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 ex- ternal 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 psycho- therapy clinics about their motives (internal vs. external) for seeking psychotherapy and their expected involve- ment, 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 thera- py; 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 basic 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 dividal feels pressured to enae in a ehav- ior ecase of otside forces Participants were 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- were 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 Yet 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 noninvolveent in therapy Tae 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 coud tia correations ere cacated eteen re- provide soe insiht into the isse of patient sponses to the otivation items and the non-in- 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- Tae 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 was psychiatric treatent and 22 were 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 Yet, even aon those patients ho stron- seein therapy, hereas sihty ore than y endorsed an eternay otivatin factor re- one-third 37.7%) 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 total percentae is Tae 3 onversey, reater endorseent of hiher than 100 an internal otive for seein treatent as sig- 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 tedious, 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.