As clinicians working in eating disorder treatment, we often encounter clients who appear unmotivated, resistant, or ambivalent about recovery. The traditional view might label these presentations as "difficult" or "non-compliant," but what if we shifted our perspective?
Research challenges our common assumptions about motivation in eating disorder treatment. Surprisingly, verbal expressions of motivation – those statements we often prize during assessment and treatment – aren't reliable indicators of actual readiness or capacity for change. This insight invites us to reconsider how we approach treatment with clients who seem reluctant to engage.
When a client presents as resistant or ambivalent, they're often protecting themselves in the only way they know how.
Every behaviour, even those we might find challenging, serves a function.
That client who answers everything with "I don't know"? They might be wrestling with profound uncertainty or fear. The one who discloses crucial information only at session's end? They're likely testing the waters of vulnerability in a way that feels safe to them.
Here's a challenging truth many clinicians encounter: our deep commitment to client recovery can sometimes work against us. When we grip too tightly to treatment outcomes, we may unknowingly create the very resistance we're trying to overcome. This often manifests when clients:
The path forward requires a delicate balance. We can be fully present and deeply caring while giving clients the space to navigate their own journey. This isn't about detachment – it's about freedom from our own agenda.
What is useful about this approach is how often those "resistant" behaviours naturally decrease over time when met with consistent validation and support. When clients feel truly seen and understood – not just in their struggles but in the wisdom of their protective strategies – they often become more open to exploring change on their own terms.
This way of working requires us to:
The field of eating disorder treatment continues to evolve, and our understanding of resistance and motivation must evolve with it. By adopting a more nuanced and compassionate approach to ambivalence, we can create therapeutic spaces where clients feel safe enough to explore change at their own pace.
Remember: Every client deserves quality treatment, not just the ones who present as motivated or "ready" for change.
To learn more, check out our free resource Working with Unmotivated or Ambivalent Clients
Or for training around working with high risk and ambivalent clients, see our on demand online course Working With Highly Complex Eating Disorders
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