Vol. 25 • Issue 18 • Page 28
Motivation is an undeniable ingredient for success in rehabilitation recovery. This intrinsic emotional-psychological resource is unique to each patient's personality, but it also can be cultivated within each patient as a skill set using a wide variety of integrative cognitive-behavioral techniques. In other words, regardless of each person's innate motivational capacities, everyone can use motivational techniques to enhance his coping skills to reach his goals.
To begin, it is important to gauge the motivational starting point for each patient. Inquire about previous successes a patient has had in working through physical challenges. Also, look out for blocks that are inhibiting natural motivation levels, such as anxiety or depression. Counseling referrals to supplement rehabilitation sessions are a critical adjunct at this juncture for some patients.
Bill O'Hanlon, a leading expert in solution-focused psychotherapy and author of Do One Thing Different, further elucidates our understanding of motivation by identifying the common ways people motivate themselves: "There are four common energies that vary between peoples' motivational styles; people are either motivated by feeling blissed-something they love; blessed-someone who validates or inspires them; pissed-something they are angry about; or dissed-feeling cheated by something and wanting to correct it," he explains.
Restated, hope, anger, frustration or a varying mix of these feelings can motivate a patient in the process of recovery; all of these energies can be engaged.
Identifying Skill Deficits
Motivation is necessary to start a recovery goal, but maintaining that motivation throughout the course of recovery requires a different skill set. It is critical to educate patients on motivational techniques so they can maintain therapeutic gains and build on the lessons taught in each session.
All patients, regardless of motivation levels, will experience stress, anxiety, distress and setbacks in the recovery learning curve. O'Hanlon shares three ways an individual can get unstuck when motivation levels are waning:
• Change the doing (action): behavioral interventions,
• Change the viewing (thinking): cognitive interventions, or
• Change the context (people or place): social support/environmental adaptations.
Design a coping toolkit using one or more the following skills to help patients strengthen or cultivate their motivational abilities.
Behavioral experiments. At the core of maintaining motivation is the spirit of conducting small experiments. "Encourage patients to try something different," O'Hanlon stated. "Take small actions to break a pattern. The aim is to reduce the locked-in feelings. The more experiments you try, the better."
For example, get up five minutes earlier or put the shades up to get more sunshine in order to lift one's mood. Cultivating this attitude is critical so that patients can be more active collaborators in sessions (see "Integrating Behavioral Skills," ADVANCE, March 31, 2008).
Tracking tools. Teaching patients how to chart progress can also be a helpful technique. Some patients may need reminders, others may need to track process, and yet other patients may be helped by tracking deficits to build on. O'Hanlon adds that it is helpful to identify the sensory mode that would engage the patient in a prescriptive way-auditory, visual or cognitive.
Visualization/guided imagery. A wide range of imagery techniques (see "Guided Imagery Techniques," ADVANCE, April 27, 2009) can instill confidence and hope when a patient is feeling inhibited. Encouraging patients to set aside time once a week to visualize a goal they are working toward can instill hope when progress is slow or the outcome is months away.
Anxiety management. Most rehabilitation goals will generate anxiety and fears of pain or relapse. Exposure techniques build anxiety tolerance and maintain patients' motivation during difficult impasses (see "Anxiety Management Training," ADVANCE, May 26, 2008).
Social support. Accountability through social support is yet another motivational maintenance tool. Engaging a form of accountability that feels supportive to the patient is yet another tool (see "Solution-focused Techniques," ADVANCE, June 23, 2008).
"It is important to let the patient guide you in the form of support that would be best for them and also collaborate on the frequency that would be helpful: once aweek or monthly for example," O'Hanlon adds.
Post-traumatic growth. In his book Thriving Through Crisis, O'Hanlon introduces the idea of post-traumatic growth, the other side of post-traumatic stress. He notes the importance of recognizing gains and successes that patients realize after a traumatic physical change. Such insights can be a base on which to build during recovery.
"The key is to find the delicate balance between acknowledging the reality of a physical trauma and leaving room for the possibilities for change," he adds.
Practitioners need to cultivate their own motivation in working with both familiar and new patients. "Constantly learning new things, listening to your clients, allowing yourself to be influenced both by complaints and feedback can keep one resilient," O'Hanlon stated. He also encouraged practitioners to revisit their workplace context, inviting them to find even better ways to make the environment patient friendly.
Instilling hope and cultivating motivation are key ingredients in making progress--both for practitioner and patient.
Reji Mathew, PhD, is a psychotherapist/clinical instructor at New York University. She is a disability advocate and freelance writer. The main focus of her work is to promote coping-skills education for persons with chronic illness and disability. Her clinical expertise is in integrative psychotherapy, particularly cognitive behavioral skills training. Reach her at her Web site: rejimathewwriter.com.