Working With Ambivalence About Recovery in EMDR
Clients seeking treatment for substance use disorders do not always arrive with a clear decision about recovery. Many recognize that alcohol, drugs, or another problematic behavior are creating difficulties, while also remembering the ways those behaviors have helped them cope, connect with others, or manage emotional pain. Holding these competing perspectives at the same time is a common part of the recovery process.
Ambivalence often creates uncertainty for both the client and the clinician. Therapists may wonder whether they should encourage greater commitment to recovery, while clients may feel pressure to "make up their mind" before they are ready. When those conversations become focused on convincing rather than understanding, clients may become increasingly defensive or disengaged.
From an EMDR treatment planning perspective, ambivalence provides valuable clinical information. Rather than viewing it as resistance, clinicians can approach it with curiosity and ask what the client is trying to protect, what they hope recovery might offer, and what concerns continue to make change feel difficult. Those conversations help clarify readiness for change while identifying treatment targets that may influence future EMDR work.
Where Does This Client Seem to Be Right Now?
Clients rarely move through recovery in a straight line. Readiness for change often shifts over time, and many clients move forward, pause, or revisit earlier stages as new challenges emerge. Understanding where the client appears to be today helps clinicians match their therapeutic approach to the client's current needs rather than where they hope the client will be. If the client:
Does not believe substance use is a problem → Explore the client's concerns while raising awareness through curiosity, reflection, and collaborative exploration.
Recognizes concerns but feels torn about changing → Explore ambivalence without pressure while helping the client examine both the benefits and the costs of substance use.
Wants to make changes but feels uncertain about how to begin → Focus on collaborative planning, identifying supports, and preparing for recovery.
Is actively working toward recovery → Continue assessing readiness as new challenges, stressors, and recovery tasks emerge.
Clients may move between these experiences throughout treatment, sometimes even within the same session. Rather than viewing these shifts as setbacks, clinicians can use them to better understand the client's evolving relationship with recovery and adjust treatment planning accordingly.
Understanding Ambivalence During Recovery
Ambivalence simply means that two competing experiences exist at the same time. A client may genuinely want to stop using while also believing that alcohol is the only way they can relax after work. Another may recognize the financial and relationship consequences of substance use while fearing that sobriety will lead to loneliness or isolation. These experiences are not contradictory so much as they reflect the complexity of change.
Substance use often develops because it serves an important function. It may reduce anxiety, create a sense of belonging, increase confidence, numb painful emotions, or provide temporary relief from traumatic memories. Asking clients to give up those benefits without first understanding what they receive from substance use can unintentionally oversimplify their experience.
Clients are also influenced by the costs of recovery. Some worry about losing friendships, changing long-established routines, or discovering they no longer know who they are without substances. Others fear failure, wondering whether another unsuccessful attempt at recovery will reinforce beliefs that they are incapable of lasting change.
When clinicians recognize these competing experiences, conversations about recovery become less focused on persuasion and more focused on understanding. Rather than asking, "Why won't this client commit to recovery?" a more clinically useful question becomes, "What makes recovery feel difficult for this client right now?"
Exploring Both Sides Without Pressure
Clients often benefit from having space to examine both sides of their experience without feeling that they must reach a decision during the session. Exploring what they value about substance use does not encourage continued use. Instead, it helps clinicians understand the psychological, emotional, and interpersonal needs the behavior has been meeting.
The same curiosity can be applied to recovery. Clients may describe hopes of improving their health, rebuilding relationships, returning to work, or becoming more present with their families. At the same time, they may express concerns that recovery will be lonely, emotionally overwhelming, or impossible to sustain.
Maintaining a collaborative stance allows clinicians to gather information without asking clients to resolve their ambivalence before they are ready. As those conversations unfold, patterns often begin to emerge that clarify where the client is in the change process. Understanding that level of readiness helps inform treatment planning, including which EMDR interventions may be appropriate as recovery progresses.
The Applying EMDR to Addiction & Problematic Behaviors: Protocol Sequencing by Stage of Change guide organizes commonly used EMDR approaches across the stages of change, providing a practical reference for matching protocol selection to client readiness. It summarizes treatment priorities from pre-contemplation through maintenance, helping clinicians integrate readiness, case conceptualization, and EMDR treatment planning into one clinical decision-making process.
→ Applying EMDR to Addiction & Problematic Behaviors: Protocol Sequencing by Stage of Change
How Readiness Influences EMDR Treatment Planning
Once clinicians have a better understanding of a client's readiness for change, treatment planning often becomes clearer. The Stages of Change model provides one way to organize those observations, helping clinicians match interventions to the client's current goals while remaining flexible as readiness evolves. Rather than assuming every client is prepared for the same work, clinicians can consider how assessment, preparation, and trauma processing fit within the broader context of recovery.
Clients in the earliest stages of change are often seeking help for concerns other than substance use. They may present with anxiety, depression, sleep difficulties, relationship problems, or the effects of trauma without identifying their substance use as something they want to address. Beginning treatment with the client's identified concerns while remaining curious about the role of substance use often creates opportunities for greater awareness without placing the therapist in the role of persuading the client to change.
As clients begin acknowledging both the benefits and the costs of substance use, treatment planning may gradually shift toward exploring ambivalence, strengthening emotional regulation, and identifying the experiences that continue to maintain substance use. Some clients naturally move toward preparation by considering what recovery might look like, while others may return to earlier stages as new questions or concerns emerge. These changes are expected and do not necessarily indicate a lack of progress.
The Stages of Change model is most helpful when viewed as a flexible guide rather than a sequence clients are expected to follow. Readiness can change across weeks, between sessions, or even within a single conversation. Continuing to assess where the client is today allows treatment planning to remain collaborative, responsive, and individualized throughout the course of EMDR therapy.
How Readiness Influences EMDR Treatment Planning
Recognizing a client's readiness for change helps clinicians organize treatment priorities, but it does not determine a single treatment path. Two clients may both express ambivalence about recovery while presenting with very different histories, strengths, and treatment goals. Readiness is one factor that informs case conceptualization alongside trauma history, current stability, available supports, and the client's broader clinical presentation.
Early in treatment, many clients are not seeking therapy because they want to stop using substances. Instead, they may be looking for relief from anxiety, depression, relationship problems, sleep difficulties, or the effects of traumatic experiences. Beginning with the concerns the client identifies often strengthens the therapeutic alliance while creating opportunities to better understand how substance use fits into the larger clinical picture.
As readiness develops, treatment planning often expands. Conversations may shift toward identifying the situations that increase cravings, exploring fears about recovery, considering recovery goals, or examining the experiences that continue to maintain substance use. These discussions provide valuable assessment information while helping clinicians determine when different EMDR interventions may become appropriate.
Readiness is also dynamic rather than fixed. Clients may move forward after gaining new insight, return to earlier stages following a lapse, or feel more prepared in one area of recovery than another. Continuing to assess readiness throughout treatment allows clinicians to adapt the treatment plan as the client's goals, confidence, and recovery needs evolve.
Moving From Ambivalence to Preparation
Preparation often begins before clients make a final decision about recovery. As uncertainty starts giving way to curiosity, many clients begin asking practical questions about what change might involve and whether they have the resources to succeed. This stage provides an opportunity to strengthen supports, identify potential barriers, and begin planning for situations that may challenge recovery.
Preparing for change involves more than deciding whether to pursue abstinence or harm reduction. Clients also benefit from identifying high-risk situations, considering how they will respond to cravings, strengthening their support systems, and exploring the fears or expectations that may influence recovery. These conversations help translate motivation into a practical plan that can be adjusted as treatment progresses.
A written recovery plan can make these discussions more concrete. Rather than relying on general intentions, clients begin identifying specific coping strategies, supportive relationships, and resources they can use when difficult situations arise. Planning ahead also creates opportunities to discuss how shame, setbacks, and changing levels of motivation can be addressed without abandoning treatment.
The Relapse Prevention: Safety & Harm Reduction Plan helps clients organize these conversations into a practical recovery plan. The worksheet guides clients through recovery goals, mixed feelings about change, fears about recovery, high-risk situations, coping strategies, support systems, and emergency planning, creating a resource that can be reviewed and updated throughout treatment.
→ Relapse Prevention: Safety & Harm Reduction Plan
Readiness Changes Throughout Treatment
Readiness for change is rarely static. Clients may become more motivated after experiencing a health scare, reconnecting with family, or gaining new insight into the role substance use has played in their lives. Others may feel confident one week and uncertain the next, particularly after encountering cravings, stressful life events, or a lapse in recovery.
These changes should not be viewed as failures or evidence that treatment is moving backward. Recovery often involves periods of progress, uncertainty, and renewed commitment, with clients revisiting earlier questions as new experiences emerge. Remaining attentive to these shifts allows clinicians to continue matching treatment planning to the client's current needs rather than assuming readiness remains unchanged over time.
Maintaining this flexible perspective also supports the therapeutic relationship. Rather than expecting clients to follow a predetermined sequence, clinicians can continue approaching each stage with curiosity and collaboration while adjusting treatment goals as recovery evolves. This stance helps reduce shame, preserves client autonomy, and creates space for meaningful clinical work regardless of where the client is in the change process.
Putting Ambivalence Into Clinical Practice
Working with ambivalence does not require clinicians to persuade clients toward recovery or resolve competing feelings before treatment can move forward. Instead, the goal is to understand what substance use has provided, what recovery represents, and which concerns continue to influence the client's decisions. Those conversations often reveal important treatment targets while strengthening collaborative treatment planning.
As readiness develops, EMDR treatment planning can evolve alongside it. Clients may begin by focusing on stabilization, emotional regulation, or current life concerns before later exploring trauma, cravings, relapse memories, fears about recovery, or other experiences contributing to substance use. Revisiting readiness throughout treatment helps ensure that interventions continue to match the client's goals and current level of change.
Continue Exploring EMDR and Addiction Treatment
Ambivalence is one of many factors that influence EMDR treatment planning for substance use disorders. Clinicians must also consider readiness for trauma processing, target selection, craving assessment, relapse prevention, and how treatment plans evolve across the recovery process.
The Addiction Treatment & Recovery Hub brings these topics together in one place, with clinician-focused articles, practical tools, and educational resources designed to support EMDR treatment planning for substance use disorders and other addictive or problematic behaviors.
→ Addiction Treatment & Recovery Hub
Continue Your Learning
This article explored how readiness for change and ambivalence can inform EMDR treatment planning for substance use disorders. Applying these concepts in clinical practice requires a broader understanding of assessment, stabilization, target selection, protocol sequencing, and the integration of EMDR within comprehensive addiction treatment.
The Applying EMDR to Substance Use Disorder Treatment continuing education course examines these topics in greater depth, including readiness assessment, protocol selection across the stages of change, and strategies for integrating addiction-focused EMDR approaches into individualized treatment planning. The course offers EMDRIA Credits and is provided by Cannon Psychology, an APA-approved sponsor of continuing education for psychologists, making it a practical next step for clinicians seeking advanced training in EMDR and substance use treatment.
→ Applying EMDR to Substance Use Disorder Treatment CE
Conclusion
Clients rarely arrive in therapy with complete certainty about recovery. Many recognize the consequences of substance use while also remembering the ways it has helped them cope, manage emotions, or navigate difficult experiences. Approaching those competing perspectives with curiosity allows clinicians to better understand the client's current readiness while identifying treatment targets that can inform individualized EMDR treatment planning.
Recovery is an ongoing process, and readiness often changes as clients gain new experiences, encounter setbacks, and build confidence in their ability to create meaningful change. Continuing to assess readiness throughout treatment helps clinicians remain responsive to those changes while supporting recovery in a way that is collaborative, flexible, and grounded in the client's own goals.
References
Hase, M., Schallmayer, S., & Sack, M. (2008). EMDR reprocessing of the addiction memory: Pretreatment, posttreatment, and 1-month follow-up. Journal of EMDR Practice and Research, 2(3), 170–179. https://doi.org/10.1891/1933-3196.2.3.170
Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Shapiro, R. (2005). The two-hand interweave. In R. Shapiro (Ed.), EMDR solutions: Pathways to healing (pp. 160–166). W. W. Norton & Company.
