How Occupational Therapists can assist those with low motivation

A challenge we often face as Occupational Therapists is encountering clients we see could achieve so much and be more engaged in social, community, and productive activities, but who just aren’t. Not because they can’t, their life circumstances are too complicated, or they don’t have any funding, but because they don’t want to. 

This could be due to a mental health diagnosis like Depression, Anxiety or Schizophrenia, where their brain tells them “Hmm, we could do that, but … we could also not do that”. The client may desperately want an aspect of their life to change, but just don’t have the motivation to work on the change themselves. Maybe they don’t know where to begin, or are apprehensive about making the change. This is where Motivational Interviewing (MI) comes in. 

A brief history of Motivational Interviewing:

MI is a technique developed by Psychologists William R. Miller and Stephen Rollnick in the 1980s for use in the drug and alcohol space. It was designed as a client-centred approach that, at the heart of it, demonstrated “empathetic understanding, unconditional positive regard, and genuineness”. While it began as a technique primarily used by Psychologists, it is an adaptable technique that has since been used by other allied health professionals for a broad spectrum of conditions and goals. 

The process of Motivational Interviewing: 

MI is a therapeutic technique in which the client and therapist collaborate to build a person’s motivation to achieve a goal, as well as to create a plan to achieve change. There are 4 processes of MI that therapists use to accomplish this:

• Engaging: This includes building rapport and using active listening and reflection to understand the client’s perspective of what is going on in their life, how they are feeling, and building their confidence to talk about change. A therapist and client may remain within the “engaging” stage while the client is undecided or hesitant toward change, is unsure of what they might want from therapy, or are feeling some defensiveness or resistance toward change. 
• Focusing: Once the therapist and the client have achieved rapport, and the client is feeling comfortable discussing their thoughts on their current life situation, the session might transition into talks of goal setting. This can include making clear definitions surrounding what aspirations the client might have, and what change might look like to them. It might also mean discussing the parameters of the goal, making sure the therapist is on the same page as the client regarding the goal, and exploring potential barriers in achieving said goal. For example, one person’s definition of keeping their bedroom clean might be different to another person’s. In this step it is also important to ensure the goal is the client’s goal, and not a goal of the therapists for the client.
• Evoking: This is where the client and the therapist engage in “change talk”. In this step, the therapist might attempt to ask questions to encourage the client to reflect on their goal and think seriously about change. 
• Planning: Once the client has reached the “planning” stage, they are motivated to achieve this goal. In the planning stage, the therapist and client will make specific plans regarding how they will achieve this goal. 

A therapist may focus on any one step for multiple sessions, depending on how focussed the client is on their goal, and how ready they are for change. Additionally, even once reaching the planning stage, they may need to revert to the “focussing” or “evoking” stage if the client does not follow through with the plan. An example of this is if the goal is quitting drug and alcohol use, and the client relapses, or if a plan has been made to achieve a goal and the client did not follow through with the plan. Conversations may be had surrounding why they did not follow through, or what external and internal circumstances contributed to their inability to achieve the goal. 

The spirit of Motivational Interviewing

In an article completed by William R. Miller regarding MI, he mentions the underlying spirit of the technique being partnership, acceptance, evocation, and compassion. The term partnership is one of the most crucial and unique aspects of this technique. MI veers away from other traditional methods of Occupational Therapy, in which Occupational Therapists might provide recommendations of strategies for clients to use to achieve their goals, which may feel one-sided, the client may not feel heard, and the Occupational Therapist leaves with a false impression of what the client was hoping to get out of therapy. MI feels more mutual, and ideas are primarily provided by the client, with the Occupational Therapist asking open-ended questions to encourage reflection and introspection. This places the client in control, empowering them to achieve their own goals. From my experience, the client is much more likely to follow through on a planned intervention if they have come up with it themselves. 

Effectiveness of Motivational Interviewing 

In a systematic review completed by Bischof, Bischof, and Rumpf (2021), it was noted that in comparison to other therapeutic intervention techniques, MI was assessed to be superior and presented with better outcomes for clients. Significant treatment effects were shown for a variety of health-related goals, including substance use, physical inactivity, body weight, and improved dental hygiene. It was noted that no significant effects were seen for self-care behaviours, however greater improvements were still shown in comparison to control groups. Additionally, research showed that even 13 months post-treatment, follow-up surveys demonstrated significant effects in comparison to control groups, in various areas. 

Who can benefit? 

A client may benefit from MI if they have goals they would like to work on but don’t know where to begin, or don’t feel ready to take the first step. MI can provide a client with an opportunity to reflect on why they had the goal in the first place, and why they think it might be beneficial to them. One may also benefit from MI if they have a mental health condition or neurological condition, or they just don’t know how to approach a goal they’d like to achieve. And this can be ANY goal. An MI-centred therapy approach puts the client at the centre. 

If you think yourself or a loved one could benefit from such an approach, do not hesitate to reach out to Vista Healthcare to get started on achieving your goals. 

Written by Vandita Raghunandan