A form of complex reflection: the therapist reflects both sides of the client's ambivalence in one utterance, using the connector "and" (not "but"!). Structure: "On the one hand [sustain talk]… and [change talk]." It is important to end on change talk — that gives it the last word. "But" creates opposition; "and" holds both poles without conflict.
Step-by-step guide
- Hear both poles of the ambivalence
- Formulate both sides without evaluation
- Use "and", "while", "at the same time" — avoid "but"
- Finish on change talk
- Go silent — let the client respond
When to use
- In obvious ambivalence: "I want to quit, but I can't"
- After a series of sustain talk — to reflect the other side too
- In the transition from sustain talk to change talk
Key phrases
It matters to you to be able to relax — and you notice it is starting to affect your family.
Follow-up questions
On the one hand, you do not see a reason to change right now. And at the same time something brought you here today.
Alternative phrasings
You like this in your life — and you notice the consequences.
Warnings
- ⚠️ Never finish on sustain talk — it reinforces it
- ⚠️ Replace "but" with "and" — "but" creates confrontation
- ⚠️ Make sure both parts are accurate — otherwise the client will feel misunderstood
Source: Miller & Rollnick, 2013
Materials are informational and educational and summarize publicly available scientific sources. They are not medical or psychological advice, are not intended for self-diagnosis or self-treatment, and do not replace consultation with a qualified professional.