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Whilst a review of the extant general psychotherapy literature suggests that ambivalence is a frequently encountered and studied phenomenon, there is little consensus on how to define and understand it. The remainder of this section will briefly review literature on ambivalence and on violence-focused therapy before describing in more detail our contribution to these fields and our theoretical stance. It thus adds to the existing psychotherapy research literature on both ambivalence and violence-focused therapy. The findings can also shed light on the topic of ambivalence in psychotherapy in general. The purpose is first to sensitize therapists to such ambivalent utterances expressed in the therapeutic context, and second to aid reflection on how to respond in order to strengthen the alliance and encourage the clients to continue the process. We aim to build clinically relevant knowledge ( McLeod, 2013 Stiles, 2013) by providing descriptions and clinical reflections that can inspire clinicians to find constructive ways of meeting clients who are experienced as ambivalent or contradictory in the therapeutic project.
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The analysis seeks to enrich our understanding ( Stiles, 2015) of how the clients participate in this therapeutic process. Violence-focused therapy is a setting in which the client and therapist often struggle to establish and maintain a strong and fruitful working alliance, with high rates of drop out ( Daly and Pelowski, 2000), and modest or equivocal outcomes ( Smedslund et al., 2007 Eckhardt et al., 2013 Koehler et al., 2013). This study explores client utterances in violence-focused therapy, that can be understood as ambivalent toward the change project in various ways. “Those who experience domestic violence can’t close the door on the world outside and feel safe” (Det kongelige Justis- og Det kongelige Justis- og beredskapsdepartement, 2013, p. They are developed on the basis of an interpretation of what seems to be at stake for the client in the here-and-now of therapy. The categories are described and understood from a clinical perspective. Using constructivist grounded theory analysis of five completed therapies, we describe three categories of client ambivalence present throughout all five therapies: I am bad, but I am not that bad I have tried and tried in vain and I know it is wrong, but I have to, I have no choice. The purpose is to enrich our scientific understanding of client contributions to therapy when they appear ambivalent to the therapeutic project and develop clinically relevant perspectives that enable us to help this and other client groups. This study examines client utterances that can be understood as ambivalent in violence-focused therapy. 2Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.1Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
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Mari Todd-Kvam 1*, Bente Lømo 1 and Odd Arne Tjersland 1,2