JCPSLP Vol 18 No. 1Mar 2016

JCPSLP

Volume 18, Number 1 2016

Journal of Clinical Practice in Speech-Language Pathology

Study 1

[Frequency]Dependsonpt’sstatusinterms

ofalertness,fatigue,availability(i.e.,other

alliedhealthorinvestigations),motivation,

compliancewithTxetc.(Georgia,workbook)

I was thinkingoptimally I wouldhave

beenseeinghimtwicedailybecausehe

wasalotmorealertandreallyinterested.

(Belinda, interview)

…then you look at leaving packages

andgroupsandthingslikethat.(Belinda,

interview)

Acutept….motivated,insightful+good

rehab potential. (Emily, workbook)

If I know they aremotivated and can,

andhavegoodfamilysupport,trytoget

materialsouttothemforfamilytosupport

orgivethemstrategies.(Sophie,interview)

Ifthepatient’sreallymotivatedithelpsa

lotintherapyalsobecauseyougetthat,

youtakesomeofthatenergyandgiveit

back to them. (Sophie, interview).

Themes

Judgingmotivation

anddecisionsabout

what to offer

Motivation, goal

setting,andtherapy

options

Family influences

on judgments of

motivation

Motivation and

discharge

Influences of

motivation on

the therapeutic

interaction

Recognising the

limitsofjudgments

of motivation

Study 2

Yeah,themotivationoftheindividual...iftheyaredesperatelykeenandyou

knowtheyareputtingalltheireffortintotheworkyouaregivingthemandit

liftsthemtobeabletocomeandhavethatchallengeandworkonitandsee

their progress, then that’s a big thing. (Ros)

Isupposeitishoweagerpeopleareinthetherapysessionorhow...whether

theypracticeornot,whetherthefamiliesareinvolvedor...alotofitispretty

subtle. (Jane)

…reallyit’stodowiththeperson’sownmotivationandbymotivation,I

meanmotivationtoattend,motivationtodotheworkthatwehaveagreedon

together,toworkthroughgoalsandtoworktowardsgoals.(Leanne)

…generallyifpeopleweremakingchange,weremotivatedtomakechange

andcommittedtomakechangeandIstillhaveasenseofenthusiasm

fromthemandtheircarersaboutmakingchange,thenIwouldplugaway

[persevere]. (Murray)

Socontinuingtooffertherapywouldbebasedonmotivationoftheclientand

hisfamilyorherfamily.AlsoIthinkapowerfulmotivatorallroundisevidence

ofimprovement,youknow,ifit’sworking,youkeepdoingit.You’renotgoing

to stop. (Rachel)

[Youlookfor]progressandtheiractiveinteraction.Andyouknowsome

peopleareverypassive.Theyjustsitthereandletyoutherapythemand

yougetnowherereally.Looksgoodonpaperandthatisaboutasfaras

yougo,sopeoplelikethatIwouldbedischargingintherelativelyshort

term. (Ros)

…ifyougetthevibesfromapatientthatthey’renotterriblyinterestedin

comingorifthey’relateallthetimeoriftheydon’tturnupandtheydon’tlet

youknow…likeyouthink,“well,whybother?”You’remorelikelytomaybe

discharge them a bit sooner. (Felicity)

Ithinktheirattitude.Obviouslyifthey’realittlebrighter,senseofhumour,you

know,workingwell,they’vegothomesupport,they’reactuallydoingsome

activepracticeofsomeform,that’salwaysbetter…andhelpsthetherapist.

Andifpeoplearereallydepressed,they’vegotnohomesupport…that

makesitalothardertomotivatethemandtosetgoalstoo…Soittendsto

probably make you discharge somebody. (Erica)

Differenttherapistscouldachievedifferentthingsbecauseofthechemistry

intermsofmotivation…andthat’snotsayinganytherapistsarebetter

orworsethananybodyelse.It ’sjustthatweknowthatthatexists.We

acknowledge that within the profession. (Belinda)

Iguessitishowconnectedtheyarewithyouinthatpartofthesessionwith

whatyouaredoing.Imeantherearesomeactivitiesyoudowithsomeand

theyarejust,theyareenjoyingitbuttheyarealsoreallyfiring,theyarereally

trying,theyarereallyobviouslystrivinginsomewaytoachievethisthingthat

ismotivatingforthem.Andinotherthingstheyarejustdoingalmostarote

responseandyoucanseetheyareactuallydoingitbecauseyouhaveasked

themtodoitratherthanitbeingintrinsicallymotivatingandmyparticular

bias and passion is intrinsic motivation and not extrinsic… (Celia)

There’stimesI’vehadquiteafewpeoplecomethrough…they’renotreally

highlymotivatedassuchand,youknow,andit’shardworkforthemandit’s

notnecessarilytheirthingbutinperseveringandgettinganoutcomeand

helpingthemgetthroughthatadjustmenttime,thenitcanbeworththat

initial push. So I don’t do it by motivation. (Angela)

Thereissomuch‘mystique’surroundingallofthis.Imeanpeoplearetold

“wellyouareveryluckytobeinthisprogramandyou’vegottograbitwhile

it’savailable”…tryingtokeeppeoplemotivatedtowardstheirhalforone

hourtherapysessionswhentheyhavegotallthisotherstuff[medicaland

emotionalissues].Andmeanwhilethey’vegottheirfamiliessaying“you’ve

gottodoit,you’vegottodoit,comeon,comeon”,almostbarracking

families…somepeoplejustgetreallyanxiousaboutallofthisandfeel

there’s a great pressure... (Murray)

Table 1 summarises the key broad themes found in the two sets of data and illustrative quotes.