Enhance Motivation for Treatment

As we continue our exploration of client retention and how this can decrease stress for clinicians by decreasing early termination of clients we will be looking at Chapter 8 - “Enhance Motivation for Treatment” from the book, Premature Termination in Psychotherapy - Strategies for Engaging Clients and Improving Outcomes, written by Joshua K. Swift and Roger P. Greenberg.

Therapists can work with clients to ensure they have the motivation to continue in psychotherapy, even when the journey becomes challenging.  Motivation in psychotherapy refers to a client's willingness to engage in the therapeutic efforts that are necessary to bring about improvement and recovery.

Motivational interviewing provides one useful and well-supported framework for addressing client motivation in treatment.  The goal of motivational interviewing is to work with clients’ ambivalence by evoking and strengthening their verbalizations of desires to change and decreasing their resistance or verbalizations not to change.  In essence, instead of trying to convince clients that they need to change their behaviors, therapists allow them to argue for their own change desires.  In so doing, these change desires become solidified, and clients are more strongly motivated to follow through with the therapeutic recommendations.

Some specific strategies for working with clients on their motivation include:

1. Therapists can focus on eliciting self-motivational statements from their clients, expressing understanding of desires to change and not to change, and rolling with resistance.
2. Rather than confronting or arguing with clients when they express resistance, therapists can simply use restatements, reflections, and reframes to help clients confront their resistance themselves.
3. Recognize when clients are ready for action.  For some clients, this may be in the initial appointment, for others, it may only come after months of work.  Whatever the timing, when clients are ready for action, therapists can best help their clients maintain their motivation by helping them develop an individually tailored change plan and carry out dynamic activities that will lead to positive treatment outcomes.
4. Therapists should develop skills in assessing motivation.  Therapists can often assess their clients’ level of motivation by listening to change talk.  Clients who are ready for action will make more statements affirming their individual desire to change for themselves and fewer statements indicating their desire to hold on to their problem behaviors. Therapists can also assess motivation by looking at their clients’ behaviors inside and outside of therapy.  Clients who lack motivation often cite others as the reason for their problems, have sought out treatment only at the request of others, and have taken few if any steps to change on their own.
5. Clinicians may choose to use the University of Rhode Island Change Assessment Scale as a self-report measure that assesses the four stages of change.

Rhode Island Change Assessment Scale

It is also important for therapists to recognize that motivation is not a stable characteristic and that client motivation may falter if the client experiences a significant setback.  In these situations, therapists can seek to normalize that setback and revert back to some of the earlier motivational strategies to get the client back on track.  In the end, a more motivated client is more likely to establish a stronger relationship with his or her therapist, another important factor for reducing premature termination.