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Thursday, 21 July 2011

Debate on Motivational Tools - Feedback

What do you usually do with your unmotivated clients? Discharge them? View them as resistant and work with them accordingly? Hope your supervisor got some ideas?
What do you do if you’re a supervisor and are at a loss?

The fact of the matter is that we could always do with some new ideas and tips on how to approach our most difficult clients.

Our recent delegate debate on motivational techniques produced some fascinating discussions about the topic and I would like to share them with you. Please read the comments to this post and feel free to contribute to this discussion by commenting yourself.

The issue of motivation is extremely interesting and multi-dimensional - that is why our training courses on Motivational Interviewing are always very engaging and lively. They are currently run in Manchester and London and until tomorrow you can book them with 30% discount. If you would like to learn more about this training follow the link:

I hope you will find this post an interesting read and look forward to continuing this discussion with you at one of our training courses.

Take care


  1. I must say out of all the clients that I have come across when counselling I haven't had many who don't want to be there or are 'stuck'.

    On the odd occasion when that has happened I always go with my inner instinct and it normally works. Staying with the client and being where the client wants to be has also worked, always keeping to the basics I find really works for me with clients I firmly believe in Person-centred counselling and find keeping to the basic theory when I am unsure always works for me.

    I am an integrative counsellor but my core belief is Person-centred, I know it is necessary to explore childhood and the past and know that the inner person needs to find themselves, I always believe that most people can do this given the environment offering unconditional positive regard, non-judgemental place, acceptance, congruence empathy when this is offered trust can be built between client and counsellor then the process normally works and once client feels confident enough to know where they want to go and how they feel inside about themselves they normally choose the changes they want to make and this is when CBT works for the client.

    I just thought I would share the way my counselling has worked for me, I really love counselling and out of all the clients I have had I think 1 or 2 may not have found the process not helpful for them.


  2. I've been working forty years as a Psychotherapist and Group Analyst.

    What I have discovered is that with such reluctant clients, something else is going on,namely that they may have reached a place where language is not helpful. What I do in such circ`umstances is to state the obvious:"We don't seem to be communicating". I then suggest that we see what the body is saying. Using the body as a transitionlal object I suggest that we play.

    The play is very simple. It begins by asking the client to stand up and just stand as they normally stand. 90% of such clients are totally ungrounded i.e they are literally not standing on the ground. Their energy is in their heads. Their bodies are totally out of alignment. Through a series of very simple exercises they come back to`earth and literally touch base.

    One last thought! My favourite philosopher is Wittgenstein. He once said something that has fascinated me:"There is a language that we speak and a language we do not speak and the second is more important."

    I forgot to tell you that I am also a cranialsacral therapist and work with new born babies who are not too good with words!!!
    Thank you.



    Dear H.W.

    Thanks for your thoughts. I’m a big Wittgenstein fan too, largely because of his influence on De Shazer and Brief Solution Focused Therapy.

    Your comments on posture are interesting because there is an increasing body of research coming out at the moment which links body posture with internal states – in other words how we stand reflects and influences how we feel and think. The idea of having pride in yourself through sitting up straight (as I remember be told at school) maybe wasn’t such a crazy idea and I used to think.

    Kind Regards


  4. Its good to read that there are tarining organisations out there that focus on providing "skills" for therapists. I like it.

    Your motivational "tips" do seem to come from NLP and so I was familiar with them. I never knew they were used by CBT practitioners too.



    Dear J.A.

    The key thing to remember is that there are very few truly new good ideas. Good ideas are both frequently rediscovered and used by good practitioners of all persuasions – it’s just they are frequently repackaged, renamed and rediscovered :-).

    Most psychotherapeutic ideas were originally outlined in some form within classical philosophy. The question of who discovered them first is redundant. The most important thing is to use them.

    Best Wishes

    Paul Grantham

  6. But how do you think to move forward with a client that has answered and knows the answer to all those questions has not found her solution? Just today I had such a person for the first time. Hence my interest in your email!

    A real interest provoker.

    So my first step is to wait to learn more and see what she brings next time and to go from there.

    With kind regards



    Dear S.E.

    I never claimed to have all the answers, simply some suggestions :-). Best of luck with your client. “Staying close to their position” is rarely a bad move.

    Kind Regards
    Paul Grantham

  8. In my experience unmotivated patients are either totally disillusioned, or fearful of internal and/or external life, and have cut off from engagement with it, which usually leaves them either depressed, or lacking in vitality, or angry and aggressive.

    Art therapists have historically worked with the most difficult to engage, unmotivated or resistant patients. We have the advantage of art materials as a “lure,” a process that works obliquely with defensive patterns and allows change to happen without seemingly doing much. It is relational, mainly experiential and done through playing with and staying in the metaphors that develop initially, until the patient can tolerate exploration and are able to think about the things that surface. However, exploration is not always necessary for change to happen. Simply being allowed a space to play can trigger curiosity, a coming together, a working through, or processing what has been, and a shift into a new pattern of being.

    Though I of course use all the skills available to encourage engagement, I depend on my own internal resources rather than on knowledge and technique, i.e. I believe we develop through what those around us are able to do, rather than on what they say or tell us. I have found that it is usually more important that I understand my own need to know and do something, or what is going on when I need patients to engage or get on with things; which I do take to supervision. If I can contain and tolerate my own feelings and urges, be patient and tolerate the anxiety that usually surfaces, and let the patient be, it is often the case that they become engaged and find their own motivation. This also means it is their achievement, not mine.

    I don’t separate cognitive functioning from the emotional, they are parts of an integrated process, but generally I find that reflective capacity, and the ability to think of options and choices, or even to imagine them, follow on from developing the capacity to simply be, i.e. having a secure place to rest from anxiety, which is free from threats, expectations or judgements, and the needs of others. From there tolerance to emotional life, and hence resilience, develops.

    I think the current demand for therapist to evidence the effectiveness of their approach and produce results sets up a very difficult dilemma that works contra to the main premise of therapy; that the patient is the centre of concern and that the therapist has to be lead by them and be able to be where they are.

    Motivational interviewing as a technique is not that different from asking open questions, which I see as part of constructive thinking, being able to be separate from the patient and retain my own mind, and therefore to feel and see things from a perspective the patient is not able to in that moment.

    Hope this is helpful in understanding what Art Psychotherapist do, and thank you for sharing your experience and what you find useful.

    Kind Regards


  9. Thank you for your tips of how motivate clients. I think it is good to explore these points, but it is important to bring into focus for the clients that however they are in their life, it is their decision. It is possible to be ok where they are, if it is their own choice. This way the responsibility of motivation is upon them and not the therapist.

    I believe that one cannot really change anything in anyone. I would appreciate if you could give me some of you thoughts regarding my comments.

    Best, S.


    Dear S.

    At one level I fully agree with you. I cannot live my client’s life for them. I cannot make their decisions and I cannot do what they need to do. Ultimately it is their responsibility. I think however that that is only part of the story:

    Firstly, I do start off from the assumption that every client I see is unhappy with their status quo – even if they’re mandated to see me. They would like to be in a different place from the one they are in at the moment. Hence, I assume they are intrinsically motivated (even though they may not be clear on WHAT to do, HOW to do it or even hold a radically different view that the one I might hold as a therapist).

    Secondly, I believe it is a myth that a client and therapist come together as contracting equals. We have different roles, powers, backgrounds and current positions. As a therapist I already have an influencing position (whether I like it or not). All one has to do is speculate on whether a client would wish to see a therapist who believes they cannot change, to know that the therapist AUTOMATICALLY has a bearing on the clients motivation. Once we accept that, the next step is to look at how we might maximise that effect.

    Thirdly, I believe Motivational Interviewing is spot on in recognising that motivation is not a client trait but a fluctuating product of the relationship between the client and therapist (or anyone else for that matter). Think about something that you vaguely would like to change and then track through how that motivation (or lack of it) changes according to who you are with. Therapists, in particular, have a powerful and privileged relationship that influences the client’s motivation.

    I hope you found the checklist helpful and I’ve at least offered some useful stimulation and debate on this rather dreary Monday morning :o)

    Kind Regards



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