A Survey of Patients' Motives for Seeking Psychotherapy Services

Archives of Psychiatry and Psychotherapy, 2018; 3: 26–30

DOI: 10.12740/APP/92165

So, who wants to be here? A survey of patients’ motives for seeking psychotherapy services and their expected un-involvement in therapy

John S. Ogrodniczuk, David Kealy, Olivier Laverdière, Anthony S. Joyce

Summary Objective: The motives that bring people to psychotherapy vary widely; while some people come on their own volition, others may not care to be in psychotherapy at all, but feel compelled to seek services because of external pressures. A patient’s motivation for therapy is believed to influence the likelihood of becoming actively and meaningfully involved in the work of psychotherapy. Methods: We surveyed 343 consecutively admitted psychiatric outpatients from three large, urban psychotherapy clinics about their motives (internal vs. external) for seeking psychotherapy and their expected involvement, or lack of involvement, in the work of therapy. Results: While most patients appear to start therapy on their own volition (76%), a significant proportion also feel compelled to seek services because of external pressures (38%). The more patients were motivated by external forces to seek treatment, the more disinclined they were to become engaged in the work of therapy; greater endorsement of internal motives was associated with reduced unwillingness to work in therapy. Conclusions: Externally motivated patients may be particularly uncertain about the relevance and/or suc- cess of therapy and may require preparatory work to help instil in them a sense of hope and investment in the treatment process.

psychotherapy, motivation, involvement

INTRODUCTION astin chane ay e ore iey to occr hen a patient fees personay invested – as opposed Psychotherapy can e hard or, and the pa to feein coerced – and activey enaed in the tients otivation to see treatent ay e therapetic process 13 efdeterination the a critica factor in their capacity to enae in, ory has ained considerae attention in the and profit fro, sch or ndeed, positive and iteratre as a conceptaiation of otivation that is appicae to psychotherapy his per John S. Ogrodniczuk1, David Kealy1, Olivier Laverdière2, Antho- spective sests that otivation, at a asic ev ny S. Joyce3:1Department of Psychiatry, University of British Colum- e, can e cassified as atonoos or controed 2 bia, Vancouver, Canada; Département de Psychologie, Université ehaviors that are atonoosy ie in de Sherbrooke, Sherbrooke, Québec, Canada; 3Department of Psy- chiatry, University of Alberta, Edmonton, Alberta, Canada trinsicay otivated are eperienced as sefin Correspondence address: [email protected] itiated and personay endorsed ontroed ie o, ho ants to e here A srvey of patients otives for seein psychotherapy services 2 etrinsic otivation is eperienced hen an in METHOD divida fees pressred to enae in a ehav ior ecase of otside forces Participants ere recrited fro three psychi yan and coeaes are that interna atric otpatient cinics offerin psychotherapy y otivated patients shod e ore iin and pharacotherapy in to provinces of an to coit to the tass of therapy and toerate ada At each cinic, a consective ne patients orin throh the inherent, t necessary, over the ae of 1, ith nish anae pro chaenes of the psychotherapetic endeavor ficiency, and ho provided infored consent, oe research sests that a patients otiva ere incded eection criteria for stdy par tion is reated to the intent to prse therapy 6, ticipation ere not iposed in order to have the eterna des ratins of patients orin ca ost cinicay representative sape possie pacity , patients coaoration in therapy 8 he tota sape incded 33 patients nfora and positive otcoes et epirica investi tion aot dianoses as not coected Partici ations of the infence of patients otivations pants copeted a rief srvey consistin of to on their epected invoveent in the therape ites enirin aot their otives for seein tic process reain scarce therapy and si ites reardin their epecta he present stdy srveyed psychiatric ot tions for noninvoveent in therapy ae 1 patients reardin their otives interna vs e he rief ypto nventory18 10 as then terna for seein psychotherapy and their e sed for assessent of enera psychiatric dis pected invoveent, or ac of invoveent, in tress and the esiraiity scae of the Persona the or of therapy in order to hep ein ad ity esearch or 11 for assessent of socia dressin this ap in the iteratre he stdy as desiraiity escriptive statistics ere sed to not deveoped to test specific hypotheses, t in characterie responses to the srvey ites Par stead to condct a preiinary srvey that cod tia correations ere cacated eteen re provide soe insiht into the isse of patient sponses to the otivation ites and the nonin otivations and epectations, and set possie voveent ites, controin for the potentiay directions for ore fora and coprehensive confondin infence of ae, enera psychiat investiations in the ftre ric distress and socia desiraiity

Table 1. Proportion of respondents endorsing survey items (N=343) Strongly disagree Disagree Neutral Agree Strongly agree % Motivation for seeking therapy I have come for therapy because other people think that 14.6 25.1 22.7 25.7 12.0 it would be good for me. I have come for therapy because I value the way therapy 0.6 2.3 21.6 53.1 22.4 can help me make changes in my life. Expectations of un-involvement in therapy I am likely to quit therapy if things become too difficult to 25.4 40.2 16.9 11.7 5.8 do or talk about. If therapy becomes boring or tedious, I will probably quit. 17.2 40.8 25.1 14.3 2.6 I would prefer to just take medications to solve my 24.5 30.6 21.6 16.0 7.3 problems. The therapist should do most of the work in our sessions 17.5 50.1 23.0 7.3 2.0 together. I am not ready to make big changes in my life. 24.2 39.1 20.1 9.6 7.0 If therapy causes me stress, I know it is not the right 14.9 34.7 31.5 15.7 3.2 treatment for me.

Archives of Psychiatry and Psychotherapy, 2018; 3: 26–30 28 ohn rodnic et a

RESULTS ost of the or in therapy, 166 reported feein nprepared to ae aor ife chanes, he sape consisted of 33 patients, of the aver and 18 eieved that stress cased y thera ae ae 3 years 122 ore than haf the py od indicate that it is not the riht treat sape ere feae 8, 6 ived aone, ent for the 33 ived ith a partner and 1 had oth ae 2 shos the partia correations eteen er ivin arraneents st nder a haf of the otives for therapy and epectations of disen sape 6 ere epoyed and 60 ere aeent fro the or of therapy indins edcated eyond hih schoo eary tothirds deonstrated that reater endorseent of an e of the sape 621 had received previos terna infence ehind seein treatent as psychiatric treatent and 22 ere previos sinificanty associated ith a of the nonin y hospitaied for psychiatric reasons voveent ites, indicatin hiher epectations As shon in ae 1, threearters of not ecoin invoved in the or of thera of respondents indicated an interna otive for py et, even aon those patients ho stron seein therapy, hereas sihty ore than y endorsed an eternay otivatin factor re onethird 3 reported ein otivated y sponded strony aree, pards of 20 had eterna forces ecase respondents can e o o epectations of not orin in therapy see tivated y oth factors, the tota percentae is ae 3 onversey, reater endorseent of hiher than 100 an interna otive for seein treatent as si eardin epectations of ecoin nin nificanty and neativey associated ith of the voved in therapy, 16 of respondents indi 6 noninvoveent ites, refectin oer epec cated that they od iey it if therapy e tations of not orin in therapy Aon pa cae too diffict, 16 od it if thera tients ith hih interna otivation responded py ecae orin or tedios, 233 od strony aree, very fe presented ith hih prefer to st tae edications, 3 indicat epectations of not ecoin invoved in the ed that they thoht the therapist shod do or of therapy see ae 3

Table 2. Partial correlations between motivations for therapy and expectations for un-involvement in therapya I have come for therapy because I have come for therapy because I value other people think that it would be the way therapy can help me make good for me changes in my life (External motivation) (Internal motivation) I am likely to quit therapy if things 0.21*** -0.14** become too difficult to do or talk about. If therapy becomes boring or tedious, 0.11* -0.11* I will probably quit. I would prefer to just take medications to 0.11* -0.07 solve my problems. The therapist should do most of the work 0.17** -0.11* in our sessions together. I am not ready to make big changes in 0.17** -0.08 my life. If therapy causes me stress, I know it is 0.16** -0.18** not the right treatment for me.

a Controlling for age, general psychiatric distress and social desirability. * p ≤ 0.05; ** p ≤ 0.01; *** p ≤ 0.001

Archives of Psychiatry and Psychotherapy, 2018; 3: 26–30 o, ho ants to e here A srvey of patients otives for seein psychotherapy services 2

Table 3. Motivations for therapy and expectations for un-involvement in therapy Patients with high external Patients with high internal motivation motivation Disagree/strongly disagree Agree/strongly agree % % I am likely to quit therapy if things become too difficult 19.4 5.4 to do or talk about. If therapy becomes boring or tedious, I will probably 14.7 2.3 quit. I would prefer to just take medications to solve my 21.7 7.7 problems. The therapist should do most of the work in our 14.7 1.5 sessions together. I am not ready to make big changes in my life. 16.3 6.9 If therapy causes me stress, I know it is not the right 11.6 2.7 treatment for me.

Discussion coitent to persistin ith treatent, and Athoh otivation for therapy has on een instaiity throhot the therapetic process reconied as a critica factor for the sccess of ecase they have not internaied a persona ac psychotherapy, reativey fe stdies have in contaiity for the process of chane itsef c vestiated this topic ith reard to patients cessf otcoes are ore niey in sch cir epectations for invoveent in treatent cstances he findins of the present stdy reveaed that he findins of the present stdy shod e the ore patients ere otivated y eterna considered in the contet of varios iita forces to see treatent, the ore disincined tions his incdes the se of srvey ites that they ere to ecoe enaed in the or of ere deveoped for the specific prpose of the therapy ch epected ninvoveent in ther stdy in order to condct the srvey in a feasi apy decreased ith reater endorseent of an e anner in a sy cinica settin rather than interna otive for prsin treatent hese sin ore coprehensive and vaidated eas findins are consistent ith and add to those de res of the constrcts of interest his iited rived fro the seina or of Peetier and co or perspectives of the types of otivations and eaes 6, as e as ore recent findins de epectations that cod have potentiay een as onstratin that intrinsicay otivated patients sessed t od e interestin to consider differ are ore iey to report an interna ocs of con ent types of eterna pressres that patients per tro, reater sefestee and positive ood, and ceive as the sorce of otivation for treatent ore positive eperiences in therapy 8,12,13 A reated assessent isse is that this stdy ad onsidered ithin the fraeor of sefde dressed patients epectations fro a pessiis terination theory, for individas to deveop tic perspective ony hie sch an approach is positive epectations aot therapetic enae innovative and contrites nie findins to ent, they st perceive that they are eercis the iteratre, it od e desirae to consider in an atonoos decision to approach treat oth optiistic and pessiistic epectancies si ent Patients otivated y intrinsic forces taneosy he stdy as aso iited y an are ore iey to invest in the assiiation of asence of dianostic inforation for the par earnin and ehaviora chane that can ead to ticipants, ths potentiay constrainin or ai positive otcoes 3 onversey, patients ho ity to ceary eneraie or findins to specific ac this perspective – feein infenced y e popations or presentin isses terna pressres sch as deands of sinificant espite their preiinary natre, the reevance others – are ore iey to eperience aiva of the findins fro the present stdy is notae, ence aot coencin therapy, diinished iven the research evidence sstantiatin the

Archives of Psychiatry and Psychotherapy, 2018; 3: 26–30 30 ohn rodnic et a considerae infence that patient otivations tion, extrinsic motivation, and amotivation for therapy. Jour- and epectations have on the sccess of psycho nal of Personality Assessment, 68, 414–435. therapy 1,1 he findins sest that patients 7. Rosenbaum, R. L., & Horowitz, M. (1983). Motivation for psy- ho are ore eternay otivated ay e par chotherapy: A factorial and conceptual analysis. Psychother- ticary dotf aot the reevance andor sc apy: Theory, Research and Practice, 20, 346–354. cess of therapy and ay reire ore persasion 8. Bachelor, A., Laverdière, O., Gamache, D., & Bordeleau, V. that treatent can indeed e of enefit to the (2007). Clients’ collaboration in therapy: Self-perceptions and nce patients fee personay invested in thera relationships with client psychological functioning, interper- py, they are ore iey to endre soe of the sonal relations, and motivation. Psychotherapy: Theory, Re- chaenes invoved and or constrctivey in search, Practice, Training, 44, 175–192. treatent to achieve a etter state of fnctionin 9. Timmer, B., Bleichhardt, G., & Rief, W. (2006). Importance of psychotherapy motivation in patients with somatization syn- REFERENCES drome. Psychotherapy Research, 16, 348–356. 10. Derogatis, L. R. (1993). Brief Symptom Inventory: Adminis- 1. Goldfried, M. R. (2012). On entering and remaining in psy- tration, scoring and procedures manual (3rd ed). Baltimore, chotherapy. Clinical Psychology Science and Practice, 19, MD: Clinical Psychometrics Research. 125–128. 11. Jackson, D. N. (1984). Personality Research Form Manual 2. Overholser, J. C. (2005). Contemporary psychotherapy: Pro- (3rd ed). London, England: Research Psychologists Press. moting personal responsibility for therapeutic change. Jour- 12. Michalak, J., Klappheck, M. A., & Kosfelder, J. (2004). Per- nal of Contemporary Psychotherapy, 35, 369–376. sonal goals of psychotherapy patients: The intensity and 3. Ryan, R. M., & Deci, E. L. (2008). From ego-depletion to vi- the ‘why’ of goal-motivated behavior and their implications tality: Theory and findings concerning the facilitation of en- for the therapeutic process. Psychotherapy Research, 14, ergy available to the self. Social and Personality Psycholo- 193–209. gy Compass, 2, 702–717. 13. Zuroff, D. C., Koestner, R., Moskowitz, D. S., McBride, C., 4. Deci, E. L., & Ryan, R. M. (2000). The ‘what’ and ‘why’ of Marshall, M., & Bagby, R. M. (2007). Autonomous motivation goal pursuits: Human needs and the self-determination of for therapy: A new common factor in brief treatments for de- behavior. Psychological Inquiry, 11, 227–268. pression. Psychotherapy Research, 17, 137–147. 5. Ryan, R. M., Lynch, M. F., Vansteenkiste, M., & Deci, E. L. 14. Constantino, M. J. (2012). Believing is seeing: An evolving (2011). Motivation and autonomy in counseling, psychother- research program on patients’ psychotherapy expectations. apy, and behavior change: A look at theory and practice. Psychotherapy Research, 22, 1–12. The Counseling Psychologist, 39, 193–260. 15. Wampold, B. E. (2015). How important are the common fac- 6. Pelletier, L. G., Tuson, K. M., & Haddad, N. K. (1997). Client tors in psychotherapy? An update. World Psychiatry, 14, motivation for therapy scale: A measure of intrinsic motiva- 270–277

Archives of Psychiatry and Psychotherapy, 2018; 3: 26–30