Sunday, March 4, 2012

Motivation and Emotion

"I'm not sure if I really need this treatment," a patient recently told me.  "I'm feeling a lot better than I was," he explained.  I looked at the symptom checklist he'd filled out before our session.  "According to this, you're still feeling anxious and on guard, you're still getting angry a lot, you're still not comfortable going anywhere that's crowded, and you're still having trouble sleeping," I pointed out.  My patient laughed.  "You have a good point," he said.

The following week I checked in with him.  "You were having some doubts about whether you needed the treatment," I recalled.  "How are you feeling about that now?"  The patient again expressed doubt, stating that he really is feeling a lot better.  "I'm to the point where I can contain the anxiety," he explained.

This happens a lot: a person starts to feel a little better and decides he doesn't need treatment anymore.  Granted, feeling better can be an indication that a patient's issues are resolved and that treatment can be terminated.  More often than not, however, feeling better simply removes the motivation to continue treatment; as a result, problems are left unresolved only to resurface again at some point in the future.

So what does motivate a person to invest in treatment?  Most people are motivated by emotional pain (sadness, grief, anger, anxiety, etc.).  More accurately, people tend to be motivated by their desire to be rid of emotional pain.  As long as the pain is there, they are willing to do the work of therapy.  Once the pain abates a little bit, the focus of therapy often shifts from acute symptoms to trying to get to the root of the problem.  This can mean working to change deeply ingrained mental and behavioral habits.  It is often a lot of work and without the pain, many people lack the motivation.

Ironically, a patient's emotional pain can be helpful to the therapist as well.  A person in pain is more likely to reveal his thoughts; these provide powerful clues as to what factors might be driving the patient's symptoms.  I find that, in therapy, people tend to be very short-sighted.  They tend to focus on their present experiences and their experiences from the recent past.  It is not unusual for a patient to come to my office and say, "I've been feeling good for the past few weeks.  I don't really have anything to talk about."  It then falls upon me to try to help the patient recall the times in his life when he was not feeling good, to identify what these times have in common, and to explore what ultimately helped him to recover so that he can use these strategies again in the future.  Typically, however, when a person feels good he does not want to think about feeling bad.  He doesn't want to remember; he wants to forget.

I an not trying to glorify emotional pain.  I am simply making the point that even negative emotions can be useful.  How many people would work to change and improve themselves in the absence of emotional pain? Sure, there would be some; most, though, would have no motivation to do so.

1 comment:

  1. Very interesting! I guess perception plays a big role here and there's a spectrum from "Hi my name is Steve, and I'm _______" to "Hi, my name is Steve, and everything thing I think, I think is real, and that's a problem." I wonder what it's like to see "hard bottoms" come to you and maybe not so hard, existential drifty type people come to you...

    I spent a year in therapy. I was having anxiety attacks at work, and to avoid them, I'd stay home, and to stay home was to dwell in perpetual depression...therapy helped, even if it just served as a placebo.Trying to help myself worked. However, I quit that job and haven't had an attack since. Was my body telling me something very simple?


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