Sunday, February 26, 2006

Motivation - everyone's loop hole

This post is about motivation and stuttering therapy. Ideally, a good treatment for any disorder does not require any motivation from the patient. For example, if I break my arm, the doctor will fix the bone. There is no motivation required on my part to assist in the treatment. The same is true for one-off pill treatments like to get rid of a headache or worm infections. You take one pill and that's it. The next level is taking pills over a longer period. Again, little motivation is required on the patients part, except of course taking the pill every morning or evening. But you would be surprised how many patients actually do not take their pills either they simply refuse, they forget to take them, they change the dose themselves, stop after symptoms stop or have a fear of swallowing pills. Amazingly, even such a low degree of required motivation considerably reduces the efficacy of treatment! So the lower the motivation required the better.

The next level is treatments that require more time possibly with inconveniences, like doing exercises for your back or going swimming. I still have to meet the first person that has always followed such treatment regime! Finally, the highest degree of motivation is needed for behavioral therapies where you need to change the way you do certain things and implement them in your daily life. To summarise, you need to work on yourself hard. Stuttering therapies are one such therapy. Others are going on a diet and keeping off the weight, and getting off legal and illegal drugs for good.

The fact that motivation is an essential part of the present stuttering treatments is of course unfortunate, but the reality. Our hope is for a better understanding to allow us to reduce the degree of motivation needed. The current situation leads to a very convenient loophole for therapists. Very often unprofessional and professional therapists blame the failure on the lack of motivation on the patient's side. It is obvious and perversely even correct: the more you are motivated, the more fluent you can become. But the situation is more complicated. The reasons for failure are
1) the patient did not by himself generate sufficient motivation, but also
2) the therapist did not succeed in getting the patient to generate sufficient motivation.
3) the therapist's choice of treatment requires a high level of motivation that considerably increases the likelihood of 1) and 2).

I get rather annoyed with people and therapists telling me: "Why did you not practise more?" I often answer to therapists: "Well, why don't you develop a therapy that requires less motivation?" I recognise of course that this line of argument is also a convenient loop hole for people with PDS. I can blame my failure on the therapists. Seriously, couldn't I have done more? So let me, in line with my personality (it seems :-), blame everyone for abusing (lack of) motivation as a convenient way-out. When a person who gets therapy fails, patient and therapists are both to blame.


John MacIntyre said...

You know, I've never considered it may be my therapist's fault! Somebody's getting a good A** Kicking on my next follow up. ;-)

Seriously though ... I see your point but don't totally agree.

In my own therapy in October, my therapist really did teach me how to speak effectively. She taught me total control and introduced me to controlling my fluency in the outside world.

I suppose she could try to motivate me, and she does to a certain degree in follow up sessions.

But really, the ball's in my court. Even if I decide to stick it in my pocket and insist that she has it.

Anonymous said...

Dear Tom,

Your blog is fascinating, intelligent stuff.

That's the first thing I wanted to tell you. I don't have much to say on the motivation question, but I did want to say that I think you're right to distinguish carefully between theory and therapy, as you do elsewhere. It's tempting, and can be very healthy, to see our own behaviour from the "outside", as something to be studied scientifically. At the same time, I think the most important thing for a stutterer is assertive self-acceptance, and that is something that only comes with practice.

(The basic distinction is an interesting one. It's the one philosopher Thomas Nagel talks about: viewing oneself either as a scientific object, at the mercy of forces we can try to understand, or as an autonomous being with responsibility for ourselves.)

Anyhow, great blog, and all best.

chirri00 said...

Well, each person have theirs motivations in his lives for follow and work the therapy. But, I believe one source of motivation is "enjoy the therapy".

If you enjoy with something, you'll repeat it. And if you enjoy the effort you have to do is less.

And for example, if I don't enjoy with my self-therapy, it will be more hard to do the therapy...