Saturday, November 19, 2011

What's My Motivation?

Before launching into a new role, the stereotypical actor will ask the director: "What's my motivation" - meaning, what is driving this character? what is the character thinking and feeling in this scene?

Therapists ask a similar question when they meet a new client - what is this client's motivation? We need to know what's getting someone in the door in order to figure out how to "meet them where they are," and harness their existing motivation to help them move toward personally meaningful goals. 

Social psychologists talk about "intrinsic" and "extrinsic" motivation. Intrinsic motivation comes from within, fueled by personal desire, interest and appreciation of the task for its own sake. Extrinsic motivation comes from external outcomes - engaging in a task to obtain a rewarding outcome, or avoid a negative consequence. So, for example, some children choose to read or draw during free time because they enjoy these activities (intrinsic motivation). However, if they are rewarded for doing these activities (extrinsic motivation), the intrinsic desire to engage in the activity decreases.

The clinical parallel to intrinsic motivation might be the desire for growth or self-actualization. When this desire is strong, some theorists (e.g., Adler and Maslow) have contended that self-actualization will happen naturally once more basic needs are met and barriers are removed. We might infer that adding some sort of extrinsic motivation when a client is already intrinsically motivated might inadvertently reduce the drive toward self-actualization - something I, for one, would not want to do. 

The truth is, however, that most of my clients come in with some form of extrinsic motivation. Sometimes there is a reward on the horizon for positive change (more independence, the ability to progress toward personal and vocational goals, functioning more effectively in personally significant roles...). More often, the motivation is stopping or avoiding a negative consequence of not changing. Most simply, the client is often suffering and wants the suffering to stop (be that depression, anxiety, dope-sickness...whatever). There may also be the threat of losing things that are important to the client - a relationship, a job, custody, financial support, housing...for some problems, even fear of losing their lives. 

The answer to "what's this client's motivation" is rarely either/or - more often it's both/and: the desire to change coming in part from hope for a better life, and the expectation of positive results, and the wish for suffering to lessen, and the fear of what might happen in the problem continues or gets worse. By learning what the specific combination of factors is for each individual client, I can help them harness and build on their existing motivation to get and keep them engaged in the treatment process. 

How do you think about motivation? How do you work to build motivation?

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