Motivational Therapy: A Humanistic Approach towards Psychosocial Rehabilitation
For over centuries, mental illness has been a concern around the world. It has a distressing consequence on the life of an individual and their families. Mental illness can cause emotional changes that comprise of cognitive and behavioral imbalances which results in low self-esteem. Practitioners have argued over how to treat mentally ill people; numerous approaches have been taken from restraining, concealing them in homes, and drilling their heads (Foerschner, 2010).
In the Pakistani context, mental health is one of the most neglected fields whereby psychiatric patients are ‘treated’ by means of spirituality and experimental herbal therapies (Javaid, 2015). Individuals are stigmatized, discriminated against, and excluded from society because of their altered mental processes, eventually hindering their chance at successful treatment. Traditionally in the East, mental illness has often been perceived as possession by evil spirits and rational management is neglected, the primary focus being on religious measures. (Sabry & Vohra, 2013). Today in western medicine, however, mental illness is properly managed and averted.
During my mental health clinical rotation, I encountered a 28 year old male patient diagnosed with schizophrenia. The patient was socially isolated from family and friends. Moreover, he frequently switched jobs and spent most of his time alone. While I interviewed him, he said that the reason behind being alone was that his family labeled him for his unusual behavior, and that he could not maintain his interpersonal relationships, which often ended up in conflict. This patient used to attend occupational therapy, but always refused to take part in activities.
In recent years mental rehabilitation has been used as a new systemic approach towards recovery. It functions to diminish patients’ disability and boost their functional capacities thus making their lives worth living. Cognitive rehabilitation can reverse the negative impacts on lives of individual with mental disorder.
With proper therapy, people living with mental health disorders can function well in relationships, at home, and out and about in the world. Other benefits of cognitive rehabilitation are that it helps patients regain control over their lives, helps to prevent further deterioration of mental health, prevents suicide incidents, enhances sense of joy and contentment, and thus quality of life and overall life satisfaction.
We can approach rehabilitation through different strategies, such as training social skills, which is effective in the acquisition and maintenance of skills and their transfer to community life; family intervention programs i.e. involving family in informal caregiving that is effective in lowering relapse rate and also in improving outcome, e.g. psychosocial functioning and significantly contributes to rehabilitation; and vocational rehabilitation, that not only improves activity and social communication, but may also promote gains in related areas such as self-esteem and quality of life. Enhanced self-esteem in turn improves adherence to rehabilitation of individuals with impaired insight.
So rehabilitation could work as an incredible impetus in the treatment of mental disorders, but for conducting an effective and sustainable rehabilitation motivation, it is an essential contributor to continued cognitive rehabilitation. According to Berk, motivation is a theoretic model that accounts for why individuals select to engross in a specific behavior at a specific time (Robert, 2003). It encompasses both conscious and unconscious aspects, such as reward and expectations. Moreover, motivation is classified into intrinsic motivation i.e. individual desire to satisfy certain needs, and extrinsic motivation i.e. which is guided by positive reinforcement.
Referring to my patient case, I identified that my patient was demotivated. His life and work clearly depicted the causation, which was the stigmatization by his family which eventually eroded his self-esteem. I came to recognize that he had potential to work and could perform daily activities, nevertheless he needed both internal and external motivation. This could boost his self-esteem and reduce his social isolation, and that would ultimately enrich his well-being and support rehabilitation.
However, sometimes it is even challenging for nurses and family to motivate a client with absent or low intrinsic motivation. Similarly, my patient had low self-esteem and residual schizophrenia which was evident by social withdrawal and therefore, as a student nurse it was all the more challenging for me to ameliorate his intrinsic motivation.
Remington (2014) explicates relation between motivation and mental illness so as to say that substantial loss of drive in schizophrenia is linked with brain abnormality i.e. dopaminergic and serotonergic deviations due to which cognitive ability deteriorates and cause barrier to optimal routine functioning (Brisch et al, 2014). Besides this there are numerous environmental obstacles which hinder motivation of a psychiatric client such as setting the wrong goals, values-conflict and stigma as in my patient. Furthermore, being demotivated has several deleterious effects on the individual i.e. lack of ability to set goals, social isolation and inability to perform well in community roles.
Management of severe mental illness should not only be focused on medication. Besides pharmacological interventions, being a nurse it is our obligation to build a therapeutic relationship in overcoming these detrimental repercussions and to promote effective recovery in psychiatric clients through various approaches. Psychosocial rehabilitation aims to encourage medicine compliance and condensed hospitalization simultaneously aggregates quality of life. Furthermore, as the patient in earlier scenario was isolated, so in clinical settings we can encourage clients to indulge in group activities.
Psychotherapy is another approach to motivate a client; it includes self-help intervention which marks the significance of authorizing the client to take their own decisions for wellbeing. According to the National Association of Cognitive Behavioral therapists, cognitive behavioral therapy (CBT) is one of the well-known forms of psychotherapy. CBT specialists work with patients to help them uncover, examine and modify their own thought patterns and responses.
CBT specialists offer patients valuable points of view, helping them improve their quality of life and actively manage stress (Austin and Boyd, 2010). Some examples of CBT are: identifying current obstacles, recognizing triggers and guiding discovery. Group therapy comprises several activities like trust building activities, recreational therapy and focus group discussions. (Elder et al, 2012).
In conclusion, motivation is a core aspect in an individual’s life that will support his/her rehabilitation. In addition, nurses should actively play a role in motivating clients in alliance with family at community, institution level and clinical settings since support is much needed to accelerate their rehabilitation.
- Foerschner, M. A. (2010). The history of mental illness: From “skull drills” to “happy pills”. Mental Illness Psychology, 2(9), 1-4
Keywords/tag: Motivation, Rehabilitation, Mental Health
- Javaid, M. (2015). OPINION: Pakistan’s mental health problem.aljazeera.com. Retrieved 7 April 2016, from http://america.aljazeera.com/opinions/2015/10/pakistans-mental-health-problem.html
- Sabry, W. M., & Vohra, A. (2013). Role of Islam in the management of psychiatric disorders. Indian journal of psychiatry, 55(6), 205.
- Robert C.Beck.,. (2003). Motivation. Delhi: Pearson Education.
- Brisch, R., Saniotis, A., Wolf, R., Bielau, H., Bernstein, H. G., Steiner, J., … & Kumaratilake, J. (2014). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: old fashioned, but still in vogue
- Axe. (2017). What Cognitive Behavioral Therapy Can Do for You. [online] Available at: https://draxe.com/cognitive-behavioral-therapy/
- Austin, W. and Boyd, M. (2010). Psychiatric and Mental Health Nursing for Canadian Practice. 2nd ed. Lippincott Williams & Wilkins
- Elder, R., Evans, K., & Nizette, D. (2012). Psychiatric & Mental Health Nursing. libby houston.
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