Is It the Clinician’s Job to Move Clients From Ambivalent to Committed?

One of the biggest frustrations I hear from practice owners is this:
“We’re driving referrals, but clients are dropping out by session two or three. Clinicians say they don’t have the right clients on their caseload, and admin are chasing ghosts who never come back. What gives?”

On and on and on I hear about finding ideal clients and using a niche and working within your competencies.  Well, here’s a little something I have to say about dropouts and referrals. 

Sometimes the problem isn’t the client or the marketing.
It’s the clinician’s stance on responsibility.

Ambivalence vs. Resistance

Clients rarely walk through the door fully committed. More often, they’re ambivalent: “I want to change… but I don’t.” That’s normal.

Ambivalence only becomes a problem when it’s ignored. Left unchecked, it hardens into resistance; you know the dance: the cancellations, the reschedules, the ghosting, the “I’m fine, I don’t need therapy anymore.”

As clinicians, you need to recognise:

• Do clinicians see ambivalence as something to engage with?
  
• Or do they believe it’s not their role; that only fully committed clients should be in the room?
  

The Clinician’s Influence

Research is clear: therapist style shapes client talk.

• Collaborative, curious clinicians draw out change talk (language in favour of change).
  
• Dismissive or overly pushy clinicians invite counter-change talk (arguments for staying the same).
  

Counter-change talk isn’t failure.  It’s feedback. It’s the part of the client that wants to stay safe. Clinicians can either lean into it with curiosity, or avoid it and risk dropout.

Monitoring & Ruptures

Commitment grows when clients can see progress. Regular check-ins, milestones, or outcome measures keep therapy relevant and sticky. Without monitoring, sessions blur together and commitment drifts.

And yes, ruptures will happen. They’re part of therapy. But clinicians who avoid addressing ruptures or ambivalence often lose clients to early dropout. Which can be disguised as “you’ve helped me, thanks” or “I’ll come back someday.”

The Traffic Light Lens

I use a simple framework with my clients:

• Green clients: committed, energising, aligned.
  
• Yellow clients: ambivalent, inconsistent, neutral. They can go green if supported or red if mishandled.
  
• Red clients: resistant, draining, clients you find yourself working harder than
  

The critical question for clinicians:
👉 What happens to the yellows in your practice?

Why This Matters for Your Practice

There’s no right or wrong answer. But there is a strategic one.

• If your clinicians avoid responsibility, your marketing must target only committed clients.
  
• If your clinicians engage responsibility, your marketing can safely include ambivalent clients
  

Either choice is fine but your marketing, admin training, and supervision need to match it.

Take Action

1. Responsibility Audit: Ask each clinician, “Do you believe it’s your role to move ambivalent clients toward commitment?”
   
2. Caseload Map: Use the traffic light system. How many greens, yellows, reds are in the diaries right now?
   
3. Progress Checkpoint: Add at least one structured moment in your client journey for clients to reflect on progress.
   
4. Marketing Alignment: Decide: are you bringing in greens only, or greens + yellows?
   

Final Word

Ambivalence is inevitable. Resistance is preventable.
Your business doesn’t need a “right answer”  it needs clarity.
Because your clinicians’ stance will tell you exactly which clients to bring through your doors.