Accountability: Accounting for Motivational Differences
Pressure to gather pre-intervention data in anticipation of measuring results seems like a straight forward practice when viewed through the lens of evaluation. But often those we are trying to help have a different view of the matter.
Increasingly, it is becoming common practice to administer several instruments (and do a variety of other "paper work") during the first session with clients. What is the impact of all this? We are hearing from practitioners who suggest that such activity is increasing client reactance and negative motivation.
It has always been hard to get the involvement of some youngsters and their families in counseling situations. No-show and drop out rates are high. The lesson of all this is that greater attention must be paid to enhancing the motivational readiness of those we want to help and, at the very least, interveners must minimize doing things that increase avoidance tendencies among clients.
In terms of everyday practice with youngsters, this means (1) discussing with parents/teachers what they should and should not say to youngsters in preparing them for the first visit to a mental health professional and (2) designing first visits around the concept of enhancing motivational readiness. Everyone needs to be honest and nonpunitive with a youngster in discussing who they are going to see (e.g., a counselor who will try to help make things better). Many students require a great deal of reassurance that going to see a counselor is not an indication that parents/teachers think the youngster is "mental" (e.g., crazy, retarded). Some react positively to the information that many other students are going and find it helpful.
Obviously, youngsters who already are well motivated require little to enhance their motivational readiness. For most, however, enhancing motivation toward participation in the intervention requires considerable attention. Because referrals usually far exceed mental health resources, it is commonplace for interveners to let difficult, unmotivated clients "drop out." Higher standards of practice call for intensive efforts to enhance the motivation of such individuals so that their problems can be addressed.
Young children initially often want the protection of a parent's (or friend's) presence. In these instances, activities may have to involve all who are present and do so in a way that feels nurturing and safe to the youngster. Premature pressure to give up the security of the parent or friend usually leads to significant psychological reactance that manifests itself as withdrawal, or various forms of anxiety and aggression.
Even with youngsters who don't require another's presence and may even prefer being alone, it can take several sessions to build the type of relationship that allows for productive one to one sessions. Again the need is for activities and techniques that establish a feeling of nurturance and safety and a sense that the counselor wants to and is able to help.
The motivational focus in subsequent visits shifts to the problem of maintaining good levels of motivation about continuing to attend and for working to overcome problems. This involves activities and techniques that continue to produce feelings of nurturance, safety, and faith in the counselor. And, it requires facilitating actions on the part of the youngster and changes in the surrounding environments that result in enhancement of feelings of competence, autonomy, and relatedness to others. The focus often is on how to handle feelings about something that has happened, taking steps toward solving current problems, planning how to deal with upcoming events, and so forth.
Finally, returning to the evaluation problem, the fact of major differences in motivational readiness points to the need to measure such differences so that data on results can be disaggregated with respect to initial motivation and subsequent shifts in motivation. Failure to account for motivation differences reflects serious naivete about the complexities involved in addressing the problems of youth.