Yes I Want Treatment … No I Don’t … Maybe I Do? Let’s Chat About Ambivalence

Managing ambivalence toward treatment?

Ambivalence is “the simultaneous existence of contradictory feelings and attitudes … toward the same person, object, event, or situation” [1]. In other words, it’s those torn, conflicted feelings or beliefs you may have when you see two different sides to something. When it comes to your health and well-being, making or not making a decision about treatment has consequences. There can be many different variables and aspects that are out of your control, which may make some people unsure of what to do. When there is a lot of pressure about making a choice, ambivalence may also be a self-protective factor to avoid failure[2]. This internal conflict can make decision making difficult for many reasons, but this experience is completely normal! It is normal to feel hesitant, ambivalent, and confused. Let’s look at why.

Decisions, decisions

You may be faced with so many different options for treatment that you don’t know what is going to be the best choice. For example, if you’re looking into a higher level of care, you may think, “There are so many different programs! Do I go virtual or in-person? If I go in-person, I may have to travel. Should I go with a treatment center close to me or, if I must travel already, should I look at centers farther away? And if I decide to go with a treatment center farther away, that opens up even more options! What if the option I choose has a waitlist? And if I have a trip, birthday, or other special event planned within the next few months, should I wait to go into treatment until it’s over, or try now?” If you factor in planning for childcare or pet care, navigating time away from work or school, figuring out costs and insurance benefits, and if and how to explain to loved ones, colleagues, and friends where you are going or what is taking up chunks of your time, it can feel overwhelming.

Paradox of choice

Psychologist Barry Schwartz describes this phenomenon as the “paradox of choice” [3]. You think that more choice equals more freedom, and freedom is always good, right? For many reasons, including incredible technological advancements, we are faced with a multitude of choices that our ancestors never encountered. This ranges from if and how to continue education or training after high school, if and when to start a family, and even such day-to-day little choices as whether to text or telephone a friend, whether to pick up something needed at the mall or order it from Amazon, or whether to work on a hobby or watch a show on a variety of streaming services available. The number of options we have has expanded, so we are making choices constantly throughout our day whether or not we realize it. In Dr. Schwartz’s TED Talk that has been viewed over 17 million times, he explains why the availability of so many options has “produced paralysis rather than liberation” [3]. People have difficulty making a choice at all, so they often put it off because they want to get it right. It’s also become normal to not be completely satisfied with the choice you made because you went into it with high expectations. You may regret your choice if you think about how you may have felt better had you made a different choice, and you may blame yourself because you didn’t choose differently. (Note: I encounter this struggle every time I write for our Recovery Blog. There are many different sources, studies, and experts that I wanted to include, but this is an article not a book, and I can’t fit everything.)

Decision fatigue

Making decisions takes brainpower, so our ability to make good choices dwindles as the day progresses and we get tired. If you find yourself procrastinating, making impulsive decisions, avoiding making choices, or experiencing indecision, that may be decision fatigue [4]. When you need to make an important decision, try to do so when well rested and early in the day [5]. When experiencing the stress of making an important decision, try to get enough sleep and take care of your body and mind, practicing self-care in ways that are meaningful for you.

Action steps if you’re feeling ambivalent toward treatment

When faced with a difficult decision, there’s an old method of making lists of pros and cons, comparing the two, and going with the list that has more items. While this may work for some situations, when it comes to your physical and mental health and safety, a pros and cons list is not the best decision making tool. Here are some action steps that may help.

• Don’t be stuck in your thoughts and feelings alone! Join a support group to hear from others who have been in your shoes, find out what they did, and get validation that it is so hard sometimes to make a big decision like this. We have a variety of no-cost, no-commitment, no-pressure virtual support groups that you can tune into from anywhere. 
  • ERC Support Groups 
  • Pathlight Support Groups
• Realign with your values. Which values do you want to drive your life and your decisions? If you’ve never explored your values before, or if it’s been a while since you’ve checked in on them, go to The Good Project to download free values card so you can reflect on which values you want to define you and what you want out of life. 
• Think about what isn’t working for you right now and write it out. If you experienced just 1 degree of change now, how might that impact your life down the road?
• Talk to someone who’s been through our treatment. We have a team of alumni ambassadors and parent advocates who are happy to share with you on a private call what brought them into treatment, their experiences with ERC Pathlight, and how they have been navigating treatment and recovery since graduating from our program. To arrange a call, please email [email protected].
• If you want more information about treatment offered at ERC Pathlight, click HERE. 
• Are you curious about treatment at home through the virtual intensive outpatient program?
  Attend these sessions to ask questions: 
  • Potential patients (18 years old and up only): every Tuesday at 2pm to 3pm MST
    • Please join us on Ring Central at: https://meetings.ringcentral.com/j/1464790792
  • Caregivers of potential patients: every Tuesday at 3:30pm to 4:30pm MST
    • Please join us on Ring Central at: https://meetings.ringcentral.com/j/1479777474 

If you’re not ready for treatment

Some people may not be ready for change. Maybe you feel that what you’re experiencing is too private to share with others in a group setting. Maybe you don’t think you’re sick enough for a higher level of care or you want more time to try to figure things out on your own. Maybe you’re not ready to give up the behaviors that have been helping you to survive, or they have become part of your identity. Maybe you tried a program in the past and it didn’t help, you’re ashamed to try again, or you’re just tired of treatment. We see you. We get it. And we’ll be here for you if and when you are ready.

Sources

[1] American Psychological Association. (n.d.). Ambivalence. In APA Dictionary of Psychology. Retrieved June 27, 2022 from https://dictionary.apa.org/ambivalence

[2] Reich, T. & Wheeler S. (2016). The good and bad of ambivalence: Desiring ambivalence under outcome uncertainty. Journal of Personality and Social Psychology, 110(4), 493-508.

[3] Schwartz, B. (2005). The paradox of choice. [Video]. TED. https://www.ted.com/talks/barry_schwartz_the_paradox_of_choice?language=en

[4] Berg, S. (2011, November 19). What doctors wish patients knew about decision fatigue. American Medical Association. https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-decision-fatigue

[5] McClanahan, S. (2020). Addressing Ambivalence for Treatment and Recovery Among Young Adults. [Webinar]. ERC and Pathlight Academy. https://www.eatingrecoverycenter.com/professionals/education-events

If you’re a clinician interested in helping your patients grapple with ambivalence, please check out our free provider continuing education courses.

• Addressing Ambivalence for Treatment and Recovery Among Young Adults, by Susan McClanahan, PhD, CED-S
• Managing Adolescents and Parents and Ambivalence and Denial of Eating Disorders: The Role of the Family in EDO Recovery, by Scott Bullock, LISW-S, LSCW, CED-S 
• The Psychology of Trauma: The Effects of Social Media, the Pandemic, Social Unrest and Ambivalence to Change, by Susan McClanahan, PhD, CED-S