JCPSLP Vol 18 No. 1Mar 2016

Table 1 summarises the key broad themes found in the two sets of data and illustrative quotes.

Study 1 [Frequency]Dependsonpt’sstatusinterms ofalertness,fatigue,availability(i.e.,other alliedhealthorinvestigations),motivation, compliancewithTxetc.(Georgia,workbook) I was thinkingoptimally I wouldhave beenseeinghimtwicedailybecausehe wasalotmorealertandreallyinterested. (Belinda, interview) …then you look at leaving packages andgroupsandthingslikethat.(Belinda, interview) Acutept….motivated,insightful+good rehab potential. (Emily, workbook) If I know they aremotivated and can, andhavegoodfamilysupport,trytoget materialsouttothemforfamilytosupport orgivethemstrategies.(Sophie,interview)

Themes Judgingmotivation anddecisionsabout what to offer

Study 2 Yeah,themotivationoftheindividual...iftheyaredesperatelykeenandyou knowtheyareputtingalltheireffortintotheworkyouaregivingthemandit liftsthemtobeabletocomeandhavethatchallengeandworkonitandsee their progress, then that’s a big thing. (Ros) Isupposeitishoweagerpeopleareinthetherapysessionorhow...whether theypracticeornot,whetherthefamiliesareinvolvedor...alotofitispretty subtle. (Jane) …reallyit’stodowiththeperson’sownmotivationandbymotivation,I meanmotivationtoattend,motivationtodotheworkthatwehaveagreedon together,toworkthroughgoalsandtoworktowardsgoals.(Leanne) …generallyifpeopleweremakingchange,weremotivatedtomakechange andcommittedtomakechangeandIstillhaveasenseofenthusiasm fromthemandtheircarersaboutmakingchange,thenIwouldplugaway [persevere]. (Murray) Socontinuingtooffertherapywouldbebasedonmotivationoftheclientand hisfamilyorherfamily.AlsoIthinkapowerfulmotivatorallroundisevidence ofimprovement,youknow,ifit’sworking,youkeepdoingit.You’renotgoing to stop. (Rachel) [Youlookfor]progressandtheiractiveinteraction.Andyouknowsome peopleareverypassive.Theyjustsitthereandletyoutherapythemand yougetnowherereally.Looksgoodonpaperandthatisaboutasfaras yougo,sopeoplelikethatIwouldbedischargingintherelativelyshort term. (Ros) …ifyougetthevibesfromapatientthatthey’renotterriblyinterestedin comingorifthey’relateallthetimeoriftheydon’tturnupandtheydon’tlet youknow…likeyouthink,“well,whybother?”You’remorelikelytomaybe discharge them a bit sooner. (Felicity) Ithinktheirattitude.Obviouslyifthey’realittlebrighter,senseofhumour,you know,workingwell,they’vegothomesupport,they’reactuallydoingsome activepracticeofsomeform,that’salwaysbetter…andhelpsthetherapist. Andifpeoplearereallydepressed,they’vegotnohomesupport…that makesitalothardertomotivatethemandtosetgoalstoo…Soittendsto probably make you discharge somebody. (Erica) Differenttherapistscouldachievedifferentthingsbecauseofthechemistry intermsofmotivation…andthat’snotsayinganytherapistsarebetter orworsethananybodyelse.It’sjustthatweknowthatthatexists.We acknowledge that within the profession. (Belinda) Iguessitishowconnectedtheyarewithyouinthatpartofthesessionwith whatyouaredoing.Imeantherearesomeactivitiesyoudowithsomeand theyarejust,theyareenjoyingitbuttheyarealsoreallyfiring,theyarereally trying,theyarereallyobviouslystrivinginsomewaytoachievethisthingthat ismotivatingforthem.Andinotherthingstheyarejustdoingalmostarote responseandyoucanseetheyareactuallydoingitbecauseyouhaveasked themtodoitratherthanitbeingintrinsicallymotivatingandmyparticular bias and passion is intrinsic motivation and not extrinsic… (Celia) There’stimesI’vehadquiteafewpeoplecomethrough…they’renotreally highlymotivatedassuchand,youknow,andit’shardworkforthemandit’s notnecessarilytheirthingbutinperseveringandgettinganoutcomeand helpingthemgetthroughthatadjustmenttime,thenitcanbeworththat initial push. So I don’t do it by motivation. (Angela) Thereissomuch‘mystique’surroundingallofthis.Imeanpeoplearetold “wellyouareveryluckytobeinthisprogramandyou’vegottograbitwhile it’savailable”…tryingtokeeppeoplemotivatedtowardstheirhalforone hourtherapysessionswhentheyhavegotallthisotherstuff[medicaland emotionalissues].Andmeanwhilethey’vegottheirfamiliessaying“you’ve gottodoit,you’vegottodoit,comeon,comeon”,almostbarracking families…somepeoplejustgetreallyanxiousaboutallofthisandfeel there’s a great pressure... (Murray)

Motivation, goal setting,andtherapy options

Family influences on judgments of motivation

Motivation and discharge

Influences of motivation on the therapeutic interaction

Ifthepatient’sreallymotivatedithelpsa lotintherapyalsobecauseyougetthat, youtakesomeofthatenergyandgiveit back to them. (Sophie, interview).

Recognising the limitsofjudgments of motivation

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JCPSLP Volume 18, Number 1 2016

Journal of Clinical Practice in Speech-Language Pathology