This is ambivalence. And far from being a sign of weakness or lack of motivation, it is one of the most normal and human experiences there is. We are ambivalent about all manner of things — careers, relationships, habits — because change involves real loss, even when that change is for the better.

In Motivational Interviewing, ambivalence is not an obstacle to be overcome. It is the starting point. The counsellor's role is not to push the person toward one side or the other, but to help them explore the tension — what MI founder William Miller describes as the gap between where someone is and where they want to be.

One of the core tools in this work is what's known as a decisional balance — exploring, without pressure, both the benefits of the current behaviour and the costs. This might sound counterintuitive. Why would you spend time on the reasons to keep using? Because if a counsellor only ever reflects back the negatives, the client instinctively defends the positives. By holding both honestly, the person can see the full picture for themselves.

With Marcus, we spent several sessions simply mapping this territory. What did alcohol and cannabis give him? Relaxation after long shifts. A way of switching off. A sense of connection with friends who also used. These were real things, and dismissing them would have been dishonest and unhelpful.

But alongside those, other things were accumulating. The arguments with his partner. The mornings lost to anxiety and low mood. The promotion he had not applied for because he wasn't sure he could manage the stress without using more. The image of the life he wanted — one with more stability, perhaps a family — that felt increasingly out of reach.

Slowly, the balance began to shift. Not because I told Marcus what to think, but because hearing himself articulate both sides, out loud, in a space where neither was dismissed, allowed him to reach his own conclusions. "When I say it all together like that," he reflected, "I can hear what I actually want."

This is, in essence, what MI offers: not answers, but a space in which people can find their own. Marcus remained in treatment and, at the time of writing, had made significant reductions in his substance use and was working toward abstinence on his own timeline.

All identifying details have been changed. "Marcus" is a composite drawn from practice themes.