Initial motivation for psychotherapy and institutional fate of psychotherapeutic outpatients

Abstract

Patients’ motivation is one of the most decisive factors for successful psychotherapy. Motivation, however, not only amounts to a quantitative entity, but the kind of this motivation is essential. Thus, our basic research aim was to develop an instrument for representing the specific quality of a patient’s therapy motivation in a clear and reliable way. Before their first interview at two Austrian therapeutic out-patient centres, we asked 202 prospective patients to respond to an open question regarding their motivation to seek psychotherapy. Based on a content analysis of their written answers, we suggest a system of 16 motif categories. The system is well documented through definitions, anchor examples, and coding rules and can easily be adopted for further research. We find that frequently patients simply wish to talk to someone and be supported – a rather unspecific motif category that previous research logic, oriented on patients’ problems and goals as it was, obviously has been hiding.Patients’ motives, as categorized by our instrument, correlate with indication to therapy. Those who are motivated by their own potential, by insight or who want to regain their love of live more often are referred to group, couple, or family therapy. On the other hand, 8 patients, all of them women, are not considered for therapy at all. They are significantly older than average and, when asked for their motivation to seek therapy, answered in ways that were rated as recommendation by others, depression, and suffering. We identify them as »problem children« of the therapy system: referred by their doctors or their relatives, they show up at the ambulance with little motivation or capacity for self-reflection – and are sent away despite of their subjective suffering.