The quality of therapy motivation

Research project P 14318 The Quality of therapy motivation Thomas SLUNECKO 26.6.2000 Over the past few years, the claim for a qualitative and practice-centered re-orientation of psychotherapy research has become increasingly explicit. The background of this development can be seen in the growing awareness that psychotherapy`s subject matter essentially consists of highly complex, non-linear, and partly non-obvious communication processes, which can only insufficiently be grasped with a purely quantitative research methodology based on a traditional understanding of the natural sciences. Furthermore, the results generated by this research programme are insufficiently applicable to the needs and problems of practitioners. In order to expand the methodological approach towards a naturalistic, life-world-based psychotherapy research, one of the most predominant tasks lies in consolidating, by means of inductive systematization, the natural-language reports given by the parties involved in the therapy. Content-wise, the proposed project is focussed on clients` and therapists` statements on the (perceived) therapy motivation. This is a variable of central importance for the explication of the access to psychotherapy in so far as the therapist`s perception of this motivation and its congruence with his or her own conceptions of the treatment lays the track for the decision on indication and thus for the ensuing `therapeutic fate` of the client. In the first part of the project open answers pertaining to therapy motivation will be used to develop a reliable scheme of categories by means of qualitative content analysis. This scheme is then employed to assess the importance of different kinds of therapy motivation as well as of the congruence between the client`s motivation and therapist`s offer or the therapist`s perception of the motivation respectively, for the access to and the outcome of outpatient psychotherapy. An additional aim of this project is to examine whether this scheme of categories can be applied to illustrate changes in motivation during the therapy as postulated in research literature.

Patients` motivation is one of the most decisive factors for successful psychotherapy. Motivation, however, not only amounts to a quantitative entity, but the kind of this motivation is essential. That a patient`s specific motivation matches with the therapist`s intention , e.g., is at least equally relevant to how much he is motivated. Our basic research goal was to develop an instrument for representing the specific quality of a patient`s therapy motivation in a clear and reliable way. Before their first interview at a therapeutic out-patient centre, we asked 202 prospective patients, to respond to an open question regarding their motivation to seek psychotherapy. Based on a content analysis of their written answers, we suggest a system of 16 motif categories. The system is well documented through definitions, anchor examples, and coding rules and can easily be adopted for further research. We notice that frequently patients simply wish to talk to someone and be supported - a rather unspecific motif that previous research logic, oriented on patients` problems and goals as it was, obviously has been hiding. Patients` motives, as categorized by our instrument, correlate with indication to therapy. Those who are motivated by their own potential, by insight or who want to regain their love of live more often are referred to group, couple, or family therapy; these patients are also younger than average. On the other hand, 8 patients, all of them women, are not considered for therapy at all. They are significantly older than average and had indicated recommendation by others, depression, and suffering when asked for their motivation to seek therapy. We identify them as problem children` of the therapy system: referred by their doctors or their relatives, they show up at the ambulance with little motivation or capacity for self-reflection - and are sent away despite of their subjective suffering. Noticeable, patients who had been in therapy before, significantly tended to report motives that were categorized as wish to talk to someone and be supported and suffering. Significantly less often these experienced patients indicated critical life events and job-related problems. This, along with some similar findings, could be interpreted as an effect of learning or as the patients` adaptation to the expectations of the therapeutic system.