Skip main navigation

Understanding ambivalence and the change process

Dr Kristen Reyher explains how to motivate lasting change, and why understanding ambivalence and stages of change should change your approach.

The next three steps, that make up the motivating lasting change activity, have been developed by Dr Kristen Reyher, and will explain how to motivate and engage in lasting change, not just in practice, but also with clients.

This video will demonstrate the importance of understanding ambivalence and the stages of change.


Due to the shared nature of the responsibility of stewardship, everyone needs to be ‘speaking the same language’ and working in conjunction with each other, so participatory approaches are key to improving understanding of this topic. For example, the bottom-up approach that was described by Lisa Morgan in step 3.5. It’s important for vets to understand the motivations and drivers behind client’s behaviours. Trust between veterinarians and clients is also crucial.

Communication is not all about vets providing clients with a huge amount of information. In fact, many people are already aware that there’s a problem with antimicrobial resistance, however this will not always mean their behaviour changes, due to factors such as monetary concerns or a low capacity for investment.

How vets communicate with clients will be further explored in steps 3.14 and 3.15.

Stages of change

  1. Pre-contemplation stage: when people do not intend to take action in the foreseeable future, due to being uninformed about the consequences of their behaviour.
  2. Contemplation stage: when people intend to change within the next 6 months and are aware of the pros of changing, but also the drawbacks.
  3. Preparation stage: when people are ready to take action in the near future and they have a plan of action.
  4. Action stage: when people are making observable changes in their behaviours and lifestyles.
  5. Maintenance stage: when people have made modifications and are working to prevent falling back into old routines.

It’s really important to understand what stage of change your client is in so that you know how to approach them when suggesting change. This will have a significant impact on how they react to certain approaches, as you will learn in the next step.


Ambivalence is a totally normal part of contemplating change and is when you want two opposing things at once. It’s almost as if you have an argument going on in your head.

This can sometimes be seen in the way people talk: if they show they want to change, this is change talk, and if they are giving reasons for not changing, this is sustain talk. When talking to clients, you should always accept this and ask more open questions, where you can fully discuss both sides, and then they may start to use more change talk.

Do you have any examples where you have recognised a client in a particular stage of change, and this made you change your approach? Have there been any times where you maybe haven’t recognised what stage of change a client has been in, and this hindered your conversation? Use the comments section to discuss.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

This article is from the free online

Antimicrobial Stewardship in Veterinary Practice

Created by
FutureLearn - Learning For Life

Reach your personal and professional goals

Unlock access to hundreds of expert online courses and degrees from top universities and educators to gain accredited qualifications and professional CV-building certificates.

Join over 18 million learners to launch, switch or build upon your career, all at your own pace, across a wide range of topic areas.

Start Learning now