Increasing client motivation

What do we do when our clients lack motivation?

Words of wisdom from our beloved Shel Silverstein.

A student clinician asked for advice on how to increase client motivation.  She is working with an adolescent client in her internship who has a very negative attitude about speech-language therapy.  He refuses to participate in language activities—he thinks they are “stupid.”  The clinician hopes, somehow, to motivate him so that he can benefit from therapy before the end of the school year.

I think we have all experienced similar scenarios with client motivation at one point or another.  Student clinicians are in a particularly unique situation because their time with their clients is limited.  This means they have less time to establish a therapeutic alliance, which can be a critical intervention component.  On top of having language impairment, adolescence is often a challenging time filled with academic pressures, social pressures, family pressures, and uncertainly about the future.

One of my all-time favorite authors, Shel Silverstein, shares wonderful words of wisdom that I even find relevant to developing therapeutic alliances in clinical practice.  In the poem “Tell Me” (Falling Up, 1996), he writes:

“Tell me I’m clever,

Tell me I’m kind,

Tell me I’m talented,

Tell me I’m cute,

Tell me I’m sensitive,

Graceful and wise,

Tell me I’m perfect—

But tell me the TRUTH.”

Teens want independence and autonomy, yet they also want relationships with adults who value them, adults they can trust, adults they like.  The latter two require that adults share some information about themselves too.  Like the poem states, they want positive feedback from adults who recognize their cleverness, their kindness, their talents, their strengths.  Caring clinicians can always benefit adolescent clients by being that trustworthy person who sees their strengths. This does not mean that clinicians sugar coat everything, since our clients also need and want the truth.  They want sincerity, so it is important that adults make sure their verbal and non-verbal cues are consistent.

Listening is critical to developing a therapeutic alliance.  When we listen, our clients feel valued, and when they feel valued, they are more motivated.  While there is no single solution for solving motivational problems, the more we know and listen to our clients, the more likely we will identify successfull strategies.  Teens want to have a voice, and they are at the age when they can, and should, have a voice in the intervention planning process.  If they initially do not want to share their thoughts about therapy verbally, there are other outlets.  For example, I have heard from some professionals who have their clients design dream boards, or collages, to illustrate their interests, desires, and goals.  Such boards can lead to engaging discussions and activities, such as role plays, that address the steps necessary to achieve that dream job, car, whatever it may be.

And speaking of listening, I find more wise words in Silverstein’s poem “Listen to the Mustn’ts” (Where the Sidewalk Ends, 1974).  These words can symbolize the many obstacles that many teens feel during this vulnerable time in their lives, particularly our clients who may perceive even greater obstacles related to language impairment.  These words acknowledge our clients’ challenges, which can sabotage motivation, and then speak about their dreams with hope.

Listen to Mustn’ts, child, listen to the Don’ts.
Listen to the Shouldn’ts, the Impossibles, the Won’ts.
Listen to the Never Haves, then listen close to me.
Anything can happen, child, Anything can be.

Communication is power, and teen clients may be more willing to engage if they sense that we are there to help empower them to achieve their goals and dreams, and that we believe in them, because Anything Can Be.

Shel Silverstein