based fidelity reliable tool. Exactly. And so yeah, I mean, and pun intended, if you're ambivalent about any of that, that there's also the option of sending an email to admin. A D M I N admin at I F I O C dot com. And we will take all sorts of requests there for either podcast topics, things for Casey and I to riff off of skill building things we do in our gold membership, where there's a whole monthly membership that if you sign up, you're here in the podcast. Now you can get the basic level for free that has these in the newsletter. Or you can have the gold membership that has skill building activities that we've customized from people's requests, or we could customize more skill building activities. We'd love to. And so that's an option. I mean, there's so many things that if you just express yourself with us to us at [email protected], that's a whole nother way. You have I F I O C dot com to put in a request for a specific kind of training. That's an option, but there's also these free options were pointing to too. So this isn't just some thing to like sell services. This is honestly adding value to help you, you know, be as we talk about the communication solution to change your world. So that's what we're really trying to do here. We hope to hear from you. And that's the last bit I got Casey. Anything else for you? No, I just appreciate it. I love that people write in and ask for us to kind of, you know, go on to these topics and walk down these paths and explore on this level. I mean, that's what we love to do. And especially that people like to listen to it and refine in value. And it is just kind of best case scenario. All right. Well, hopefully this helped you in a most cheesy way. Resolve your ambivalence about engaging further with some aspect of your communication and helping people to be that communication solution to change the world for the better. So we appreciate you taking your time and effort and hope to see you in the future. Take care. Thanks. Take care.