How to boost client motivation in therapy

3 ways to use a person's sense of identity to help them change

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Tap into your clients' identity to help them find the motivation to change

How many psychotherapists does it take to change a lightbulb?

Only one, but the lightbulb really has to want to change!

Okay, that’s an old joke (and maybe not a very good one), but its roots are planted in a long-standing belief about psychotherapy and client motivation, which seems to be true.

But it’s also true that a ‘cunning’ (I use the word advisedly), skilled therapist knows what motivates people to make the changes they want, can help generate that motivation, and builds it in clients who may not – yet – really want to change.

Dancing with the stars

Years ago, I was called by the staff of a retirement home by the sea to help one of their residents, Margaret. She was in her eighties and had suffered a fall while using her Zimmer frame. Miraculously, the fall hadn’t injured her, so she was perfectly physically able to walk with her frame. But she wouldn’t. In spite of all the staff’s encouragement, she’d spent the intervening six weeks refusing to move about independently.

Of course, with muscle, as with many things, it’s a case of ‘use it or lose it’. The longer she didn’t use those leg muscles, the more risk there was that she wouldn’t be able to.

“Margaret’s developed a sort of phobia of using her frame and insists on being pushed about in a wheelchair, even though she could perfectly well use her frame!” her nurse informed me, exasperation oozing through her every word. “The trouble is, she doesn’t want to walk for herself. She’s lost her confidence, but she doesn’t want it back!”

Zimmerphobia

Ushered into Margaret’s room, I found her sitting in an armchair and was graciously received in the style of a bygone era. We were both well aware of why I was there, but neither of us mentioned the ‘Zimmer phobia’. That metal walking frame stood upright on its four rubber feet in the corner, making me think of a bizarre angular idol, mocking us mere mortals.

I couldn’t help but notice the numerous photos of a younger Margaret – a ballerina – arranged on her table. We started to talk about the life she’d led. With perfect congruence, I commented on the ‘grace’ she showed in these pictures, on her ‘poise’, on the ‘athletic femininity’ she’d developed as a dancer. Her eyes began to shine.

Then I spoke in general about how some people just have a natural physical grace and others don’t. About how the limbs of some people are naturally shapely and, if she would permit me to say so, I could see that she had a naturally perfect dancer’s figure.

She asked if I’d like to take tea with her in the communal lounge. “Follow me!” she said, getting up from her chair.

“Ah, you move like a born dancer!”

And she did. Without her Zimmer frame. “Yes, I always was a dancer.”

“And I think: once a dancer, always a dancer!” I said (perhaps a tad sycophantically – but she loved it).

She practically waltzed down the corridor, causing the jaws of the nursing home staff to drop like leaves in October in our wake as we made our merry way to tea.

Awakening a difficult client’s motivation to change

I visited her three more times. As far as I know, she never used her Zimmer frame again but continued to enjoy her ‘dancer’s figure’. We didn’t once discuss why I was there or her ‘phobia’.

I could have got all ‘clinical’ and ‘professional’, been all ‘appropriate’ (and ineffective) with her, or done a ‘proper’ hypnotic induction.

But why do something when something else works better?

By reawakening her long dormant pride in her self identity as a beautiful woman of grace and movement, I also awakened her motivation to change. The fact that I was (at that time) a young man paying her attention and framing her as someone of movement appealed to her and was enough to make her want to change.

This is not a random approach. It’s based on three natural principles.

Here are 3 techniques I use to motivate my clients to change:

1. Appeal to their point of pride

We’re often cautioned about pride (it comes before the fall, they say), but it frequently is what motivates people to do any number of things, from achieving something in order to feel good to defending an incorrect belief in order to avoid feeling bad. So if someone is or has been proud of something – nationality, skill, talent, achievement, whatever it may be – we can link what they need to do with that point of pride and use it to help them ‘want to want to change’.

And this can be done either covertly, as I did with Margaret, or overtly. I both protected Margaret’s pride by not being the therapist (after all, it was other people who’d asked me to see her) and appealed to it to get her up and moving again.

I also appealed to pride while working with Arnold, who told me how his daughter (who had died a year before) used to call him ‘Daddy Lion’ when she was little. Now, his business had failed and Arnold felt he’d lost all his drive to care for himself, for his wife, or about trying to rebuild his business. We talked about how a young person might think about a lion and he acknowledged that his daughter had seen him as powerful and strong.

While he was in hypnotic trance, I talked to him about how he might ‘truly honour’ his daughter’s perception of him as a proud man of strength by ‘allowing his lion nature to express itself once more’. This appealed strongly to him, linked as it was with his cherished daughter and a feeling of who he had been ‘before’. He had described how he ‘used to be’ and I fed this back to him as ‘who you really are’.

So you can see how the principle of pride appealed to both Margaret and Arnold’s cases.

And talking of ‘principle’, you can…

2. Appeal to their point of principle

A husband and wife, both very politically liberal university history professors, came to see me to quit smoking. They knew consciously that they’d fallen prey to subconsciously associating smoking with a counter-culture identity, but this wasn’t enough to help them stop.

As we talked, it became clear they both had a very real passion for fighting what they described as the ‘evil of big business around the globe’. Easy.

I spoke about the ‘con’ of smoking, the ‘injustice’ of it, and the way generations have been duped into being turned into ash by the very thing being turned into ash by them. I went on about the tobacco industry and how Sigmund Freud’s nephew Edward Bernays, the ‘inventor’ of public relations and the use of psychological techniques in marketing, had purposefully set out to link smoking with being ‘cool’ and gotten a generation of women hooked on smoking.

During their hypnotic inductions, I didn’t mention ‘smoking’, but ‘the smoking conspiracy’ and talked about how, as people ‘wised up’, ‘big tobacco’ would have to find fresh new smokers who hadn’t yet seen through the ‘globalization of poisonous commerce’ that was proceeding apace in developing countries even as we spoke. Because, I said, the tobacco industry needs people to selflessly sacrifice themselves to maintain all the profits.

I didn’t tell them they shouldn’t smoke, but I did totally demolish any claim smoking may have had on being an acceptable part of their self identities. Both stopped on principle.

If fairness, honesty, hard work, or ‘protecting the common man/woman’ is important to someone, then use it. One nervous flyer who saw herself as ‘fair minded’ above all was told during trance to ‘be fair to the aircraft’ by allowing it to make the adjustments and noises it needs to in order to fly – especially through turbulence!

If fairness, honesty, hard work, or 'protecting the common man/woman' is important to someone, then use it.

3. Appeal to their area of expertise

A lot of my clients know a lot more than I do about a lot of things, even if it’s how a drug culture works or treatment for an illness they’ve had. And most people take pride in and enjoy sharing their expertise. Through discovering what your clients know a lot about, you can use that knowledge and enthusiasm to help them change.

For example, what one of my teenaged clients didn’t know about online games wasn’t worth knowing. But he hadn’t played any games for a while; in fact, he’d stopped doing all the things that had connected him to community, goals, and life. Depression had made him withdraw from the very parts of life that ultimately make life worth living.

I talked to him about how depression convinces people to think in all-or-nothing, simplified, negative ways. About how it stops us getting proper rest from our sleep (even when it lets us sleep). About how it makes us think in certain predictable ways and messes with what motivates people day-to-day. And about how, in a way, it needs to be outwitted.

When I asked him to describe what made a ‘really great online game’, he talked about the importance of collaboration with other players, ‘letting them help you and helping them in turn’. About having new challenges, interesting ‘side quests’, really difficult ‘bosses’ to defeat (I confess, I had to ask what a boss was!), different levels to conquer as you become a better player, and so forth.

I suggested life itself could be seen as a kind of game. I said to him, “I know very little about online gaming, but from what I’ve said about depression, if you and I were to develop an online game to defeat depression, what do you think we would include? What sort of ‘bosses’ would a player encounter? How could they be beaten?”

He proceeded to talk at great length about how the ‘beat depression’ game would work and look. In effect, he described exactly what you would have to do to get to the point of no longer being depressed. And he enjoyed ‘playing’ the game of defeating depression while in a deep, relaxing trance.

We had collaboratively merged our areas of expertise and developed a strategy for him linked to his sense of what he knew about.

What motivation really is

By linking motivation to change to a person’s perceived sense of self identity, the healthy focus for change can become merged with their sense of who they are – and this is what makes it motivating.

The examples given here were, of course, tailored to fit the idiosyncrasies of the unique individual involved. But the principle of appealing to a person’s sense of identity is universal and timeless.

What are the techniques you’ve used to spur your clients’ motivation to change? I’d love to hear your approaches in the comments!

  • Peter

    Great article Mark. I get the sense that you are indeed a *natural* therapist. You seem to work with great spontaneity and retain an awareness, perhaps unconsciously, of appropriate principles to inform practice. Not to suggest that those principles are only acknowledged ex post facto, it is a sign of expertise. Thanks for sharing.

    • http://www.uncommonhelp.me/ Mark Tyrrell

      Thanks Peter,
      I don’t always get it right and, only tend to write about the times I do. Some people are also much easier to work with than others : ) I think it’s important though to be at least potentially able to work with as many different types of people with many different types of problems as possible. I also think that therapy should feel natural to the client as far as possible and not too psycho-babbly.
      Thanks
      Mark

  • http://jeninemarieministriesinternationa.org/ Rev Jenine Marie

    I really like this, very helpful!