Working with Terminal Ambivalence

When we talk about working with trauma, especially with complex trauma, our focus can be drawn almost like a magnet to issues such as ‘how to resolve traumatic memories’. We think in terms of flashbacks, hyperarousal, hypervigilance, or dissociation. We might think in terms of patterns of relating based in disorganised attachment. And we might immediately feel that sense of the complexity of this work, the tenderness of it, and how often and how likely it is to get stuck.

These are all really valid aspects of working with complex trauma. But in this course I want to cut a path through them to a phenomenon that lies underneath them all: that of terminal ambivalence. This is the state of being stuck or being unable to commit to a course of action or to follow through on our decisions. We both want to do A and we want to do B, and that conflict between those desires ‘terminates’, or puts an end to, our action: hence terminal ambivalence. We get stuck and we stay stuck, and very often we then just beat ourselves up for it.

These are the clients who come to therapy because they want change in their lives, but just can’t enact that change. They’re stuck in freeze. They’re stuck in wanting to resolve their trauma but they’re unable to face their trauma. Or they desperately want to reduce the symptoms of trauma in their lives, but they seem unwilling or incapable of doing anything at all to bring that about.

Why is this? In this course, I explain how terminal ambivalence is a logical consequence of trauma, how it is driven by dysregulation, and arises from conflicting survival strategies. We will look at how we need to develop curiosity and compassion to both explore this inner rift and also to heal it. Join me on this fascinating exploration of how the back brain’s attempt to stay safe after trauma leads to a fundamental inability to take action and move forwards, and to understand how to work therapeutically with it.

This course is aimed at counsellors and psychotherapists but is also suitable for a range of professionals working with clients with a history of trauma.

SESSION SUMMARIES

Session 1: Introduction

In this session, I introduce terminal ambivalence – where conflicting desires ‘terminate’ our ability to follow through on decisions. We want A and B simultaneously, leaving us frozen. I explore how this manifests in therapy through breakthrough sessions followed by regression, and how it affects both client and therapist wellbeing.

Session 2: How trauma exacerbates traumatic ambivalence

I examine how trauma worsens ambivalence through three factors: back brain dominance (focusing only on immediate needs), derealised living (adjusting reality to cope), and dissociation from our own wants and needs. We explore how childhood survival strategies create adult resistance and self-sabotage patterns.

Session 3: Traumatic powerlessness and ambivalence

I explore how trauma embeds powerlessness, making us expect therapy to work magically on us rather than through our action. I introduce the front brain-back brain conflict and ‘bears and berries’ metaphor, emphasising that regulation always precedes integration in resolving this neurobiological split.

Session 4: Dysregulation drives ambivalence

I focus on shifting from control and coercion towards compassion and collaboration in our relationship with ourselves. The real problem isn’t the problem we’re trying to fix, but how we try to fix it. Most terminal ambivalence happens during dysregulation – it’s a survival issue, not self-control.

Session 5: Collaborating with the back brain

I explore developing compassionate curiosity towards back brain parts rather than being punitive. These parts have urgent, life-or-death survival energy. I demonstrate how therapeutic modelling of cooperation and collaboration helps clients internalise this approach, moving from battling themselves to working with themselves cooperatively.

Session 6: The path heading north

I introduce recovery as ‘heading north’ – each person’s unique journey. I outline four elements for change: identifying goals, clear pathways, resources, and motivation. We distinguish between front brain goals (approach-based, growth-oriented) and back brain goals (avoidance-based, safety-obsessed, maintaining status quo through trauma focus).

Session 7: Berries and bears

I explore self-sabotage patterns where progress triggers back brain resistance. Front brain goals seek berries (approach), whilst back brain goals focus on bears (avoidance). We examine how back brain goals masquerade as therapy work, seeking pain relief rather than resolution, reflecting childhood magical thinking about rescue.

Session 8: Obstacles on the path

I focus on creating clear pathways to goals. We must challenge trauma-based beliefs (‘I can’t’ scripts), get granular about specific steps, and plan for when plans fail. I introduce the concept that sometimes therapy itself becomes the easier path to lesser goals rather than genuine change.

Session 9: Overcoming obstacles

I continue exploring obstacle planning through identifying WHO (people who benefit from our stuckness) and WHAT (back brain sabotage behaviours) block our progress. I introduce implementation intentions and forcing functions to support front brain goals whilst thwarting back brain resistance.

Session 10: Resources for the journey

I clarify that goal-setting reveals the front brain-back brain split that needs healing. Complex trauma survivors face a double burden: massive pain plus massive lack of resources. Crucially, lack of resources is both a trauma symptom and an unconscious survival strategy to maintain powerlessness and elicit rescue.

Session 11: Lack of resource as survival strategy

I explore how the back brain believes resources must remain scarce to signal need for rescue. Acquiring resources threatens the survival strategy of appearing powerless. The solution involves re-regulating the back brain whilst building front brain capacity to work for resources, like supporting child development step-by-step.

Session 12: Motivation for overcoming ambivalence

I examine motivation, distinguishing between avoidance-based (avoiding bears) and approach-based (seeking berries) motivation. We change when pain of staying exceeds pain of changing, but avoidance strategies like dissociation numb this pain. Sometimes therapists must amplify awareness of pain rather than immediately soothing it.

Session 13: Challenge for change

I explore how therapy can collude with avoidance by providing weekly pain relief. Trauma survivors need therapy to change things, not just feel better. Empathy becomes the vehicle for delivering challenge. True compassion seeks to relieve suffering at root, not just sympathise with it.

Session 14: Healing the rift

In this session, I consolidate the approach to healing the front brain-back brain split through three principles: cooperation and collaboration (never coercion), compassion and curiosity (not irritation), and focusing on process over content. We act as mediators between brain parts rather than taking sides in the internal war.

Session 15: Conclusion

In this concluding session, I emphasise that terminal ambivalence isn’t about character defects but front brain-back brain conflict. The framework helps explain why trauma survivors are at war with themselves. With both parts working cooperatively together, there will be no terminal ambivalence – just humans learning to integrate conflicting aspects of themselves.