Reading: Motivation is something you can influence
Why motivation is a state that changes with the conversation, not a fixed trait the client either has or lacks.
Reading: Motivation is something you can influence
What you’ll learn
- Explain why motivation changes over time and with the conversation.
- Recognize older ideas about addiction that research no longer supports.
- Describe your role: drawing out the client’s own motivation rather than supplying it.
Ask a room of counselors what makes treatment hard, and “the client isn’t motivated” comes up quickly. It sounds like a fact about the client. TIP 35 suggests it’s better understood as a fact about the moment, and that moment includes the conversation the client is having with you.
What motivation is
Motivation matters. Readiness to change is consistently linked to seeking help, staying in treatment, finishing it, and better outcomes. But motivation isn’t a single switch that’s on or off. TIP 35 describes it this way:
- It has many parts. It includes the client’s own desires, needs and values, and outside pressures such as family, courts, employers and consequences.
- It changes. It rises when reasons and goals become clear and falls when doubt and ambivalence take over, sometimes within a single session.
- It’s shaped by relationships. Supportive family, friends and community strengthen it. Isolation, friends who use, and stigma weaken it.
- It can be strengthened. Your counseling style is one of the biggest influences on it, for better or for worse.
Two parts of motivation are especially good predictors of change: how important the change feels to the client, and how confident they are that they can make it. You’ll practice asking about both in Module 4.
Self-determination theory adds a useful distinction. Intrinsic motivation comes from the client’s own values and goals. Extrinsic motivation comes from outside, such as a court order or a worried spouse. People do best when they feel in charge of their choices, capable, and connected to others. A relationship that respects the client’s autonomy and builds their confidence helps turn outside pressure into reasons of their own.
Ideas the field has moved past
Some older views of addiction still show up in treatment settings, even though research doesn’t support them. They matter because they shape how counselors talk to clients.
- People with SUDs share an “addictive personality.”
- What the research showsNo distinctive personality traits predict who develops an SUD. The idea focuses on deficits and makes addiction sound fixed and hard to treat.
- Denial and rationalization are features of addiction.
- What the research showsPeople with SUDs don’t have more or stronger defenses than other clients.
- Resistance is a trait of unmotivated clients.
- What the research showsLabeling clients, directing them, or giving them no say in their goals predictably produces pushback. Much of what looks like resistance is a response to the interaction.
- Defenses have to be confronted and broken down.
- What the research showsAdversarial confrontation is one of the least effective ways to help people change, and it can lower motivation.
| Older idea | What the research shows |
|---|---|
| People with SUDs share an “addictive personality.” | No distinctive personality traits predict who develops an SUD. The idea focuses on deficits and makes addiction sound fixed and hard to treat. |
| Denial and rationalization are features of addiction. | People with SUDs don’t have more or stronger defenses than other clients. |
| Resistance is a trait of unmotivated clients. | Labeling clients, directing them, or giving them no say in their goals predictably produces pushback. Much of what looks like resistance is a response to the interaction. |
| Defenses have to be confronted and broken down. | Adversarial confrontation is one of the least effective ways to help people change, and it can lower motivation. |
Your role
Change is the client’s responsibility, and many people change their substance use without any formal treatment. Your job isn’t to teach, instruct or give unsolicited advice. It’s to help the client notice where their substance use conflicts with what they value, and to strengthen their own reasons and confidence to change.
Natural change shows how this works. People cut back or stop for all kinds of reasons: after a car accident, after college, before a pregnancy, before looking for a job, or on a doctor’s advice. The same processes that drive those changes, such as new awareness, an emotional jolt, or a shift in what matters, can be encouraged in a counseling conversation.
I don’t know why my doctor sent me. Everybody I know drinks like this.
From where you sit, your drinking looks pretty normal, and the referral came out of nowhere.
Kind of. I mean, she did say my liver numbers were up.
So that part caught your attention. What did you make of it?
The counselor doesn’t argue that the drinking is a problem. Reflecting the client’s view leaves room for the client to raise their own concern, and they do.
Write a response that respects the client’s view and invites them to say more.
ClientMy kids are the only reason I’m here. They’re overreacting.
Show a model answer
“Your kids are worried enough that you came in, even though you think they’re overreacting. What do you think has them worried?” It reflects without arguing, recognizes that the client chose to come, and opens the door to the client’s own view of the concern.
Key takeaways
- Motivation is a state, not a trait. It changes with circumstances and with the conversation.
- Confrontation and labels tend to strengthen the client’s arguments for not changing.
- Your job is to draw out and strengthen the client’s own reasons, not to supply yours.
Adapted from SAMHSA, TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment (2019), chapters 1–2. Public domain. Open TIP 35, chapter 1: the nature of motivation