How to Motivate Your Patients for Success
As therapists, we know it can be challenging to motivate our patients to do their programs. There are often barriers keeping them from getting back on their feet. Fortunately, the world of psychology has a multitude of strategies that we can apply to our field.
As a health promoter, continuity of care is one of the biggest gifts you can give to a patient or client.
Continuity of care is when a patient and their physician-led care team cooperate in an ongoing health care plan, trying to achieve a shared goal which includes high quality, cost-effective medical care. As a therapist and clinician, the same rules apply. Continuity of care has been directly linked to increased patient satisfaction, overall outcomes, and most importantly; decreases in mortality.
When it comes to motivating others, the most prominent theory is the “Self-Determination Theory”. Gaining traction in the 1970’s, Self-Determination Theory has become a large factor in understanding why humans do the things we do. Its main tenant is based on intrinsic motivation.
The underpinnings of motivation started with Maslow's Hierarchy of Needs. This theory of personal motivation was based on one’s basic psychological needs being met before reaching self-actualization. For one to reach self-actualization, things like psychological safety, adequate food, water, and rest are all valuable traits to develop. Only after meeting these goals could you become what your mind’s eye has envisioned. Maslow’s Hierarchy and intrinsic motivation are the perfect couple.
“Intrinsic motivation refers to behavior that is driven by internal rewards. In other words, the motivation to engage in a behavior arises from within the individual because it is naturally satisfying to you. This contrasts with extrinsic motivation, which involves engaging in a behavior in order to earn external rewards or avoid punishment.”
Intrinsic motivation is at odds with extrinsic motivation. Extrinsic motivation is pursuing things to please others, receive a reward, money, and fame. This may be why after a certain financial set-point, happiness does not increase. A Princeton study titles ‘High Income Improves Evaluation of Life but not Emotional Well-Being’ showed that after achieving a financial set-point of $75,000 a year, objective measures of happiness do not increase. While it is important to self-actualize, basing this off of extrinsic measures like status, fame, and money can be a recipe for disaster.
On a macro-level, this self-determination theory is based upon becoming intrinsically motivated. But how can one become intrinsically motivated? Here are the steps to take:
#1 Developing Competence
Competence is the need to be effective in dealing with the environment. It has two main factors. Feeling control over your life is the first step to achieving competence. Humans have an inherent need to feel control in a chaotic world. Aptly named locus of control, it is the extent to which people believe they have power over events in their lives.
Palak Shah, head of PT Services, specializes in orthopedics and has some great input on how to increase competence with an aging patient. One of her patients recently refused to do her home exercises, due to a perceived lack of competence. Understandably, a fall could prove disastrous to this patient. Shah’s goal was to achieve a safer transition from the bed to walking. Using graded exposure allows for progressive strengthening in a safe manner and can help decrease a patient’s dependency on caregivers and family member to do their HEP. In turn, this achieves consistency in their HEP, which improves competence and overall functional strength. Once the patient feels confident, start progressing the patient to bedside squats.
The second piece of competence is developing mastery. This can be defined as gaining enjoyment by becoming better at something. Mastery plays a big role in the hobbies you enjoy and even your commitment to a lifelong career. Conversely, a lack of mastery is the reason it can be frustrating to be a beginner. While feeling incompetent can be unpleasant, satisfaction is quickly gained when mastery has been achieved.
#2 Becoming Autonomous
The next facet of the self-determination theory is developing autonomy or, the need to control the course of your life. Your patients have a large need for autonomous decision making. This is one of the reasons why we must listen more than we speak. Mandating that a patient must do something undermines their autonomy. A balance must be made to ensure treatment gets done, without making our patients feel a lack of autonomy.
“A good way to help a patient develop autonomy,” says Shah, “is by emphasizing development of long-term goals with your patient during the initial visit. Keeping physical therapy patient-focused helps in developing a treatment plan that sets up patients for success”. Digging deep and seeing how you can best serve your patient’s goals while encouraging them on their path to recovery can significantly help them feel an increase in their locus of control. Instead of delegating your treatment plan, incorporate exercises that help the patient reach their goals. Educating the patient on how these exercises will help their overall functional activity goal will help your patient feel less controlled by the therapist, and more in-tune with their personal recovery.
#3 Creating Relatedness
The final aspect of our theory is relatedness or the will to interact, be connected to, and experience caring for others. Whether introverted or extroverted, humans have a biological need to experience human connection. Loneliness is an epidemic and your presence is positively influencing your patient’s life for the better.
The Losada Ratio is a great tool to incorporate. While the soft sciences can get a bad reputation for being too subjective, these studies can give you unique insights into how your patient’s think. Social scientists have discovered that you can accurately predict the viability of a relationship on the ratio of positive to negative expressions. Ensuring overall patient well-being in a nursing home takes a 3:1 ratio. We can take this example and extrapolate it to our physical therapy practices.
An example of trying to manage a personal relationship by increasing the Losada Ratio is by influencing the patient with your own actions. While this may seem disingenuous, try it for yourself and see if you can influence your surroundings in a more positive manner. By invoking the power of mirror neurons, a human’s natural desire to mirror others, you can ensure a positive experience with your patient. By making the psychological environment as positive as possible, adding positive encouragement and optimism, and positive non-verbal communication like smiling and laughing, a patient will begin to mirror your communication patterns. Patients will be more receptive to doing their exercises.
Figuring out how to motivate our clients shouldn’t be so challenging. Next time a patient is having a hard time adhering to a treatment plan, think back to the self-determination theory.
With psychology guiding us, we can help our patients achieve their goals.